How can I deal with hot flashes during menopause?

There are a number of ways to deal with hot flashes during menopause. Try dressing in layers (of cotton, not wool or synthetics), so you can quickly take off a layer of clothing when a hot flash comes on. You can try deep, slow breathing when you get a hot flash. Relaxation techniques you learn through yoga, meditation, or tai chi can help. Keep ice water handy, to drink when you get a hot flash.

Try to figure out what brings on the hot flashes, whether it’s certain drinks (coffee or tea, for example), the weather (maybe it’s hot outside), stress, or certain foods. If you can identify the trigger and avoid it, that might help.

Keep a fan nearby and make sure the temperature in your house or office is cool enough. For hot flashes and other menopausal symptoms, some women find relief by going to an acupuncturist, getting enough exercise, drinking plenty of water, not smoking, and avoiding certain types of foods and drinks (such as spicy foods, alcohol, and caffeine). Soy products are good to incorporate into your meals, because they might prevent or decrease hot flashes and other menopause symptoms.

Some women use herbal remedies for their hot flashes as well, though you should discuss this with your doctor first.

You can also talk to your doctor about getting a prescription for hormone replacement therapy (HRT), since hot flashes happen when your sex hormone levels fluctuate. HRT replaces the estrogen (and maybe the progesterone) that your body stops making during menopause. This can help with symptoms of hot flashes.

Not all women are candidates for HRT, however, and the drugs come with a long list of possible side effects. Ask your doctor about the risks and benefits of HRT. Some antidepressants, anti-seizure drugs, blood pressure medicine, and mild sedatives also help with hot flashes. Talk to your doctor about whether those would be appropriate for you.

Pharmacologically, estrogen and/or progesterone can minimize the sensation of hot flashes, as can clonidine, a medication sometimes used for blood pressure control. Lifestyle changes which have been reported to help include a diet high in anti-oxidants, strengthening exercises, smoking cessation, and decreased alcohol intake. Some individuals find counseling helpful in dealing with the stress of menopause.

In the past women were told: "Hot flashes are all in your head." This suggested that women could control or suppress their hot flashes using willpower. Some of my patients have the idea that they should be able to banish their symptoms of menopause -- that is, conquer them through sheer will. Hot flashes may be triggered by anxiety, and they often are made worse by stress, but this does not mean they are imaginary.

Many women in previous generations were told to "Just tough it out, the hot flashes will go away on their own." Now we know this is not always possible. While it's true that some women never have night sweats or hot flashes, this is not due to their willpower. Their bodies simply do not have the precipitous drops in estrogen that trigger these symptoms. Some women's hot flashes are milder and less frequent, and therefore more tolerable.

If you have hot flashes from menopause, help turn down your internal thermostat by dressing in layers that are easily shed. A number of Web sites offer moisture-wicking clothing for women who have hot flashes. Keep one room in your home cool and retreat to it when flashes start. Try plunging your hands in cold water and patting it on your face, neck, and chest. Deep breathing exercises, initiated at the beginning of a hot flash, may nip it in the bud. There is some evidence that 40 mg daily of Remifemin, an over-the-counter compound of the herb black cohosh, is also effective.

Although it's debatable whether hot flashes are the sole culprit for lost sleep, they are certainly implicated. Sleeping in a cool room and using bedding and nightwear made of materials that wick moisture away from the body may prevent you from waking drenched at 2 a.m.

Wearing layered, cotton clothing, drinking cold fluids at the start of a hot flash, and keeping a glass of cold water by the bedside may help alleviate hot flashes during menopause. There is some evidence that exercise, acupuncture, taking black cohosh, and engaging in various forms of relaxation therapy (e.g., meditation, yoga, or breathing exercises) may be helpful in alleviating symptoms. Keeping a journal helps track symptoms and helps identify personal, hot flash triggers.

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There are a variety of strategies for coping with hot flashes, ranging from short-term hormone therapy (estrogen alone or estrogen plus progesterone for approximately two to three years and no more than five years) and other medical options to herbal remedies, but lifestyle strategies may be the easiest and quickest changes to try first:

• Dress in layers that may be removed if you find you're getting too warm.
• Sleep in a cool room.
• Drink plenty of water.
• Avoid hot foods such as soups, spicy foods, caffeinated foods and beverages and alcohol, which can trigger hot flashes.
• Try to decrease stress.
• Exercise regularly.
• Breathe deeply and slowly, if you feel a hot flash starting; rhythmic breathing may help to "turn down" the heat of a hot flash or prevent it from starting altogether.
• Use a hand-held fan.

Hot flashes can be managed by avoiding triggers such as alcohol or spicy foods. Some other triggers may be smoking, stress, and heat. Also, try to wear loose-fitting clothing and keep air circulating. Fans can be a help to keep rooms cool and well-ventilated. Deep breathing exercises at the beginning of a hot flash may lessen the intensity, too.