What can I do to relieve uncomfortable hot flashes?

DEAR DOCTOR K:

What can I do to relieve uncomfortable hot flashes?

DEAR READER:

Yesterday I discussed new research showing that menopausal hot flashes can last for much longer than the “several years” the textbooks say they are supposed to last.

We are beginning to understand why women in menopause (and sometimes for years after) get hot flashes. There is a center in the brain that is constantly measuring the inner temperature of our bodies. For example, body temperature rises on a hot day, or when we exercise.

When the brain center thinks the body needs to cool off, it causes little blood vessels near the skin to open wide. You get red and feel hot, and then your body heat is released into the air near the skin. The brain center also activates glands that make sweat: Wet skin also releases heat from the body.

Before menopause, the brain center sends signals cooling the body when it sees your temperature rising just half a degree. During menopause, the brain center sends out these cooling signals when the body’s temperature rises even less than half a degree. So you get hot flashes because the brain thinks you need to cool off.

There are things you can do to make hot flashes less severe or less frequent. Here are some lifestyle changes to start with:

  • Drink a glass of cool water at the beginning of a hot flash to lessen discomfort.
  • Drink six to eight glasses of water per day.
  • Avoid caffeine and alcohol.
  • Cut down on red wine, chocolate and aged cheeses. They contain a chemical that can trigger hot flashes.
  • Plunge your hands in cold water and pat it on your face, neck and chest when a hot flash starts.
  • Begin deep-breathing exercises at the beginning of a hot flash to help nip it in the bud.
  • Wear loose, comfortable cotton clothing whenever possible.
  • Dress in layers. Remove some clothing if you suddenly feel hot.
  • Don’t smoke. Smoking can make hot flashes worse.
  • Keep your house and office cool.
  • At night, use lightweight blankets. Remove them as needed.
  • Regularly engage in vigorous exercise.

If lifestyle changes are not enough, consider hormone (estrogen) therapy — the smallest dose that relieves your hot flashes. Talk to your doctor about the risks and benefits of hormone replacement therapy in your case, as they can be quite different from one woman to another. Also ask your doctor whether you need to take progestin hormones.

Other types of medications can be used for hot flashes. One example is antidepressants. Venlafaxine (Effexor) and paroxetine (Paxil) are often the first choice. Gabapentin (Neurontin) is an anticonvulsant drug that is moderately effective in treating hot flashes. And clonidine (Catapres) is a blood pressure medication that can relieve hot flashes in some women.

The herbal remedy black cohosh had been previously promoted as a treatment for hot flashes, but more recent research reports that it works no better than a placebo.