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Treating hot flushes

Hot flushes are the most common symptom of menopause. Your hot flushes can happen during the day or at night (also known as nocturnal sweeting). Your hot flushes can be mild and tolerable, moderate and uncomfortable, or severe and weakening. Hot flushes are less intense with time. Even though some women have hot flushes for a few years, some women have them for decades. It is not clear why some women have severe hot flushes for many years, while others don´t have them or have a few very mild ones that pass rapidly. If your hot flushes are mild or moderate, you may alleviate them with changes in your lifestyle. If you have severe hot flushes, you may also benefit from changes in your lifestyle, but you also have the option of taking over the counter remedies or prescribed medication, including hormones in order to help control your symptoms. Changes in lifestyle Studies have found that women with hot flushes have a more sensitive thermostat in the brain, reason why they are more comfortable only among a lower temperature range. Keeping cool and decreasing stress are the main changes in lifestyle in order to control hot flushes. Some women can find relief with these alternatives:
  • Avoid hot rooms, hot beverages and meals, alcohol, caffeine, excessive stress and smoking. Dress with layers of clothes manufactured with light materials that allows transpiration, take off one or two layers of clothes when you feel hot and put it on again when you feel cold. Refreshing products such as sprays, gels and the Chillow pillow may be of help.
  • In order to reduce stress and assist in having a reinvigorating sleep, exercise regularly, but not too close to sleeping time. Meditation, yoga, tai-chi, positive feedback, acupuncture or massages can also decrease the levels of stress.
  • When hot flushes begin, try to breathe calmly and slowly, with an abdominal breathing, inhaling through your nose and exhaling through your mouth. Do only 5 to 7 breathings per minute, much slower than the usual.
  • Try different strategies to keep yourself fresh while sleeping. Use light sleeping clothes that allows you to transpire. Use layers of blankets that allow you to easily remove them during the night. Keep fresh by using a ventilator. Keep an ice pack or a frozen bag under your pillow, and frequently turn your pillow around so that your head always rests on a cold surface. If you wake up during the night, drink cold water. Try different techniques to go back to sleep, such as meditation, calm breathing, or get out of bed and read until you feel sleepy again.
  • Overweight women have more hot flushes, reason why they must maintain an adequate weight and exercise regularly in order to decrease hot flushes and improve your health in general.
Over-the- counter remedies Even though there are many over-the- counter remedies to reduce hot flushes, it seems to be due to the “placebo effect”. When over-the- counter products are scientifically studied, they are typically as effective as a placebo (inactive medication). Even if the relief is due to a placebo effect, you can expect hot flushes to decrease in approximately 30% with the majority of over-the- counter remedies such as soy, herbs or acupuncture. Over-the- counter remedies do not receive a careful government supervision and generally they are not studied with enough attention to know all the potential and adverse risks, especially with their long term use. Consider using products manufactured in North America which follow good manufacturing practices. Let your physician know that you are using over-the- counter remedies. Over-the- counter remedies that you may consider to alleviate hot flushes include:
  • Soy: Take one or two portions of soy foods per day (containing isoflavones), such as varieties of low fat tofu, tempeh, soy milk or soy toasted nuts. Some supplements containing soy isoflavones, such as Promesil, reduce hot flushes in some studies.
  • Herbs: Supplements containing certain herbs such as black cohosh, Remifemin, decrease hot flushes in some studies.
Prescription Medication The following prescription medications decrease hot flushes more than placebos in scientific studies. They can be good options if you have frequent and uncomfortable hot flushes. Each medication has risks and adverse side effects. Review your medical history with your physician when considering using prescribed medication. Hormonal options
  • Prescribed hormonal therapy with estrogens is the most effective treatment for hot flushes. Even though the use of hormones may increase your risk of breast cancer and heart diseases, studies show the benefits can exceed the risks for healthy women younger than 60 years of age with moderate to severe hot flushes. The objective is to use a lower dose of hormonal therapy to treat your symptoms and for the shortest time possible. Women with uterus need to combine estrogen with progestogen.
  • A new option for women with uterus combines estrogen with bazedoxifene to protect the uterus (Duavee). Bazedoxifene is an estrogen agonist/antagonist, which means it acts as estrogen in some tissues and opposes to the actions of estrogen in others.
  • If it has not been a year since your last period and you are a healthy none-smoker woman, you can consider a contraceptive pill with an estrogen progestin combination.
Non-hormonal options You can also consider the following non-hormonal medications. They are more effective on scientific studies, though not as effective as hormonal therapy.
  • Paroxetine (Brisdelle) in small doses is the only non-hormonal option approved by the government for treating hot flushes.
  • Some approved drugs to treat depression reduce hot flushes in women without depression. Effective drugs include paroxetine (Paxil), venlafaxine (Effexor), and escitalopram (Lexapro). You must not take paroxetine if you are taking tamoxifen for breast cancer.
  • Gabapentin (Neurotin) is an approved drug for treating epilepsy, migraine or neural pain, but it can also reduce hot flushes. It can cause excessive sleep, but it is a good option, especially if you are having uncomfortable night sweating and are taking gabapentin before sleeping.
  • Sleeping medications such as Ambien, Lunesta and Benadryl will not reduce your hot flushes, but they can help you sleep while they happen. They are available with medical prescription or over-the- counter.