Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
30 May

Dear Carrie: Hot Flashes

Every week I attempt to field at least one reader question in my Dear Mark series of blog posts. Some of the inquiries that are submitted are outside my scope of knowledge or experience, or are questions that are addressed to my wife, Carrie, specifically. While I could (and have been known to) dig into the research on such topics as cellulite, menopause, nursing, giving birth and the like, I think it’s valuable to offer a woman’s perspective on these and related topics of interest. And so, enter Carrie…

Hi, everyone! It’s good to be back on MDA. I so appreciate the emails I regularly get from everyone. Thanks for all your questions and kind messages. I love this community and always enjoy contributing. I get a lot of questions about family and the female perspective in living Primal. One common topic is menopause. I know how intricate a life transition menopause can be, being I’m navigating it myself now. There are a million questions I think women have about menopause, and I know they’ll be more relevant posts coming up. For today, I thought I’d take up one reader’s forum post about hot flashes and sleep. (Do I already see some heads nodding out there?)

I’ve just been looking around on the forum regarding hot flashes increasing on the primal diet for peri and menopausal women there are several threads on it – so figure I am not alone and wondering if you or maybe a guest contributor could do a more pointed column on this?  (i.e. I am dying from no sleep – up every night between 12 and 5 cycling through hot flashes)  For the first time in 17 months on the primal lifestyle – i feel like crap and its all from the sleep deprivation. I’d like to make one last valiant effort with diet, lifestyle and supplements before I go the Bio ID hormone route and hoping you might have some suggestions?

Thanks to Barb for the great question. Since some three-quarters of women experience hot flashes during the menopause transition, it’s a subject well worth exploring. For those of you unfamiliar with the experience, hot flashes occur when blood vessels in the head and neck suddenly expand. They can come during the day or at night with or without sweating and other symptoms like dizziness, faster heart rate, or headache. Hot flashes can start in the years leading up to menopause (a.k.a perimenopause) as estrogen levels sharply drop. They often resolve themselves over time but can linger for some women well into their post-menopausal years.

Researchers are still filling in some of the picture, but they believe hot flashes are a result of both the hormonal changes happening during the menopausal transition and their effect on areas of physical functioning. Hot flashes are associated with both the withdrawal from estrogen hormones women experience in the peri-menopausal and menopausal years as well as the “surges” of lutenizing hormone that occur during this time. (For the record, men can experience hot flashes when undergoing androgen deprivation therapy, which imposes a sudden and dramatic reduction in their testosterone levels.)

As much of a pain as they are, I should add that some studies suggests that hot flashes bode well for post-menopausal health. Researchers have found that women who experience hot flashes, especially early in menopause, have a lower risk of developing breast cancer, stroke, and heart disease. For what it’s worth in those hot, miserable moments…

During the menopausal transition, the body’s thermostat (part of the hypothalamus function) can take time to recalibrate with ongoing hormonal changes. Hot flashes, experts believe, may be related to this process. Women with severe hot flashes (in terms of both intensity and frequency) can have their sleep regularly disrupted and are at risk for chronic insomnia, like Barb has been experiencing. Given that some women can experience several a night that may last up to thirty minutes each, a good night’s sleep can be next to impossible. The effects can be grueling over time. Moreover, women are at a higher risk for other sleep disorders like sleep apnea during and following menopause because of the shift in hormones.

Although most women will experience some degree of hot flashes during menopause, certain factors like obesity, smoking, and inactivity can put your at higher risk. Caffeine, alcohol, sugar, and spicy foods can exacerbate hot flashes. Exercise and relaxation practices help many women cope with both the hot flashes themselves and the resulting sleep deprivation.

As for alternative remedies, I would give acupuncture a chance. The research looks pretty good as a whole, and I can say it’s had an impact for me personally. In terms of herbs, I’d recommend trying (individually) black cohosh, chasteberry (which are both used in Europe for management of menopausal symptoms), keishi-bukuryo-gan tea (PDF), and perhaps dong Quai (which can help dilate blood vessels). Other common options women try for hot flashes include Evening Primrose oil (less effective in my experience), and maca root. Although your best bet for menopause nutrition is an all around, nutrient dense diet, you might try increasing your intake of vitamin E, and vitamin C (to aid the absorption of vitamin E).

