Menopause Part 12: The National Institute on Aging Addresses Hot Flashes

Welcome to part 12 of the ODX Menopause Series. In this post we review the National Institute on Aging guidelines for reducing hot flashes and supporting a healthy menopausal transition.

The ODX Menopause Series

1. Menopause Part 1: A Quick Overview of a Slow Process
2. Menopause Part 2: Biology and Physiology of Menopause
3. Menopause Part 3: Increased Risk of Disease Associated with Menopause
4. Menopause Part 4: Identifying Menopause: Signs and Symptoms
5. Menopause Part 5: Laboratory Evaluation of Menopause
6. Menopause Part 6: Cardiovascular Risk in Menopause
7. Menopause Part 7: Beyond Hormone Testing in Menopause
8. Menopause Part 8: Natural Approaches to Menopause
9. Menopause Part 9: Diet and Nutrition Intervention in Menopause
10. Menopause Part 10: Characteristic of Herbal Derivatives used to Alleviate Menopause Symptoms
11. Menopause Part 11: Lifestyle Approaches to Menopause
12. Menopause Part 12: The National Institute on Aging Addresses Hot Flashes
13. Menopause Part 13: Hormone Replacement Therapy (HRT) in Menopause
14. Menopause Part 14: North American and European Guidelines for Hormonal Management of Menopause
15. Menopause Part 15: Bioidentical Hormone Therapy
16. Menopause Part 16: Optimal Takeaways for Menopause
17. Optimal The Podcast - Episode 10

The National Institute on Aging recognizes the importance of addressing symptoms associated with menopause. Sometimes hot flashes are tolerable if symptoms are mild. However, if symptoms seem intolerable, a 3-month trial of lifestyle changes is recommended before hormone therapy is considered.[1]

General

• Dress in layers that can be removed.
• Carry a portable fan
• Avoid alcohol, caffeine, and spicy foods that may make hot flashes worse.
• Quit smoking
• Maintain a healthy weight
• Get adequate sleep, keep the room cooler at night, try a bed fan

Mind-body practices

• Yoga or tai chi have been found to improve menopausal symptoms
• Deep breathing, relaxation breathing
  • In a comfortable position, place one hand on the belly, one on the chest
  • Slowly inhale through the nose allowing the chest and belly to rise
  • Slowly exhale through the mouth, pressing gently on the chest and belly to exhale completely
  • Repeat for several minutes throughout the day and before falling sleep

Non-hormone options

• Selective serotonin reuptake inhibitors (SSRIs), low dose
  • Side effects may include dizziness, drowsiness, headache, jitteriness, nausea
• Benefits and risks of natural treatments such as black cohosh, DHEA, and phytoestrogens are still being studied.

Hormone therapy (lowest dose, shortest duration possible)

• Estrogen and progesterone replacement therapy may help treat hot flashes
• Increases risk of blood clots, breast cancer, dementia, gallbladder disease, heart attack, stroke, especially for postmenopausal women over age 60.
• Contraindications include
  • Breast or uterine cancer
  • History of blood clots, bleeding disorder, heart disease, heart attack, liver disease, stroke, vaginal bleeding, or current possibility of pregnancy.
• Forms include creams, gels, implants, patches, pills, rings.
  • Dermal patches may be safest for those at cardiac risk.
• Composition includes conjugated estrogen, estradiol, selective estrogen receptor modulators (SERMs), synthetic or compounded hormones.
• Side effects include bloating, breast tenderness, cramping, spotting or monthly periods.

Reference

[1] The National Institute on Aging. Hot Flashes: What Can I Do? Accessed August 10, 2021.