A friend calls these power surges, a metaphor that fails to amuse when she is in the midst of the discomfort brought on by this transition in life.  Sweating, flushing, anxiety, heart palpitations, and a flow of heat through the body from the inside out….  these are not the trappings of power, but of discomfort.  Doctors know that decreasing estrogen levels cause the symptoms of hot flashes; they just don’t know why a drop in estrogen causes them.  When the Women’s Health Initiative (WHI) study found that long term estrogen/progesterone hormone replacement therapy (HRT) increased a woman’s risk of heart disease, stroke, breast cancer, and blood clots, many women went off HRT and have been trying to handle hot flashes as best they can.  The severity of symptoms is unique to the individual and requires some trial and error to manage them.  What follows is an overview of natural alternatives and their effectiveness. 

1. Mind over matter.  Stress and anxiety have been linked to more intense hot flashes.  When you feel the flush coming over you, take several very deep breaths.  Studies have shown that the frequency of hot flashes can be reduced up to 60% with this simple process.  Meditation or yoga has also been found helpful in reducing frequency and severity.  Bottom line:  Relax. 

2. Eating habits. Spicy foods, alcohol, sugar, and caffeine have been reported to initiate a hot flash and are best avoided.  High fiber diets reduced frequency in cancer patients.  Phytoestrogen rich soy food is often recommended to help moderate hot flashes, but studies are unclear as to whether soy is safe and so recommendations of the medical community are to avoid soy supplements or regular consumption of soy powder. 

3. Dress for temperature changes.  Wear layers that allow you to remove a layer until the moment passes.  Choose cotton clothing that breathes and allows skin moisture to evaporate quickly, enhancing the cooling effect.  This is especially true of nightwear.  Night sweats are more quickly alleviated when moisture is not retained next to the body by nylon and synthetic fabrics.

4. Natural progesterone.  One of the most effective alternatives to HRT.  Brought to national attention by Dr. John R. Lee, the transdermal absorption of natural source progesterone that has been converted to actual progesterone in the laboratory has a record of success for dramatically reducing the severity and intensity of hot flashes.  The Abbey’s Weary Woman Wild Yam Crème has the recommended levels of natural progesterone for hot flash relief.

5. Herbs.  Black cohosh is the most promising herbal natural alternative.  Women provide a large amount of positive anecdotal evidence but controlled studies on its effectiveness have been mixed. More will be known next spring when the results of a year-long study at Columbia University are published.  Stay tuned also for the results of an ongoing study at the University of Illinois is comparing black cohosh, red clover, and a placebo for hot flashes.  Note:  Black cohosh has been implicated in liver damage and while there is no clear evidence, prudence dictates that you avoid it if you have liver problems or take medications affecting the liver.

Red clover is a phytoestrogenic rich herb that appears safe and many women find it useful in relieving hot flashes.  A 2004 study of postmenopausal women taking red clover for a year were found to have no changes in breast tissue, but there was also little change in hot flashes.

Infusions (teas) are a very effective and soothing way to obtain the benefits of these herbs. 

Any product taken for the relief of menopausal symptoms, whether natural or synthetic, should be paused for a few days every month, or for one or two weeks every three to six months, to gauge your need to continue.  Be prepared for some short-term increases in symptoms until the body adjusts to the change.