In the last few years, there’s been a trend toward using off-label pharmaceutical treatments (e.g. Gabapentin — a seizure medication, Clonidine –a high blood pressure treatment, and a few anti-depressant varieties) for menopausal symptoms, especially severe hot flashes. Given the potential for serious side effects over time, I would suggest avoiding these medications (as I would conventional, synthetic HRT).

Although Mark tells me they’ll be more to come on menopause in the coming months, I just want to offer a word of support for Barb and other women who are looking at bio-identical hormones. Although I believe in first trying natural ways to handle menopausal symptoms, I don’t consider it failure by any means to embrace the bio-identical HRT route, especially if you’ve tried other measures with little success. I think bio-identical hormones are a reasonable option for women who can’t find relief from natural means when ongoing problems seriously impact their well-being.

A couple of years ago I gave bio-identical hormones a try (a low dose mix of estrogen, progesterone, and testosterone) when I exhausted the possibilities of various herbs and supplements I could find at the time. (For me, it was more memory issues than hot flashes.) Although the hormonal combination didn’t help my memory situation, it eased a lot of other symptoms I was having. I felt great in ways I hadn’t for a long time.

These days I’m still searching for something to address the memory fog. I’ve gone off the bio-identical hormones for now and am trying a new regimen of Chinese medicinal teas and acupuncture that I’ve designed from my research. It’s a work in progress, and I’ll let you know more when I’ve given it time. For now, I’ll say I’m sleeping better and experiencing less dramatic hot flashes, but I haven’t seen as much change on the memory front yet.

MDA readers, I hope you’ll share your thoughts and stories on coping with hot flashes. I’ll be back with more “Dear Carrie” answers in the near future. Have a great week, everyone!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Wow, does this hit home. I’m 54 1/2 and stopped getting my periods when I was 52 1/2. For the first year, I felt great! No hot flashes, few if any night sweats, then almost exactly one year to the day, boom! Hot flashes every hour. Multiple night sweats every night. I thought I was going to lose my mind.

    I was determined not to do HRT as every woman I know that has done this has gotten breast cancer. So, I tried black cohosh, maca, no alcohol, no caffeine. Nothing helped. In desperation, I turned to my doc, who recommended very low dose HRT. I reluctantly decided to try for just a few months.

    Well, I took it for 4 days and thought I had lost my mind. I was irritable, started breaking out, diarrhea, ick. I immediately threw them in the trash and haven’t looked back. Yes, it’s been a long road, but since going Primal 100% yesterday. I’ve not had the hot flashes as bad and I slept through the night for the first time in a long time. Amazing!

    Gypsykim wrote on April 19th, 2013
  2. I like making Love to someone I kinda love

    Hana Helper wrote on May 21st, 2013
  3. I thought I was completely through peri-menopause and had not had a period or symptom in 9 months. Starting eating the paleo lifestyle and within ONE week of eliminating grains and sugar (I had already eliminated dairy and don’t drink coffee or alcohol) – I had got my period again and developed hot flashes at night which I never had before. Otherwise I have seen lots of positive changes. Maykes me go hmmm… Curious as to the connection.

    barb wrote on June 6th, 2013
  4. what I found to work 100% for me was simple, safe, and very much EFFECTIVE!
    When you find yourself getting a hotflash, drink a glass of ice cold milk.Other advantages you will receive by doing this,is you will notice that you re physically stronger,&your hair will get really,really shinny! what do you have to lose??

    alexis proctor wrote on July 1st, 2013
  5. Physicians wouldn’t dream of not treating a low thyroid level. Why is the rest of the endocrine system left to ruin as we age? This is the same time frame when diseases of all types appear in women….menopause. I’m told “it’s natural” to loose your hormones. “Let nature take its course.” Getting cancer is “natural”. We treat that. Women is this age group need to take this seriously. Our doctors do too.

