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Healthy Aging > menopause

How to Tame a Hot Flash (No Hormones Required)

By Sheryl Kraft

Created: 10/13/2015
Last Updated: 10/13/2015

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If I asked 1,000 women what the most troublesome and annoying symptoms of menopause were, the majority would no doubt answer hot flashes.

By no means a scientific survey, all I have to do is remember my own and look around me. Every time I see that familiar look (red face, beads of sweat, clenched teeth) and watch those familiar body movements (wildly fanning with whatever object is within reach, throwing windows open, stripping off layers of clothing), I silently commiserate.

To the three-quarters of North American women who suffer from menopausal hot flashes: I feel your pain and discomfort. We who suffer are desperate to find solutions, especially since the latest research finds that hot flashes can last 11 years—or more (sorry, ladies!).

As someone who hates the cold weather and is always freezing once the temperature outside gets below 60, being married to a man with the opposite type of thermostat has been a challenge. That is, until menopause hit. That's when I finally moved over to his side: go ahead and throw the windows open even though it's winter outside; keep the thermostat low. My winter sweaters got packed away, and I stocked up on short-sleeved T-shirts to get me through numerous long winters.

Understanding hot flashes is tough. Not even the experts can fully figure out what causes them or how to eliminate them. Diana Bitner, MD, recently named NAMS Certified Menopause Practitioner of the Year by the North American Menopause Society (NAMS), explains it this way:

Hot flashes are complex, triggered by more than just low estrogen. To understand, it helps to go back to the physiology. In our brain, we have a thermostat, similar to the thermostat in your home, detecting when our body is too hot or too cold. The thermostat's job is to get the body to heat up in response to cold (by shivering) or to cool off (hot flashes, sweating).”

Many women turn to hormones to cool their flashes, but what about those who can't use hormones for medical reasons, or choose not to?

Fifty percent to 80 percent of women turn to nonhormonal therapies. There are plenty of products and techniques touted for taming hot flashes. But questions about their safety and effectiveness remain. The trouble is that many women experiment or continue to suffer because there is little out there telling them what actually does work.

A NAMS statement says that one survey showed that nearly half of all women feel confused about their options for managing menopause symptoms. Another survey showed that 75 percent don't feel fully informed about herbal products.

Wouldn't it be nice to know the real deal?

To answer that vexing question, NAMS convened a panel of experts to examine the evidence and reach some recommendations for the suffering masses. Those findings were recently published online in the journal Menopause.

The panel found solid evidence that a few therapies were indeed helpful.

Significantly effective:

  • Cognitive-behavioral therapy combining relaxation techniques, sleep hygiene and learning to take positive, healthy approaches to menopause challenges were found help "reduce women's ratings of hot flash problems—although not their number."
  • Also recommended: Clinical hypnosis

May be beneficial, but recommended with caution because evidence is not as strong:

  • Weight loss
  • Stress reduction
  • Soy derivative under study called S-equol
  • Stellate ganglion block, a type of nerve block

May be helpful, although may not offer as much relief as hormones:

Various nonhormonal prescription medications including:

  • Selective serotonin reuptake inhibitors (SSRIs). These include paroxetine (the one FDA-approved nonhormonal therapy for hot flashes).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine, gabapentinoids (gabapentin and pregabalin) and clonidine.

Do not work, but may offer other health benefits:

  • Yoga
  • Paced respiration
  • Acupuncture

Unlikely to help:

Over-the-counter and herbal therapies such as:

  • Black cohosh
  • Dong quai
  • Evening primrose
  • Flaxseed
  • Maca
  • Omega-3s
  • Pollen extract
  • Vitamins
  • Relaxation
  • Chiropractic intervention

Perhaps you've tried some of these and found success (or not). What works for one woman may not work for another.

"It is our job to recognize the best way to counsel a patient is to understand her unique situation and offer options," says Dr. Bitner. "Each person has barriers that make one modality more likely to fit within her daily lifestyle based on habits, beliefs and health status.”

My opinion? Seek out all your options. Because menopause is complicated, some health care providers are hesitant to address its many variables and offer treatment. The data can be confusing and thorny.

Another reason to be informed and empowered to be your very best health advocate!

More Reading:
Menopause and Anxiety: What's The Connection?
8 Ways to Deal With Hot Flashes in the Heat (Or Is-It-Hot-In-Here-or-Is-It-Just-Summer?)
September Is Menopause Awareness Month


This is one ordeal I'm lucky to have sailed through. Menopause is such a tricky little problem -- individual to all of us.

I have had very few of these but the ones I've had have been intense! Thank you for this great list.

All good and I'll pass it along. As for me, well, I had about 6 hot flashes total and that was that. Yeah, I know. My mom was the same. Don't hate us. LOL

Great and informative piece! I am so glad to be through that part of life now too, although somewhat short lived it felt like eternity when I was there.

I do have some wicked flashes in the middle of the night, but since going to a mostly vegetarian diet, it has helped.

This subject has been confusing to me for years. I manage many of the symptoms with HRT but it was a long road to get there. If you ask 10 physicians the same question, you will get 10 different answers. Very frustrating! Thanks for sharing.

Having gone through all of these I found that relaxation techniques DO NOT work well enough to offer any true relief but paroxetine and transdermal low-dose estrogen/progesterone like Evamist work wonders.

Information is power. So is a good attitude. I was lucky I guess as the upheaval, turmoil, and rollercoaster ride of peri-menopause was my personal hell. "My flashes were not bad and short lived," she said reaching for a fan.

I recently received a topical gel called Cool Flash that does the trick for me so far. No hormones and no estrogen, just lots of natural things including gingko biloba, ginseng and various extracts. I do wish it were easier to figure out what to do when the flashes get worse (as it seems like they surely will, considering mine have been relatively tame so far). Thank you for the help here!

The suggestions really helped me a lot in getting relief. Thanks! Can be trusted.

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I am fifty-five, with hot flashes starting at age 45. About seven years ago, I discovered that I could get immediate relief from my hot flash when I urinated. Further, even before I feel the sensation to urinate, when I feel the heat coming, I know that I need to go.

I can even control night sweats by limiting my intake of beverages and foods (those with significant moisture)close to bedtime. Before I discovered the connection, I would suffer throughout the night: wake up startled and drenched; change clothes and bedding; and repeat several more times during the same evening. Now that I know that there is a connection, when I eat and drink close to bedtime (socializing with family and friends; otherwise, I do not), when the heat awakens me, I, then, go to the bathroom; and I have immediate relief. Depending upon the amount that I have eaten and drunk, I might have three or four more incidences; and each time, I get immediate relief by going to the bathroom.

I certainly do not understand the connection, but without a doubt the two are related. While, I am pleased to be able to get some relief, ideally, I wish that the flashes would stop altogether. I avoid medications and herbal supplements for relief. My focus is on nutrition; perhaps, I am deficient in a vitamin, mineral, or protein. My hope is to eat my way to stopping the flashes.

I eat a lot of fruits and vegetables; some dairy; fish, seafood, poultry, pork, and beef (declining order). I do not frequent fast food restaurants and I do not drink alcohol. I drink lots of water. I exercise everyday and I weigh 129 at 5'7".

With so much attention on understanding hot flashes, maybe researchers could discover the connection. If I had the money to conduct the research, I would. But for now...bathroom time.


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