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Menopause - What Can I Do About Hot Flashes And Night Sweats?

What Can I Do About Hot Flashes And Night Sweats?

What Can I Do About Hot Flashes And Night Sweats By Madelon Hope

Hot flashes can be a nuisance and even debilitating (when extreme) but they may have positive side to them. Vicki Noble, author of Shakti Woman, a book about feminine power, suggests that hot flashes can be viewed as a natural cleansing of our body. The increased temperature may be nature's way of killing off cancer cells and viruses that might otherwise lead to illness later on.

Hot flashes are rushes of heat primarily to the head and neck region occurring when blood vessels near the surface of the skin dilate. Some women have a premonition of an impending hot flash which may be felt as pressure in the head, anxiety, a tingling sensation, or nausea. The sensation of heat may also be widespread. The heart rate increases. Surges of blood to the hands can result in a tingling sensation. Following a flash, body temperature drops and many women experience a chill. There is no change in blood pressure at this time. About eighty percent of American women experience hot flashes at some time during menopause. They last mostly anywhere from a few seconds to a few minutes but, in rare cases, can extend to a half hour or about an hour. They are associated with but not necessarily caused by fluctuating levels of estrogen since women who experience hot flashes and those who don't have been known to have the same levels of estrogen, according to Susan Weed in "Menopausal Years". Weed's book is an extraordinarily useful source for herbal information about hot flashes and other menopausal changes. Most women have hot flashes for a period between two months and two years. A smaller percentage continue to have them a decade after their last menstrual flow.

The worst hot flashes are often experienced by women who have an abrupt loss of ovarian estrogen due to surgery, radiation or chemotherapy.

Thinner women may experience more hot flashes since fat cells convert hormones secreted by the adrenals into estrogen.

Hot flashes are much less common in non-western cultures. Studies in Japan, Hong Kong, pakistan and Mexico suggest that 10 percent or less of menopausal women experience hot flashes. The low incidence in Japan has been linked to high soy bean consumption which stimulates estrogen production. In American society, of those who have hot flashes, only a small minority (10 to 15 percent) experience enough discomfort to seek medical help. Night sweats, however, can be tough to handle since interrupted sleep can lead to extreme fatigue and anxiety.

Hot flashes can be categorized as mild, moderate or severe, according to Ann Voda, ph.D. in "A Friend Indeed", November, 1994. Mild flashes last less than a minute and produce a feeling of warmth with little or no perspiration. Moderate flashes are warmer, produce obvious perspiration, and last 2 to 3 minutes. Severe flashes causes profuse perspiration, generate intense heat, last longer and interfere with ongoing activity.

Clothes made of natural fibers (cotton, wool, silk) can disperse heat away from the body. It is more practical to dress in layers so that clothing can be removed and added as needed.

Hot flashes deplete our bodies of the B vitamins, vitamin C, magnesium and potassium so it is helpful to increase our consumption of these nutrients.

Triggers for hot flashes include spicy food, hot drinks, alcoholic drinks, white sugar, stress, hot weather, hot tubs and saunas, tobacco and marijuana and anger, especially when unexpressed, Susan Weed reports.

The medical profession has generally ignored natural, less risky approaches to hot flashes in favor of Hormone Replacement Therapy. Alternative approaches tend to strengthen and support the endocrine system. Natural remedies work in conjunction with a healthy diet and adequate exercise and tend to work more slowly.

It is important when using herbs and vitamins to pay attention to our bodies' responses and to remember that natural doesn't mean we can take large amounts of a substance without thinking of side effects. Herbs are generally available individually or in combination in capsule or extract form. It is very difficult to prescribe exact doses for herbal remedies since every body responds differently. Sometimes it is useful to work with someone who is familiar with herbs and vitamins to get advice on dosages and adjustments.

For ordinary hot flashes, try vitamin E with dosages between 400 and 800 IUs. Read labels carefully. D-alpha tocopherol means that it comes from a natural source, but DL alpha means a synthetic.

One common regimen is vitamin E, 600 to 800 IUs daily with vitamin C. When flashes subside, take 400 IUs daily. perhaps 50 percent to 66 percent of women will find Vitamin E effective. However, it may take 2 to 6 weeks before the effects are really felt. Women who are diabetic or taking high blood pressure medication or with rheumatic heart conditions should take vitamin E under a doctor's supervision. Do not take vitamin E with digitalis.

Bioflavonoid in supplements of 250 mg five to six times daily can help relieve hot flashes.

