Dr. Amy’s Wellness Tip for October: Feeling Warm?
Contributed by Dr. Amy Whittington, Trilogy’s Naturopathic Physician
This is a bit of a rhetorical question for those of you here in Phoenix with me, but I’m actually speaking in particular to the women reading this article, especially those of you between the ages of about 45 and 70. You probably already know what I’m alluding to, because hot flashes and generalized “warmth” remain one of the most common and drastic symptoms for women in perimenopause and menopause. This symptom can be a simple, mild increase in temperature (which annoyingly coincides with your husband’s decrease in muscle tone, making him colder and causing a sudden swap in sides in the thermostat war), or it can involve major fluctuations in temperature that can lead to dripping sweat multiple times during the day and night. Most women only suffer from such symptoms for a few years, but others can experience hot flashes for decades.
What Are Hot Flashes?
Hot flashes, technically called vasomotor symptoms, are a sign of hormone imbalance. Our ovaries are the primary producers of estrogen and progesterone, the two main female sex hormones that allow for reproduction. As we get older, our bodies are no longer ideal for reproduction, and our ovaries begin to decline in function, first in a phase called perimenopause. The first hormone that declines is progesterone, and women can spend up to a decade with fairly normal estrogen production, but low production of progesterone. Many women will begin to suffer from insomnia and fluctuating cycles during this time, usually between the ages of 40-50, but a small group of women will also begin to have episodes of hot flashes. We typically think of hot flashes as being a symptom of estrogen deficiency, but they can actually be caused by both an estrogen or progesterone deficiency. Progesterone is often the culprit if a woman is still cycling. As ovary function continues to decrease, estrogen levels will eventually begin to decline as well, and the symptom of hot flashes becomes more pronounced and more common. Women who have not cycled for a year are considered menopausal, and will typically have both low estrogen and progesterone.
As stated before, some women sail through perimenopause and menopause with no, or only slight, hot flashes and other symptoms. Other women, however, can be nearly debilitated for years on end. For all sufferers, from the warm to the drenched, there are some lifestyle modifications that can make a significant difference.
How to Mitigate the Effects of Hot Flashes
1.Nix Sugar and Alcohol
The first is to cut back (or cut out) simple sugars and alcohol (because it wasn’t depressing enough that you were just getting older). Sugar fluctuations in your system are probably the most significant trigger for hot flashes for many women. Often times, women note that an evening with wine and/or dessert will result in a night of temperature fluctuations and misery. I will often have patients totally avoid sugar and alcohol for a short time (i.e., with a 10-day cleanse) to see what effect these items have on their hot flashes and choose them with caution in the future. Decreasing sugars including sweets, sodas, white breads and pastas, and alcohol can totally eliminate hot flashes for some women.
2. Cool Down Your Surroundings
The second lifestyle tip is easier: turn your thermostat down, especially if you are in Phoenix or really anywhere in the summer, and especially at night. Once you get warm, especially while you are asleep, the vasomotor responses that cause hot flashes can be difficult to stop. It is easier to not let them start by staying cool. If you are tortured by your hot flashes, adding a few degrees to your thermostat is not the place to save a buck. So turn that temperature down and stay cool. And yes, you can show your husband this article and yes, he may need a blanket!
3. Stay Calm & Hit the Gym
Decreasing stress and increasing exercise have also been linked to fewer and less intense hot flashes for many women. Both likely help to stabilize cortisol levels which if elevated can contribute to vasomotor responses. Adding exercise and stress reducers like yoga and meditation have all been shown to decrease flushing.
4. Make an Appointment
If changing your diet, lifestyle, and thermostat aren’t enough, it’s time to see a provider for help.
Hormones are of course a common option, and we will get back to those shortly, but there are other strategies available, too. Anti-depressants, both prescription and natural pre-cursors such as 5-HTP, have been shown to decrease symptoms of hot flashes for many women. An extraction from rhubarb has also been shown to be effective for some women at decreasing vasomotor responses and works outside of both the hormonal and anti-depressant realm, which is attractive to many women seeking treatment. Hormone therapy is often pursued to decrease hot flashes and other symptoms associated with declining hormones. For women in perimenopause, remember that during this time the hormone responsible for the hot flashes is often declining progesterone. As progesterone declines, estrogen becomes high relative to progesterone’s low level. Replacing progesterone to bring these two hormones back in level with each other can decrease symptoms including hot flashes, insomnia, and mood changes.
All hormones should be considered on an individual basis, with risks and benefits discussed between you and your prescriber. Many studies show that prescribed compounded progesterone cream or oral preparations also likely play a protective role against a relatively higher estrogen level that is occurring. Conversely, in perimenopause, you can decrease those relatively high estrogen levels using a cruciferous vegetable extract called diindolylmethane (DIM). Lowering estrogen to be in alignment with the lowered progesterone can decrease symptoms for some.
Once a woman has reached menopause, we begin to blame the lack of estrogen, not progesterone, for hot flashes, and phytoestrogens become a treatment option. Phytoestrogens are plant-based estrogen-like compounds that have, for many, decreased their hot flashes. They likely do this by “fooling” some estrogen receptors into thinking that more estrogen is present. Black cohosh, Dong quai, licorice, and soy are commonly used phytoestrogens that can be effective. Because they are “fooling” the estrogen receptors, they are not completely risk-free as cancers can have estrogen receptors that can be fooled also. So, these, like hormones, should be used with caution and overseen by a physician.
Last but not least, replacing declining estrogen levels with bioidentical hormone therapy (BHRT) is needed for some women suffering from menopausal symptoms including hot flashes. Estrogens should always be given in conjunction with progesterone (even if you don’t have a uterus, which is opposite of what we used to think was true), and again should be considered on an individual basis. For women suffering with major hot flashes, or major menopausal symptoms of any kind, a prescription for BHRT can make life livable again.
From lifestyle changes to bio-identical hormones, the warmth that comes with menopause can often be decreased with the right treatment. Talk to your naturopath or integrative provider to find out what is best for you.
Stay healthy & be well!
– Amy Whittington, NMD