Hot flushes (also known as hot flashes) are one of the main symptoms of the menopause, alongside night sweats, mood changes, and sleep disturbances. In fact, eight in 10 women experience them for an average of seven years. While they are completely normal and down to natural hormonal fluctuations at this time of life, they can be both uncomfortable and debilitating.
The good news is, you don't have to suffer in silence, as there are plenty of treatment options to help this particular perimenopause symptom. That includes HRT but also one of the many alternatives to HRT. There are also ways to manage your temperature away from treatment entirely, using simple lifestyle changes.
What are hot flushes and when do they begin?
If you're of menopausal age (usually between 45 and 55 years old) and are finding that you need to suddenly fling open the window or wake up drenched in sweat, then you could be experiencing hot flushes.
In perimenopause, hot flushes are caused by a disruption in the brain's body temperature regulation system, triggered by hormonal fluctuations - and particularly a drop in oestrogen levels.
The intensity varies, but they are usually recognisable as a sudden, creeping feeling of intense warmth or heat. A hot flush can often come from nowhere and quickly spread through the face, neck, chest and body. Sweating, palpitations, and dizziness may accompany them.
Hot flushes tend to start with the onset of perimenopause and may last through menopause, which happens on average at the age of 51 in the UK, says Dr Louise Newson, a GP and author of Menopause. Genetics, underlying medical conditions and treatment for cancer could cause the menopause to begin early, which is defined as being before the age of 40.
"Hot flushes can last anything from a matter of seconds or up to an hour," notes Dr Newson. For some women, they’re mild, but others report that their flushes make them feel like they’re trapped in a furnace. They can disrupt routines and knock confidence levels. However, it's worth noting that while they are a common menopausal symptom, they can also occur for other reasons.
How often is normal? Every woman will experience menopausal symptoms differently. This means there’s no ‘normal’ when it comes to the frequency of hot flushes. Having between five and ten flushes a day is considered to be average. However, some women may suffer from more than this, while others will report having none at all.
What makes hot flushes worse?
1. Alcohol
Drinking causes the blood vessels to expand in the body, and the increased blood flow through the vessels can make you feel hot and cause the skin to flush. All types of alcohol can bring on one, but red wine, in particular, is a known trigger. Sweating is also common with a hangover, so drinking may also worsen night sweats.
To minimise the effect of alcohol on menopausal symptoms, it could be advisable to switch to drinks with a low-alcohol content or drink spritzers to reduce your intake. Mindful drinking is another way to cut back on your units.
2. Spicy food
Some food ingredients and spices can bring on a hot flush. This is due to a ‘fiery’ food compound called capsaicin that is found in peppers and chili powder.
3. Caffeine
A cup of coffee may leave you feeling alert and raring to go, but it could also cause a hot flush. That's because caffeine speeds up the heart rate, so blood is pumping through the body faster, leading you to feel hotter. Rely on your daily cuppa as an energy boost? There could be something else going on if you frequently feel tired in winter.
Other common triggers include:
- Hot food and drinks
- Smoking
- Stress
- Tight clothing
- Hot baths
- Using a hairdryer
Identifying and steering clear of your own ‘triggers’ can help to reduce the frequency and severity of your flushes.
How can you treat hot flushes?
Hormone replacement therapy
Often the first line of treatment for women suffering from menopausal symptoms, hormone replacement therapy - often known as HRT - could be an option. One US study found that low-dose estradiol, which is a form of estrogen, helped to reduce hot flushes by 50%.
Other types of HRT include combined HRT patches, which contain an effective duo of estrogen and progestogen. Speak to your doctor to find out if it’s the right option for you.
Other medications
If you don’t want to take HRT, other prescription medicines - including certain antidepressants and clonidine (usually prescribed to help with blood pressure) - might help.
Stay cool
Heat triggers flushes for some women. Using a fan and taking cooler baths and showers may help. You could also try cooling gels or placing a cold compress on the back of your neck when you feel one coming on.
Cultivating a good bedtime routine is important, too. Wear layered clothing and switch your duvet for layers of sheets and a cooling pillow. And, strange as it sounds, some women wear socks to bed because it helps to lower their core body temperature.
Reduce stress
Keeping your stress levels down is often easier said than done, but it can really help. Try relaxing with one of the best meditation apps. Some women also do slow, deep abdominal breathing to ease symptoms - and it can be worth doing 15 minutes in the morning and evening, as well as when a hot flush starts, to help control the severity. Yoga for beginners and tai chi may also help.
Eat well
Phytoestrogens are found in plant foods like soy beans, chickpeas, lentils, ground flaxseed and red clover. These natural compounds have a similar chemical makeup to estrogen, and as a result, there's some evidence that eating foods rich in phytoestrogens can help to reduce the frequency and severity of hot flushes.
Women’s health specialist Dr Sally Moorcroft suggests eating green vegetables daily, since they’re packed with magnesium. She also advises drinking kefir for gut health, explaining: "A happy gut leads to less inflammation in the body, which can reduce your symptoms." The adaptogenic herbs ashwagandha and tulsi may help to reduce the effects of stress on the body and ease flushing.
Supplements for hot flushes
- Folic acid: Taking 1mg of folic acid a day has been found to reduce the severity, duration and frequency of hot flushes
- Vitamin E: Taking 400IU of vitamin E a day has likewise been found to help ease hot flushes
- Ibuprofen: Some women find that taking an anti-inflammatory, non-steroidal painkiller relieves their hot flush symptoms.
This article is not intended as medical advice. Always speak to your doctor before taking an new supplements for treatment for hot flushes and other symptoms of menopause.
Complementary therapies for hot flushes
Hypnosis
It may seem like an unusual solution, but hypnosis can help with hot flushes and night sweats. “It may also be beneficial for anxiety or low mood that accompanies them,” says Dr Caroline Houlihan-Burne, clinical hypnotherapist at The Princess Grace Hospital.
Want to try it at home? “Close your eyes, breathe deeply and count down from 10 to one on each 'out breath'," explains Dr Houlihan-Burne. "Repeat a positive suggestion in your mind, such as ‘I’ll remain cool and calm all day’. When you’re ready to come out of self-hypnosis, count from one to 10. On the count of 10, your eyes will open and you’ll come out of the trance."
Cognitive behavioral therapy
Cognitive behavioural therapy for menopause is a form of talking therapy. It identifies negative thought patterns to create positive changes in feelings and behaviour. It’s particularly effective during the menopause, explains clinical psychologist Professor Myra S Hunter.
“CBT has been found to help women handle hot flushes and night sweats, as well as improve mood, sleep and quality of life,” explains Professor Hunter. Talk to your doctor about whether it may be suitable for you.
Acupuncture
A study found that women given 15-minute sessions of acupuncture weekly, for five weeks, were significantly less troubled by hot flushes.
So, how does it work? Mark Bovey, head of research at the British Acupuncture Council, explains: “Acupuncture’s effect on neurotransmitters linked to pain relief and mood regulation may influence the thermoregulatory centre in the hypothalamus region of the brain.”
