Managing Hot Flashes: What You Need to Know!

Women's Health

Hot flashes during peri-menopause and menopause can be very dis­ruptive and confusing, and they can be induced by many factors other than low estrogen.

Instant menopause caused by chemotherapy, pelvic irradiation, or surgery to remove the ova­ries can be especially shocking to the system. But there is hope: it is possible to have a hot-flash-free life even without estrogen.

Estrogen Is Not the Only Solution

Women who cannot take estrogen because of estrogen receptor–positive cancer or other risk factors (such as cardiovascular disease) should not despair. Estrogen is powerful, but it is not the only solution. Research is continuing to reveal that acupuncture can provide significant relief, as can medications other than estrogen. Most important, perhaps, is the evidence to sup­port the significant improvement women expe­rience when they make consistent, healthy life­style choices.

Cognitive behavioral therapy may help relieve hot flashes.

British scientists have reported that cognitive behavioral therapy (CBT) may help women find relief from hot flashes. Researchers at King’s College in London conducted a study that included 140 women who had been suffering from hot flashes and night sweats at least 10 times per week for a month or more. The women were randomly assigned to one of three groups: group-based CBT, a self-help program of CBT, or no treatment. Cognitive behavioral therapy is a psychotherapeutic approach aimed at addressing the underlying emotional, thinking, and behavior patterns that can feed mental or physical symptoms. The approach involves a variety of techniques, including individual therapy, group therapy, imagery, and more.

In this study, the group-based CBT included four group sessions per month, whereas the self-help CBT involved one meeting with a psychologist plus the use of a CD and book. The therapy was designed to help women develop useful, accepting approaches to hot flashes, including breathing exercises to divert attention away from the hot flashes and negative thoughts.

After six weeks, 65 percent of women in the group-based CBT and 73 percent in the self-help group reported a meaningful drop in hot flash symptoms, compared to just 21 percent of women who received no treatment. What’s more—the benefit was still noticeable six months later.(1)

Researchers concluded that CBT delivered in a group or self-help format is an effective treatment strategy for hot flashes and night sweats. They noted that the benefit seemed to come from changes in how women perceived their symptoms—while women may have still experienced hot flashes, they were better equipped to cope with them.

Women who exercise tend to have fewer, less severe hot flashes.

Although exercise may seem counterintuitive when you’re overheating, recent research indicates that in women who experience mild to moderate hot flashes, those who exercise have fewer hot flashes for 24 hours afterwards.

The recent study included 92 menopausal women aged 40 to 59, none of whom were taking hormones. The women were recruited for a study examining physical activity. They wore accelerometers that measured their physical activity as well as devices that measured skin moisture and hot flashes. The researchers followed the women for 15 days, assessing their daily physical activity and also supervising a 30-minute moderate-intensity aerobic workout on a treadmill.

While many assume that physical activity will increase hot flashes as the body warms up, the results of this study indicate that is not what actually happens. Both subjective and objective measures of hot flashes revealed that the hot flashes decreased after the acute exercise session. The researchers observed that moderate aerobic exercise decreases hot flashes for 24 hours after exercise; however, they noticed that not everyone received the same benefits from exercise. Women who were overweight, less fit, or had more frequent or intense hot flashes did not reap the same benefits from exercise.

The researchers concluded that women who suffer from mild to moderate hot flashes may benefit from exercise to help reduce those symptoms. They were uncertain whether losing weight and becoming more fit could help other women reduce their hot flashes as well.

The takeaway message—exercise can’t hurt and it might help when it comes to hot flashes. There is no reason for women to avoid physical activity for fear of exacerbating hot flashes. In fact, more women might benefit from incorporating exercise, losing weight, and becoming more fit—it’s a good recipe for overall health as well as reduced menopausal symptoms. (2)

The bottom line: get moving and stay moving—before, during, and after menopause.

