Is it hot in here, or is it me?
by Roberta Lee, MD (topic expert: health)

Most of us have either uttered these words ourselves or heard someone else say them. Either way, you're likely to know what they refer to: hot flashes the most common symptom women face in perimenopause and menopause. Last month I discussed the biology of menopause. This month I will make some suggestions about alternatives that women have used for hot flashes. Eighty-five percent of the women in the United States experience hot flashes as they approach menopause and for the first year or two after their menses stop. Between 20 and 50% of women continue to have them for many more years and these tend to decrease over time.

What causes hot flashes?

Hot flashes are mostly caused by the hormonal changes of menopause (drop in estrogen and progesteron), but can also be affected by lifestyle, foods eaten and some medications. A lowering level of estrogen has a direct effect on the hypothalamus, the part of the brain responsible for controlling your appetite, sleep cycles, sex hormones, and body temperature. Experts think the dropping levels in estrogen confuse the hypothalamus.This "command center" of the brain then interpretes the signals for body temperature as being too warm and alerts the rest of the body to respond accordingly by shunting blood to the body's surface for increased radiation of heat and so forth..

When you're having a hot flash, you might experience:

• A feeling of mild warmth or heat spreading through your body including the face
• A flushed appearance with blotchy red patches on your skin especially the face, neck and upper chest
• Palpitations or rapid heartbeat
• Perspiration (more common on the upper body )

Lifestyle tips you can follow to lessen the flashes:

• Layer your clothing
• Exercise
• Get enough sleep
• Avoid excessive caffeine, alcohol, spicy foods
• Attend to your stress and relax

What can help with hot flashes:
Conventional options:

• Hormone therapy- (progesterone and estrogen)
• Low dose antidepressants
• Gabapentin (neurontin� a medication used for seizure control)
• Clonidine ( a blood pressure medication)

Alternative options:

• Black cohosh: This herb is widely used in Europe for hot flash treatment. Its' safety record has been good but the last National Institutes of Health study in late 2006 did not find a statistically significant effect using black cohosh in reducing hot flashes against placebo. Still many women report relief with this herb.
• Soy and red clover: These two plant sources have estrogen-like substances known as isoflavones and have weak estrogen-like effects. Estrogen experts suggest consuming the foods sources of soy rather than isoflavone pills at approximately 50 g/day. Studies using soy for the reduction of hot flashes has not shown the benefit of reduction. Similarly, red clover has not proven useful in reducing hot flashes.
• Acupuncture: Several studies have shown that acupuncture is helpful in relieving hot flashes. Researchers at Stanford University found in their study in 2006 that seven weeks of acupuncture treatment reduced the severity of nighttime hot flashes by 28 percent among menopausal women compared with a 6 percent decrease among women who had a sham acupuncture treatment
  
  Huang, M., Fertility and Sterility, September 2006; Vol. 86: pp. 700-710.

Fighting hotflashes are very challenging but many conventional and alternative approaches are available. Despite the difficulty in demonstrating the effectiveness of some of the more alternative treatments in clinical trials, a multilayered combination of lifestyle modification, conventional and alternative interventions may still be useful.