Hot flashes are one of the most common menopausal vasomotor symptoms, affecting more than 80% of menopausal women. Of these women, 65% will complain of hot flashes for over two years and 36% for more than five years (12). With the correct treatment, hot flashes can be treated. This article will discuss considerations for evaluating and treating hot flashes, focusing on those caused by hormonal imbalances during the perimenopausal and menopausal periods of a woman's life.

[signup]

What Are Hot Flashes?

Hot flashes are sudden, episodic sensations of heat felt on the chest, neck, and face. They are often accompanied by sweating and reddening of the skin. Hot flashes vary in duration and intensity but typically last one to five minutes. They can be very uncomfortable and disruptive to daily activities and sleep, especially if they occur frequently. 

What Do Hot Flashes Feel Like?

Hot flashes are often accompanied by sweating, heart palpitations, headache, weakness, fatigue, and anxiety. These episodes' duration, intensity, and frequency will vary between individuals. (10) 

Regarding perimenopausal and menopausal hot flashes, the frequency and severity tend to increase during the perimenopausal transition. Hot flashes can occur several times per week or up to ten times daily and generally last less than five minutes. Menopausal hot flashes can persist for months to years after a woman's final menstrual period, on average lasting 1.2 years after onset. (12) 

What Are the Possible Causes of Hot Flashes?

Various hormones and neurotransmitters modulate hot flashes through their role in central thermoregulation. The hypothalamus is a part of the brain responsible for regulating body temperature. It contains receptors that are sensitive to changes in estrogen levels. As women go through menopause and perimenopause, their estrogen levels naturally decline. Estrogen plays a role in maintaining the stability of the hypothalamus and its control over body temperature. With decreasing estrogen levels, the hypothalamus can become more sensitive and reactive to minor changes in body temperature. It may misinterpret the body as being too hot, even when it's not, triggering a response to cool down. In response to the misinterpreted overheating signal, the hypothalamus sends signals to dilate blood vessels and increase blood flow to the skin's surface. This can lead to a sudden rush of warmth, reddening of the skin, and sweating. (20) 

Serotonin and norepinephrine may also play a role in hot flashes. In addition to regulating mood and emotions, serotonin regulates body temperature. Fluctuations in serotonin during menopause may contribute to the occurrence of hot flashes. This is supported by the fact that selective serotonin reuptake inhibitors (SSRIs), which increase the availability of serotonin in the brain, are often prescribed to manage hot flashes. Norepinephrine plays a role in the "fight or flight" stress response. Research has documented rising plasma levels of norepinephrine metabolites, which trigger peripheral dilation of blood vessels, before and during hot flashes (12).

Hot flashes can be triggered or exacerbated by various factors, including stress, hot weather, smoking, spicy foods, drinking caffeinated and alcoholic beverages, and tight-fitting clothing.

In women of any age, it is important to rule out pathologies that can cause hot flashes as a symptom. The differential diagnosis for hot flashes includes:

• Allergies and anaphylaxis
• Carcinoid tumors
• Drug and alcohol use
• Food sensitivities (6) 
• Infection
• Medication side effects
• Pheochromocytoma
• Systemic mastocytosis and mast cell activation syndrome
• Thyroid disorders

Functional Medicine Labs to Test for Root Cause of Hot Flashes

If your doctor suspects a medical condition other than (peri)menopause as the cause of hot flashes, they will order a combination of tests to investigate. Depending on your history and symptoms, this may include a complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid panel, tryptase, histamine, urinary metanephrines and catecholamines, and allergy testing.

Hormone testing can provide valuable information regarding how the body synthesizes, metabolizes, and eliminates hormones from the body. Various functional medicine tests are available to provide an in-depth analysis of hormone imbalances contributing to hot flash severity and frequency. 

Female Hormone Panel

Female sex hormones, including estrogen, progesterone, FSH, and LH, are used to track the perimenopausal transition and diagnose menopause. Blood testing provides a snapshot of hormonal balance at the time of the blood draw. However, this type of testing cannot provide insight into hormone fluctuations throughout the menstrual cycle or how the body's detoxification systems metabolize the hormones. 

Therefore, a popular functional medicine test panel is the DUTCH test, which uses salivary and urinary samples to measure the metabolites of sex and adrenal hormones. This test can detect dysfunctional hormone metabolism and stress responses as causes of hot flashes. This test also measures organic acids, which may indicate nutritional and neurotransmitter imbalances known to contribute to hot flashes and other menopausal symptoms. 