Focus on Wellness

Specifically, the idea is to focus on the essen­tial components of wellness: make a daily habit of taking simple steps toward health. I like to offer women an easy way to remember the key pillars of a healthy lifestyle, with the acronym SEEDS, which stands for seven essential ele­ments of daily success:

  • Water: 80 net ounces per day (total servings of water minus caffeine and alcohol)
  • Sleep: 50 quality hours per week
  • Micronutrients: multivitamin and vitamin D
  • Macronutrients: a healthy balance of protein, smart carbohydrates, and fat (and only one treat)
  • Daily exercise: should include a balance of aerobic exercise three times per week and strength-training or interval training three times per week, as well as regular stretching
  • Fiber: 35 grams per day to promote healthy bowel habits
  • Meditation or gratitude practice: twice per day

Making a conscious effort to live a healthy lifestyle can reduce hot flashes as well as improve your overall health; for cancer survivors it can also reduce the risk of recurrence. Poor lifestyle choices, on the other hand, can cause hot flashes—even for those already taking hormones.

How the SEEDS Were Planted

Whether a woman is 20 years old and menopausal after chemo­therapy for leukemia, 35 and has received chemo for estrogen recep­tor–positive breast cancer, or 45 and BRCA-positive and has undergone risk reduction surgery to remove her ovaries, the symptoms of meno­pause can be overwhelming.

Since 2008 I have spent many hours working to understand the symptoms of menopause. As a gen­eral OB/GYN who has seen many women get through the transition with minimal symptoms and others suffer from symptoms that inter­fere with quality of life, I wanted to help.

As I considered my experiences with patients, I was confused about why women could have symp­toms even though they took estro­gen. That neither make sense nor fit what I had been taught about menopause. I asked myself, Is there a better solution than a prescrip­tion for estrogen?

My aha moment came with a patient I will call Deb. She was 54 and experiencing terrible symptoms that she knew to be associated with menopause, including hot flashes, night sweats, trouble falling asleep and staying asleep, irritability, lack of motivation, debilitating fatigue, foggy brain, and zero sex drive. She had started estrogen prescribed by her primary care doctor, but she was not feeling relief from the dose—the maximum her doctor would prescribe—and came to me wanting the dose increased. She needed the symptoms to go away.

At the time I was not sure what to do, but I did know that a higher dose would increase the risk of com­plications, so I did not increase her dose. Unfortunately, another phy­sician did agree to up Deb’s dose, and she developed a blood clot in her lungs—and almost died. And the higher dose of estrogen had not reduced her symptoms.

After her successful recovery, Deb returned to my office to discuss options. By this time I had been to several North American Meno­pause Society conferences, had researched the cause of menopausal symptoms, and had developed a strategy for symptom treatment. I realized that the best treatment required consideration of the whole person.

In evaluating Deb’s overall health, I was able to understand the many factors contributing to her symptoms. In addition to low estro­gen, Deb’s poor daily health hab­its, co-existing health conditions (such as obesity and prediabetes), many life stressors, and unhealthy relationships were contributing to the frequency and intensity of her symptoms. By addressing barri­ers, talking through solutions, and improving her habits, Deb was able to find a comprehensive strategy that worked.

A Daily Journey toward Health

While estrogen can be effective in helping women address hot flashes and other frustrating symptoms of menopause, there are other solu­tions for women who suffer from hot flashes, night sweats, fatigue, sleep deprivation, and emotional upset. As Deb’s case illustrates, a whole-person approach to health can offer many benefits.

At the end of the day, even with my years of experience and insight into the causes of menopause, I still have the occasional night sweat myself. I use it as a gift to invite review of my daily habits and con­sider the factors I need to keep in mind to stay well during my own menopause transition.


  1. Ayers BD, Smith MD, Hellier J, et al. Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): A randomized controlled trial. Menopause. Published early online: February 14, 2012. doi: 10.1097/gme.0b013e31823fe835
  2. Elavsky S, Gonzales J, Proctor D, et al. Effects of physical activity on vasomotor symptoms: Examination using objective and subjective measures. Menopause. Published early online June 25, 2012. doi: 10.1097/gme.0b013e31824f8fb8

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