Herbs commonly used to alleviate hot flashes include ginseng, black cohosh, vitex agnus castii, blue cohosh, dong quai, wild yam root, licorice root, false unicorn and sarsaparilla. Experiment with using one herb or several in combination.

Evening primrose oil alleviates hot flashes and promotes restful sleep. These benefits may be due to the gamma linolenic acid in the oil which is said to influence prostaglandin production. (Evening primrose oil is used to relieve premenstrual syndrome (pMS) and tenderness of fibrocystic breasts). Depending on the amount of primrose oil in each capsule, effective dosages vary from 2 to 8 capsules a day. (A Friend Indeed, November, 1985).

Chickweed tincture (25 to 40 drops) once or twice a day reduces the severity and frequency of hot flashes.

A few homeopathic remedies suggested by Susan Weed in "Menopausal Years" and Diane Stein in "The Natural Remedy Book for Woman" are Lachesis for mental irritation and hot flashes, pulsatilla for hot flashes followed by intense chills and emotional upset, Valeriana for intense sweating and insomnia and Sepia for flashes that make you feel exhausted and depressed.

Drink several cups of sage tea daily. Use one tablespoon of sage per cup of water and infuse it for twenty minutes.

Many women experience relief from hot flashes with the topical use of a progesterone cream made from extract of wild Mexican yam. proGest cream is absorbed through the skin and carried directly to where it is needed. It is non-toxic and without the same sorts of side effects as synthetic progesterone. It is available through professional and Technical Services, 333 Northeast Sandy Boulevard, portland, Oregon 97232, 1-800-648-8211.

Acupuncture, meditation and biofeedback have helped women find relief from hot flashes.

Exercise helps to decrease hot flashes by lowering the amount of circulating FSH and LH and by raising endorphine levels (which drop during a hot flash). Even 20 minutes three times a week can significantly reduce hot flashes.

Slow abdominal breathing, six to eight breaths per minute, can bring about a 40 percent decrease in frequency of hot flashes, according to two research psychologists from Wayne State University. Women used this technique for 15 minutes twice a day and when they felt a hot flash coming on. ("A Friend Indeed", April, 1993).

In extremely hot flashes, try:

black cohosh root extract, 30 to 60 drops when taken up to four times a day.

Ginseng has earned respect as a way to alleviate hot flashes. The most useful is panex sold as Korean ginseng or American ginseng. ("A Friend Indeed", Nov., 1985). Dosages vary according to body weight. The easiest way to be sure what dosage you are getting is to buy it in capsule form. Use 500 mg twice a day for those weighing less than 130 lbs., three times a day for those up to 160 lbs., and four times daily for those over 160 lbs. Ginseng works best on an empty stomach and can be taken before breakfast and before dinner. It is recommended that you not eat fruit for two hours after taking ginseng and that you take it separately from any vitamin supplement . It is not advised for women with high blood pressure or diabetes. Women with asthma or emphysema would do well to avoid ginseng because of its histamine liberating properties. Ginseng is also available in tinctures, teas and tonics.

Motherwort extract, 25 to 40 drops every four hours.

Royal jelly can be bought in Chinatown or in a health food store. Use 3 to 7 glass ampules a week.

Bee pollen, 500 mg, 3 tablets per day reduces hot flashes for some women.

Sucking on a piece of hard candy has been known to head off a hot flash or moderate an intense one.

For night sweats, try homeopathic Nux vomica when you are awakened and feel chilled and irritable. Use all cotton sheets and natural fibers. Use 10 to 25 drops of Motherwort extract three times a day or upon awakening with a night sweat. You will notice a difference in two to four weeks. For prompt relief, use an infusion of garden sage.

Menopause 2

Menopause is the cessation of the monthly female menstrual cycle. Women who have not had a menstrual cycle for a year are considered postmenopausal. Most commonly, menopause takes place when a women is in her late forties or early fifties. Women who have gone through menopause are no longer fertile. Menopause is not a disease and cannot be prevented.

Many hormonal changes occur as women go through menopause. primarily as a result of decreases in estrogen, postmenopausal women are at higher risk of heart disease and osteoporosis. For a discussion of these conditions, see the sections on Osteoporosis, Cholesterol, and Atherosclerosis. A number of unpleasant symptoms may also accompany menopause. Some, such as vaginal dryness, result from the lack of estrogen. Others, such as hot flashes, are caused by more complex hormonal changes.

Dietary changes that may be helpful: Soybeans contain compounds called phytoestrogens that are related in structure to estrogen. Soy is known to affect the menstrual cycle in premenopausal women. Researchers have linked countries where people eat substantial amounts of soy products with a low incidence of hot flashes in women going through menopause.1 As a result, some doctors of natural medicine recommend that women going through menopause eat tofu, soy milk, tempeh, roasted soy nuts, and other soy products. Supplements containing isoflavones extracted from soy are also available.

