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!