    Goddess wrote on July 1st, 2013
  6. Hi there!!

    I am 39 years old and was thrown into a surgical menopause 2 years ago. I was on HRT for a while, but just can’t afford it any more. I am having severe HOT FLASHES. Really really bad at least 3 times an hour, and with being in the middle of summer I’m not fairing well. Today I’m at my worst and its really starting to effect my being in good spirits! It’s hard to smile when I feel like I’m sitting on a fire.. Please help .. I’m not sure what to do..I don’t sleep we’ll because I’m so hot then I get cold my husband is freezing because I have the air on 24/7 and a fan on top of that. Akkkkkk I’m frustrated


    Andrea wrote on August 2nd, 2013
    • Sounds like where i was a year ago….I ve had great success over the past year with acupuncture and taking vitex and black cohosh and of course following a primal diet and exercise routine. Do keep it cold at night – your husband can bundle up – tell him to wear socks to stay the warmest :) good luck.

      barb wrote on August 3rd, 2013
  7. It seems all I do is look on the internet for menopause relief. It’s a full time hobby these days. I’ve tried sage, red clover, EPO, Vit E, progesterone cream (worked for a while), Estrovera (ruhbarb extract which worked for a while) etc. Leary of Black Cohosh. Maca isn’t good for thyroid patients. I heard that flax is goitrogenic as well. Really sick of hot flashes and sleep issues. I also experience them whenever I turn over in bed. Thinking of trying MCT but I read it can mess with your liver just as Black Cohosh can. Who needs that?
    I’m going to check out some of the herbal remedies people have recommended here but I figure they will just contain the usual suspects. It is really frustrating.

    Liz wrote on August 14th, 2013
  8. Hi Carrie,

    I am writing to ask your perspective on menopause in the athletic woman.

    As we begin to feel our bodies alter in such ways as needing more time to recovery and experiencing a few more aches than in previous years how do we maintain our levels of athleticism and energy as the hormones wax and wane?

    I am 50 years old and I admire and respect older women who age gracefully, emotionally, spiritually and physically, they are beautiful role models for the rest of us, and perhaps I can in turn be a role model for the next generation of young women as they come of age.


    Kim Allen, RN

    Menopause in athletic women wrote on August 20th, 2013
  9. OK girlfriends. All together now…can you say “bioidentical hormones?”

    Goddess wrote on August 30th, 2013
  10. I’m in peri-menopause, and my first hot flashes happened several months ago. They came several times a day. A couple of months after they started, I began taking cod liver oil daily to improve general health. I noticed a short while later that I was no longer having any hot flashes. I haven’t really made any other major changes in my diet other than the cod liver oil, so I have to think that’s what’s helped. Haven’t had any hot flashes since. I look forward to the publication of Primal Woman next year!

    scribbler2013 wrote on September 27th, 2013
  11. I used to suffer badly from hot flashes,mood swings and increased impulsivaty and decreased attention span. I have ADHD and peri-menopause. My brother told me about a commercial of Amberen. Well I researched it and found it to be too damn expense. However I noticed that the main ingrediant was amber acid. Then I found that amber acid could be affordably ordered by amazon. Well this is marvelous stuff! It works on the mitochondria which makes the ovaries balance the hormones! No more mood swings or hot flashes and my energy is up. However I am having dosing problems for the evenings. It has been interfearing with my sleep. So today I am changing the times I take the amber acid and hopefully I will sleep better tonight! But I have to tell you it does not work for everyone. But for those it does it is miraculous!

    Elizabeth Ewins wrote on November 9th, 2013
    • hi – wondering if you were able to adjust your dosage of amber acid to allow for good sleep?

      barb wrote on January 28th, 2014
  12. Is having hot flashs something to worry about I am a 33year old female suffering with depressing and I am biopoloer

    Corrina Rodriguez wrote on December 28th, 2013
  13. Hot flashes stink! Just saying! Trying all the alternatives I can think of! OMG! Don’t get old! That’s the key! :-)

    Chrissy C wrote on February 9th, 2014

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