Hot flashes—a review of the literature on alternative and complementary treatment approaches

Alternative Medicine Review, August, 2003 by Hazel A. Philp

Abstract

Hot flashes are a common experience for menopausal women, with an 85-percent incidence in the West. With the increased knowledge of side effects attributable to conventional treatment options, more women are exploring natural alternatives. Although more definitive research is necessary, several natural therapies show promise in treating hot flashes without the risks associated with conventional therapies. Soy and other phytoestrogens, black cohosh, evening primrose oil, vitamin E, the bioflavonoid hesperidin with vitamin C, ferulic acid, acupuncture treatment, and regular aerobic exercise have been shown effective in treating hot flashes in menopausal women.

Introduction

Because of a gradual increase in life expectancy during the last century, women are now living nearly one-third of their lives beyond menopause. In the year 2000, 31 million women in the United States were estimated to have reached menopause, and by the year 2020. it is estimated that the size of this group will be 46 million. (1)

Menopause is a normal biological process, not an estrogen deficiency state, occurring naturally at an average age of 50. (2) A transitional period occurs prior to menopause termed the climacteric or perimenopause. A diagnosis is often difficult during the perimenopausal period because it can be made only after menses have ceased for at least 12 uninterrupted months.

With the widely reported risks of conventional therapies for hot flashes, many women are exploring as an alternative the use of botanical medicine and dietary supplements. (3) In 2000 the retail sales of natural products in the United States surpassed $15 billion, (4) with sales of products for menopause accounting for approximately $600 million. (5) In one study based on an interview with 100 menopausal women attending a San Francisco health conference, (6) the women using dietary supplements alone perceived their quality of life highest, followed by those taking dietary supplements plus hormone replacement therapy. The former group also had a greater sense of overall control of their symptoms. This, coupled with the perception that dietary supplements have significantly fewer side effects than hormone replacement therapy, may have contributed to their reported higher quality of life. This sense of empowerment that accompanies the use of dietary supplements is echoed throughout the literature. (7)

Symptoms of menopause range from mild to severe, with the classic symptom being the hot flash. The prevalence of symptoms is subject to wide cultural differences, being appreciably higher in Western women. For example, women in the United States report more hot flashes (8,9) than women from developing countries, where menopause generally seems to be associated with fewer complaints. (10,11)

A hot flash is experienced as a warm or hot sensation that often begins at the top of the head and progresses toward the feet. The scalp, face, and neck are primarily affected, but an entire body sensation is sometimes experienced. Objective signs of cutaneous vasodilation such as flushing and sweating are observed, followed by drop in core body temperature, leaving some women feeling chilled after the event. Concomitant symptoms include palpitations, anxiety, irritability, and night sweats. Hot flashes may last from seconds to as long as an hour, (12) and may occur as often as hourly. (13)

Hot flashes can begin prior to the last menstrual period, with nearly 60 percent of women reporting them before any menstrual changes are experienced. (14,15) Patterns may change over time, with some women experiencing hot flashes less frequently and intensely with time, while others continue to experience discomfort well into their later years. (12) Hot flashes may be triggered by surgical menopause as soon as one week post-surgery, (14) and are typically more frequent and severe at night (often awakening a woman from sleep) or during times of stress. One of the major complaints associated with hot flashes is insomnia, which can have a domino effect on the woman's overall quality of life. (16) In cooler environments, hot flashes are fewer, less intense, and shorter in duration. (17)

Risk Factors, Triggers, and Differential Diagnoses for Hot Flashes

Risk factors for hot flashes include a maternal history, (18) cigarette smoking, (18) menopause before age 52, (19) alcohol use, (19) menarche before age 12, (19) and a history of irregular menses. (19) Low levels of estradiol and high levels of follicle stimulating hormone (FSH) have been associated with hot flashes before menopause, whereas high levels of thyroid stimulating hormone (TSH) have been related to hot flashes during menopause. (20) On the other hand, high levels of testosterone and dehydroepiandrosterone (DHEA) after menopause appear to protect against hot flashes. (20) Triggers include spicy foods, exercise, hot or humid weather, and confined spaces. (21)

Not all hot flashes are hormonally induced, and it is essential other medical conditions, medications, and food additives that can cause hot flushing be considered in the differential diagnosis (Table 1). (21,22)