It is the most common and most talked about experience of perimenopause, menopause & beyond: hot flashes.

Did you know the actual term is “hot FLUSH”?

We took the question of what to do about hot flashes to Dr. Jerilynn Prior who correctly uses “flush” here in her reply, even though most of North America and many media and advertisers use “flash”. Just another one of those quirky things about navigating the topic and figuring out all the confusing and conflicting info….

Dr. Jerilynn Prior

From Dr. Jerilynn Prior, MD, Professor, Endocrinology, University of British Columbia & Founder of Centre for Menstrual Cycle and Ovulation Research:

For night sweats and hot flushes what I recommend as the most natural — and therefore least harmful — therapy is anything that decreases your feeling of stress. Good evidence supports what is called “paced breathing.” It is a kind of meditation or relaxation therapy that uses slow, deep, controlled breathing. Sit in a quiet place, with your body relaxed and your eyes closed and first become aware of your breathing. Then slowly take a deep breath and equally slowly, let it out. You might count as you breathe in, perhaps up to 10. Let your breath out without any effort (say a count of 5 or 6). Focus on the breath and nothing else.

Alternate methods of relaxation are to sit in the same quiet place and relaxed way and visualize yourself in the most calm, secure and lovely place you can imagine. If you practice, you will be able to smell the air, feel the breeze on your face, see the whole full-colour environment. For these relaxation or breathing methods to be effective you will need to do them for 10 to 20 minutes twice a day. One good time is just before going to sleep. If you practice, you will learn to be able to capture the same calm in the middle of a busy day.

In addition to these ways of decreasing your stress responses, it’s a good idea to see if there are any ways you can lighten your load, or deal with the things that are bothering you. If I am under great stress, my night sweats return no matter how hard I try to relax.

The second option is an herbal product called Black Cohosh that is marketed as “Remifemin.” The four papers that have tested this for hot flushes/night sweats used different doses but it looks like 4 mg twice a day is the effective dose (read the package label). It has one disadvantage – it has some estrogen-like activity and, therefore, may not be safe for long term use (in other words, for more than six months). For example, two of the two studies that tested the effect of Black Cohosh on the vagina (like a pap test) found it acted like estrogen and therefore may make vaginal dryness better. However, that means there are also risks for breast tenderness, breast lumps and possibly breast cancer as well as for vaginal bleeding or unwanted periods.

Vitamin E (400 IU once or twice a day) has been tested for hot flushes in only one recent trial and was statistically stronger than placebo but was not importantly so. However, there may be other reasons to take vitamin E and it is also likely to be safe. So you could begin with 400 IU a day while working on your breathing!

I believe that night sweats that persistently waken you from sleep need to be treated. If not, there are adverse effects on mood, muscle and joint symptoms and potentially other problems such as increased bone loss. If you try these natural therapies and they help, but not sufficiently to prevent night sweats then I would recommend progesterone. There is one trial showing that the progesterone cream (available over the counter in the USA) when used in a dose of 20 mg/day improves hot flushes in menopausal women. (Progesterone cream is not officially available in Canada except by a doctor’s prescription.) Whether this dose is helpful in perimenopause is not known.

My preference would be oral micronized progesterone (Prometrium®) which is bio-identical to your ovary’s own progesterone. It is available as 100 mg round capsules that look like beige salmon eggs. They are made with peanut oil to increase absorption and therefore those allergic to peanuts or other nuts should avoid them. Progesterone should be taken just before going to bed because the oral medication has a side effect (excellent one!) of causing drowsiness. It may also cause some dizziness for the first 2-3 hours after first taking it. This is not a serious side effect and shouldn’t worry you—just lie down and go peacefully to sleep.

The Prometrium® dose that I know is effective for night sweats in perimenopause is 300 mg at bedtime daily. It does not cause vaginal bleeding, breast tenderness, depression, weight gain, migraines or acne. (The drug books that indicate that these are progesterone side effects are, for medico-legal reasons, referring to everything that has been noted with estrogen and male-hormone derived progestins that are in birth control pills.)

If you prefer to use a natural progesterone cream you should ask for a prescription from your
doctor for a dose of 100 mg twice a day. Ask around for a compounding pharmacy that can make this for you. (Shirley Footnote: I use Pure Pharmacy in Vancouver.) Be sure that they supply it with a measuring device and will tell you how many mg in one unit of measure. The dose could safely be increased if needed. (Shirley Footnote: The container from Pure has a clicking device on it. One click = one unit of measure.)

from Menopause Chicks: ALWAYS work with a health care practitioner to get informed and choose the journey that is right for you!

For more information, please visit Dr. Prior’s website at The Centre for Menstrual Cycle & Ovulation Research (CeMCOR). CeMCOR is a not-for-profit and relies on donations to carry out critical research on women’s health. To support the important work, you can donate here.