[signup]

Conventional Treatment for Menopausal Hot Flashes

According to the American Academy of Family Physicians, there is insufficient evidence to suggest that lifestyle modifications effectively treat hot flashes. Instead, they recommend hormonal and nonhormonal options for managing hot flashes in menopausal women. Estrogen is the most effective treatment for hot flashes and should be combined with progesterone in women with intact uteruses. Hormone replacement is used in the smallest effective dose for the shortest possible duration. Other non-hormonal pharmaceutical treatment options for hot flashes include low-dose SSRIs and gabapentin. (9) 

Integrative Medicine Protocol for Menopausal Hot Flashes

In addition to bioidentical hormone replacement (HRT) and natural supplements to balance estrogen and progesterone levels, an integrative treatment protocol will also incorporate nutritional, stress management, and sleep hygiene modifications to address the imbalances in the body and environmental triggers contributing to hot flashes. 

Therapeutic Diet For Menopausal Hot Flashes

Adherence to a Mediterranean-style diet is associated with a decreased risk of hot flashes. The Mediterranean diet, inspired by the traditional eating habits of Mediterranean countries, emphasizes a high consumption of fruits, vegetables, whole grains, legumes, nuts, and healthy fats like olive oil. It limits the consumption of unhealthy fats and sugars, which increase the risk of hot flashes. (8) 

Foods to Incorporate Into Diet to Manage Hot Flashes

Various foods have been shown to help balance hormones and reduce hot flash intensity and frequency. Soy-based products, such as tofu, tempeh, and edamame, contain isoflavones and other phytoestrogens that reduce hot flashes without raising the risk of breast cancer. Other phytoestrogen-rich foods can help manage hot flashes by mimicking estrogen's effects on the body. Flaxseed, oats, seeds, and legumes are all rich in phytoestrogens. Traditional Chinese medicine (TCM) practitioners will also encourage eating cooling foods, like cucumber, radish, and watermelon, to keep the body's temperature in balance. (18) 

Foods to Limit From the Diet to Manage Hot Flashes

Conversely, avoiding and limiting certain foods can help prevent hot flashes. Coffee and alcohol increase hot flash severity and can intensify other symptoms that accompany hot flashes, such as increased heart rate and anxiety. Having high blood sugar, insulin resistance, and hypertension can increase the risk of hot flashes during menopause; reducing intake of processed foods and sweetened beverages helps stabilize blood sugar levels and normalize blood pressure. (6, 18) 

Best Supplements For Managing Menopausal Hot Flashes

Certain supplements and herbs are commonly used in functional medicine to manage hot flashes associated with menopause. 

Black Cohosh

Black cohosh (Cimicifuga racemosa or Actaea racemosa) has been studied since the 1950s for its ability to manage menopausal symptoms. Many studies show that black cohosh can effectively reduce hot flash symptom scores. At the end of a six-month trial, black cohosh was more effective than fluoxetine (an SSRI) in treating hot flashes and night sweats in postmenopausal women.

Dose: 40-80 mg daily

Duration: 12 weeks

PhytoEstrogen Herbal™ 

This powdered formula by Vitanica offers a phytoestrogen-rich blend of botanical herbs, soy isoflavones, and flaxseed lignans. As discussed in the nutrition section, phytoestrogens are plant-derived chemicals that activate estrogen receptors and exert weak estrogenic effects in the body. One systematic review, including 15 randomized control trials, concluded that phytoestrogens effectively reduce the frequency of hot flashes in menopausal women without serious side effects. (4) 

Dose: 1 level scoop mixed into a liquid of choice 1-2 times daily

Duration: 12 weeks

Vitamin E

As estrogen levels decline during perimenopause, oxidative stress may increase. Vitamin E, an antioxidant, may neutralize this oxidative stress. Vitamin E has been shown to improve hot flash severity and frequency. (19, 21) 

Dose: 400-800 IU daily 

Duration: at least four weeks

When To Retest Labs

The timing of a reevaluation may vary depending on the route of treatment that the patient pursues. Many functional doctors will recommend monitoring hormones one month after initiating bioidentical hormones, but will postpone follow-up until three months for a natural treatment plan utilizing natural supplementation and lifestyle modifications.

Learning More About Hot Flashes

• Case Study: Joan's Remarkable Journey of How She Achieved a Dramatic Reduction in Menopausal Hot Flashes and Night Sweats
• Live Class: Using DUTCH TEST Plus to help your patients glide into The Other PMS ™️: Perimenopause/Menopause Syndrome
• Bootcamp: Connecting the Dots on Female Hormones: From PMS to PCOS using the DUTCH Complete Test

[signup]

Summary

Hot flashes are a vasomotor symptom common during perimenopause and menopause. A protocol using diet and natural supplements can be used therapeutically on its own or complementary to conventional treatment to effectively resolve and prevent hot flashes from interfering with the quality of life of those affected.