Hot flushes are one of the most frequent symptoms associated with the menopause and are experienced to some degree by 70-75% of women. Hot flushes usually begin during perimenopause, about two years before menstruation ceases.

85% of these women will continue to experience hot flushes for more than 1 year and up to 50% for as long as 5 years.

Hot flushes vary in intensity and some women only experience a few seconds of feeling 'warm' around the face. For others a hot flush can involve a dramatic rise in temperature throughout the body, along with feelings of dizziness, nausea and faintness.

Some women feel embarrassed about having a hot flush because they think it may signal their menopause to others. However, it's more than likely to go completely unnoticed because there is actually little change to the colour of the face during a flush.

Hot Flush Symptoms

• Feelings of warmth. Hotflushes may come on suddenly and vary in intensity. Most commonly experienced around the face and neck but can also affect the arms, torso, and sometimes the whole body.

• Facial flushing: Blood flow is directed to the skin which can occasionally cause a visible flush.

• Sweating: During the hot flush it is common to begin sweating. This can be mild to severe.

• Cold chills. Immediately following the hot flush there can be a significant drop in body temperature. Thus, a chill may be experienced afterwards.

• Palpitations: Rapid or irregular heartbeat and pulse, including heart palpitations.

• Night Sweats. The hot flushes that accompany the menopausal transition can occur at night and cause sweating. This is very common in perimenopausal women. Estrogen levels are often lowest at night, which is why women often experience nocturnal hot flushes. More on Night Sweats

• Other Symptoms: Nausea, Dizziness, Anxiety and Headaches.

Hot Flushes Causes

The primary cause of a hot flush associated with the menopause is the changing level of oestrogen in the body. This has a direct affect on the hypothalamus, which is a part of the brain responsible for controlling appetite, sleep cycles, sex hormones and body temperature.

For some reason the drop in estrogen confuses the hypothalamus and makes it think your body is too hot. The brain responds by sending out an alert which initiates a number of changes; your heart pumps faster, the blood vessels in your skin dilate to circulate more blood to radiate off the heat, and your sweat glands release sweat.

This is how your body prevents you from overheating during the summer. However when it results from a drop in estrogen it can make you very uncomfortable.

Treatment for Hot Flushes

As a first course it's worth looking at natural ways to manage menopause symptoms like hot flushes. Not only does this avoid any potential side-effects associated with medications, but it's often best to begin with the least aggressive approach. If you find that lifestyle and natural approaches don't help, there are a number of medical treatments you can move onto.

• Avoiding the triggers: Identifying things that trigger a hot flush is the first step. Try keeping a record of your hot flushes and what you were eating or doing at the time. Many women find that stress is a primary trigger. Other common triggers include caffeine, alcohol, spicy food, diet pills, hot food, hot stuffy rooms, hot weather and smoking. If hot flushes or night sweats are a problem try to avoid these wherever possible. You may also need to review the way you dress. Try wearing layers that can easily be removed and then replaced, such as a light cardigan over a shirt, rather than one woolen jersey. Wear natural fabrics that breathe.

• Deep Breathing: Robert R. Freedman, Ph. D., called the 'dean of hot flush research', strongly advocates deep breathing exercises to combat hot flushes. He recommends women take yoga classes to learn the correct technique. As reported in the December 2005 issue of The American Journal of Medicine, yoga breathing reduced hot flushes by 50%.

• Try deep, slow abdominal breathing (six to eight breaths per minute). Practice deep breathing for 15 minutes in the morning, 15 minutes in the evening and at the onset of hot flushes.

• See Meditation and how to get started.

Medical Treatments

If you find that lifestyle changes and natural approaches do not help, or your hot flushes are impacting on sleep or daily life, there are many proven medical treatments that can help.

• Hormone Replacement Therapy (HRT). Menopausal hormone replacement therapy, or estrogen therapy, is probably the most effective way to relieve hot flushes, but concern over long term safety has reduced its popularity with both doctors and patients.  Numerous trials have shown that it is effective. According to a report from Thomas Jefferson University, an analysis of 24 trials, which included 3,329 women, showed a 75.3 per cent drop in the frequency of hot flushes experienced each week, and an 87 per cent reduction in severity of symptoms.

• More on HRT

• Antidepressants: Low dose antidepressants have shown to help prevent hot flushes by rebalancing or intercepting the chemicals in the brain that transmit the hot flush alarm, epinephrine and serotonin. In a study by Dr. Charles Loprinzi at the Mayo Clinic antidepressants reduced hot flushes by 50% in 60% of women. Many doctors now consider anti-depressants the medication of choice for moderate to severe hot flushes for those who can't or won't take HRT. They aren't as effective as HRT but do avoid many of the potential side-effects such as nausea, dizziness, sexual dysfunction and weight gain.

• Gabapentin: An anti-convulsant, previously approved for the treatment of seizures and also pain associated with shingles, has been shown to reduce hot flush symptoms. A study by Wayne State University School of Medicine involving 59 women found a reduction of hot flush frequency of 45 per cent compared to 29 per cent for placebo treatment. Another study found that gabapentin produced side effects such as headaches, dizziness and confusion so it’s worth talking to your doctor about the most appropriate treatment.

Herbal Treatments

In light of controversy and concerns associated with the use of HRT, many women, particularly those with milder symptoms are choosing to take a natural approach to menopause. Herbs such as black cohosh and dong quai, have been used to treat menopause symptoms such as hot flushes and night sweats. While anecdotally many women and natural health experts report benefits, scientific evidence remains inconclusive and a recent study has put their efficacy into question.

• Black Cohosh: Black Cohosh has been widely used to help combat a number of menopausal symptoms including hot flushes. How effective it is remains unclear. Some short studies (less than 6 months) have shown mixed results. The best of those studies showed that black cohosh did not relieve hot flushes or night sweats. In a year-long clinical trial funded by the US National Institutes of Health, it was found to be no better than a placebo for relieving hot flushes. Researchers are still looking into the possibilities.

• Black Cohosh is a phyto-oestrogen so talk to your doctor before using it if you have had cancer or intend to use it for more than three months.

• Dong Quai Dong quai (Angelica sinensis) root has been used for more than a thousand years as a spice, tonic, and medicine in China, Korea, and Japan. It is commonly used by herbalists to help manage Hot flushes. Very few studies have been done looking at the use of dong quai in humans. Some lab tests suggest that dong quai contains compounds that may help reduce pain, dilate blood vessels, and stimulate and relax uterine muscles. More studies are needed to see whether dong quai is effective.

• Dong qaui reduces blood clotting, so if you are having surgery let your doctor know beforehand that you are using this herb. You should stop using it two weeks before surgery. Avoid combining this herb with asprin or other drugs that thin your blood.

• More on herbs for menopause 

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