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Sudden sweltering weather and smothering midnight heat waves–hot flashes and night sweats–are the most common complaints of perimenopausal and menopausal women.

No one really knows what causes hot flashes, but it’s thought that a main factor is increased levels of hormones from the pituitary gland attempting to stimulate the ovaries’ production of estrogen and other hormones. Changes in levels of adrenal hormones such as norepinephrine and epinephrine and in hormones such as serotonin or prostaglandin have been implicated. Clinical and preclinical imbalances in adrenal and thyroid function may also contribute to hormone imbalances.

Menopausal symptoms may also be attributed to cigarette smoking, the onset of menopause before age 52, maternal history of menopausal symptoms, alcohol use, and history of irregular menses. Traditional Chinese medicine suggests that deficient yin (cool) energy leads to increased yang (heat) in the blood, causing hot flashes.

As more is known about the side effects, such as cardiovascular risks and breast cancer, attributable to hormone replacement therapy, (HRT) more women are exploring natural alternatives.

Natural Remedies

Phytoestrogens are plant substances functionally similar to the steroidal estrogen made by the body, but they produce much weaker effects. Studies have shown that women who use phytoestrogens have fewer menopausal symptoms, particularly hot flashes. Phytoestrogens are derived from dietary sources such as soy products, lentils, chickpeas, rye, rice, oats, flax, onions, garlic, sunflower seeds, fennel, barley, wheat germ, apples, pears, and carrots. Some botanical sources include alfalfa, hops, clover, and sage.

While studies are still being done on the effects of phytoestrogenic plants on breast cancer, patients who have estrogen-receptor-positive breast cancer should avoid concentrated phytoestrogenic herbal supplements. Small amounts in the foods mentioned above will not cause problems.

Soy products - Some studies have shown that 20 to 40 grams of soy protein may provide positive benefits for symptoms of menopause. Too much soy (more than 60 grams), however, can have negative effects on thyroid function.

Red clover (Trifolium pretense) - is a rich source of phytoestrogens. Recommended dose is 300 to 500 mg standardized to 25 to 40 mg of isoflavone, two to three times daily.

Sage (Salvia officinalis) - is effective for treating menopausal symptoms, particularly hot flashes. It is also useful for reducing anxiety. Steep one teaspoon (5 mL) of leaves in 1/2 cup (125 mL) of boiled water for 30 minutes; drink 1/4 cup three to four times daily.

Hops (Humulus lupulus) - is effective in the treatment of hot flashes and insomnia. Recommended dose is 30 to 40 drops of tincture taken two to three times in the evening, or two teaspoons (10 mL) of flowers added to two cups (500 mL) of boiled water, steeped for 15 minutes.

Black cohosh (Cimicifuga or Actaea racemosa) - has been used for the treatment of hot flashes and other menopausal symptoms for over 100 years. Although further research is needed, some studies have caused concern about the safety of black cohosh for women with a history of breast cancer. Other studies suggest it may, in fact, have anti-estrogenic activity. Recommended dosage is 40 to 80 mg of the standardized root extract daily.

Evening primrose oil (Oenothera macrocarpa) - has been shown to help with night sweats but not daytime hot flashes. Recommended daily dosage is four capsules twice a day of 500 mg.

Vitamin E - has been shown to help with hot flashes and other menopausal complaints such as vaginal dryness. Recommended daily dosage is 100 to 500 IU.

Hesperidin and vitamin C - Hesperidin, a flavonoid from citrus fruit, may improve vascular integrity and decrease capillary permeability. Studies show that 900 mg daily, taken with 1,200 mg vitamin C, relieves hot flashes.

Your Last Resort

Bio-identical HRT uses synthesized hormones that are chemical replicas of those produced by the body; these are better utilized and have fewer side effects than standard prescription HRT such as Premarin. These hormones are available by prescription from your physician. However, I would recommend that women try relieving their symptoms with natural botanical and nutritional supplements, as well as with lifestyle and dietary changes before resorting to hormone replacement, bio-identical or otherwise.

Remember that menopause is a natural (and temporary) biological process, not a disease requiring decades of drug therapy.

Dealing with Hot Flashes: Diet and Lifestyle

• Avoid alcohol and caffeine.
• Avoid heat-producing foods such as garlic, cayenne, ginger, etc.
• Drink at least two litres of water daily.
• Minimize stress.
• Wear breathable cottons rather than synthetic fabrics.
• Exercise regularly; it lessens the frequency and severity of hot flashes.
• Try acupuncture; some women have found it to help reduce hot flashes

Karen Jensen, ND, is the co-author of No More HRT: Menopause, Treat the Cause (Fitzhenry and Whiteside, 2002) and The Complete Athlete (alive Books, 1998). Drkarenjensen.com.

Source: alive #270, April 2005

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