Hot flashes and night sweats
The most dramatic symptoms of early menopause are hot flashes and night sweats.
Fortunately, there are many options available today that can help reduce or even eliminate these annoying signs of menopause.
The most effective treatments for hot flashes and night sweats are estrogen pills and the estrogen patch. I prescribe FDA-approved bio-identical estrogen for many women, but only after we have a detailed discussion about whether it is a safe and good option for them.
When women start the medication, their hot flashes and night sweats are usually improved within 10 days. Yes, 10 days.
So, who should take estrogen? The perfect candidate is a woman who:
- Is less than 10 years from menopause
- Is in good overall health
- Has low risk factors for heart disease and stroke
- Has never had a deep vein blood clot
- Has never had breast cancer
Many studies show how well women do when they take prescription estrogen and how safe it is to take these medications. It is amazing how technology can be used to help with decisions about estrogen use.
The North American Menopause Society app called Menopro is used to check for risk factors. It is a scientifically based decision tool that helps women and their doctors decide about using estrogen.
Unfortunately, there are too many false beliefs in the community about estrogen, and these false rumors are taking away the chance for more women to enjoy the benefits of using estrogen.
For some women, estrogen is simply not an option because of risk factors. These women should first focus on living a healthy lifestyle.
Women who are even slightly dehydrated, for instance, become hot more quickly. A drink of cold water can cool the core and shorten a hot flash.
Keeping excess weight off can also help avoid hot flashes in the first place, because extra weight is like wearing a sweater that can’t be taken off. Add a 90-degree day to that extra weight and the hot flash may last all day!
Avoiding alcohol, eliminating extra stress, getting plenty of sleep and practicing daily gratitude can also help women feel healthier.
Regardless of whether a woman can take prescription estrogen, a healthy lifestyle should always be the first thing she strives for to eliminate hot flashes and night sweats.
One medication proven effective in treating hot flashes is from a class known as selective serotonin re-uptake inhibitors, or SSRIs. These medications are FDA-approved for helping with depression and anxiety disorders.
This may sound like a mouthful, but it’s important to understand why and how this medicine works for women in menopause. Without the explanation, you may think your doctor or nurse practitioner is confusing your hot flashes and night sweats for anxiety or depression.
If you don’t understand why you have been prescribed a depression medication, you might wonder what is going on with you.
When you fill the prescription and start reading the package insert, you may feel insulted that your physician thinks you need something for anxiety or depression.
The SSRI Lexapro, however, has proven to be very effective for hot flashes—almost as good as estrogen.
There can be some trial and error in finding the right medication for you, since there’s currently no way to measure brain levels of serotonin. If you can take SSRIs and have only minimal or no side effects, you can have years of good relief.
Several other options can complement medications. Studies have shown that acupuncture can be effective in reducing hot flashes.
Many women also wonder if soy products are helpful. The answer: Soy can help for some women, although usually only with minimal results.
The issue is that most soy products need to be converted in the body to a compound called equol. Unfortunately, most women who are not of Asian descent and are not raised on a soy-based diet cannot convert the soy to equol. As a result, the supplements are often a waste of time and money for most women.
Back on track
I had a patient—we’ll call her Janice—come to see me last summer when the temperatures outside really started heating up.
Janice said, “I thought I could just soldier through and get through menopause without any medication, but I am not sleeping. I am red-faced and hot all day at work and I can’t even get ready in the morning without getting sweaty. Help!”
Janice was just beginning her transition, having only been without a period for seven months. She was officially either in late perimenopause or early menopause.
Either way, Janice didn’t care what we called it—she just wanted it fixed!
I first asked her about all her symptoms. We made a list so we wouldn’t forget anything.
Then we went through her daily habits and talked about the SEEDS to see if she was following them or could do better with her habits.
Overall, Janice was quite healthy, but we discovered she wasn’t drinking enough water, she wasn’t getting enough sleep, and she was eating too much sugar.
Of course, I explained how improving these habits could help her symptoms. I promised that we would revisit the SEEDS topic and her list of symptoms at each visit to help keep her on track.
One last suggestion I gave to Janice before she left my office: download the Menopro app on her phone.
We walked through the steps on the app together to make sure she understood how it worked and could use it once she walked out my door.
The final plan for Janice included trying the patch estrogen and the pill estrogen. This seemed like a good fit for her because she was low risk for complications or bad side effects from hormone therapy.
Two weeks later, I received a message from our nurses that Janice reported being better about following the SEEDS. She was also using her medication as prescribed and her hot flashes and night sweats were almost gone.
Janice began to feel like herself again and she was sleeping through the night. I couldn’t have asked for a better report.