Nutritional supplements that may be helpful: Many years ago, researchers looked at the effects of vitamin E in reducing symptoms of menopause. Some,2 3 but not all,4 studies found vitamin E to be helpful. Many nutritionally oriented doctors suggest that women going through menopause take 800-1,000 IU per day of vitamin E for a trial period of at least three months to see if symptoms are reduced. If helpful, this amount can be continued.

1,200 mg of vitamin C and 1,200 mg of the bioflavonoid hesperidin, taken over the course of the day, was shown in one study to help relieve hot flashes.5

The hormone progesterone is the natural equivalent of synthetic progesins and closely related to estrogen. progestins are recommended, along with estrogen, during or after menopause to restore hormone balance.

Are there any side effects or interactions (Refer to the individual supplement for complete information.) Vitamin E toxicity is very rare, and supplements are widely considered to be safe.

Some individuals develop diarrhea after as little as a few thousand milligrams of vitamin C per day, while others are not bothered by ten times this amount. However, high levels of vitamin C can deplete the body of copper, an essential nutrient. It's prudent to ensure adequate copper intake at higher intakes of vitamin C; copper is found in many multi-vitamin/mineral supplements.

No consistent toxicity has been linked to the bioflavonoids. The exception is for a bioflavonoid called cianidanol, which is not found in supplements.

progesterone is a hormone, and as such there are concerns about its inappropriate use. A nutritionally-oriented physician should be consulted before using this hormone as a supplement. Few side effects are associated with topical progesterone creams, but can include skin reactions and, in a few women, sleepiness. Greater amounts of topical progesterone increase the likelihood of drowsiness and lethargy.

Synthetic progestins have many well-known side effects, including the increase of LDL cholesterol (the "bad" cholesterol) and the decrease of HDL cholesterol (the "good" cholesterol). Other side effects reported with synthetic progestins include bloating, breast soreness, depression, and mood swings. Consequently, the natural forms of progesterone that are relatively safer are preferred by many doctors of natural medicine.

Herbs that may be helpful: The leading herbal treatment for women suffering from hot flashes associated with menopause is black cohosh.6 Black cohosh has weak estrogen-like activity, which may reduce hot flashes. Many women use a highly concentrated extract in the amount of 40 mg of black cohosh two times per day.

Vitex does not contain hormones. Its benefits stem from its actions upon the pituitary gland-specifically on the production of estrogen and progesterone. Vitex increases the production of the hormones that help regulate a woman's cycle. Many people take 40 drops (in a glass of water) of the concentrated liquid herbal extract in the morning. Vitex is also available in powdered form in tablets and capsules, again to be taken in the morning.

Traditional uses of dong quai include treatment for hot flashes associated with menopause. Dong quai is believed to have a balancing or adaptogenic effect on the female hormonal system. The powdered root can be used as an herbal extract, capsules, or tablets or as a tea. Many people take 3-4 grams per day.

Contrary to popular belief, wild yam is not a natural source of progesterone. Although a pharmaceutical conversion process can produce progesterone from wild yam, the body cannot duplicate this conversion. Women who require progesterone should consult their nutritionally oriented physician and not rely solely on wild yam or other herbs.

Licorice acts like a weak form of estrogen. For this reason, it is often used in menopause, a time when estrogen levels decline.7

Sage may be of some benefit for women who are sweating due to menopause.8

Are there any side effects or interactions (Refer to the individual herb for complete information.) As black cohosh has an estrogen-like effect, women who are pregnant or lactating should not use the herb. Large doses of this herb may cause abdominal pain, nausea, headaches, and dizziness. Women taking estrogen therapy should consult a physician before using black cohosh.

Side effects are rare using vitex. Minor gastrointestinal upset and a mild skin rash with itching has been reported in less than 2% of the women monitored while taking vitex. Vitex is not recommended for use during pregnancy. It should not be taken during hormone therapy.

Dong quai is generally considered to be of extremely low toxicity. It may cause some fair-skinned persons to become more sensitive to sunlight. persons using it on a regular basis should limit prolonged exposure to the sun or other sources of ultraviolet radiation. Dong quai is not recommended for pregnant or lactating women.

Licorice products without the glycyrrhizin removed may increase blood pressure and cause water retention in some people. Long-term intake of products containing more than 1 gram of glycyrrhizin per day can cause these side effects. Deglycyrrhizinated licorice extracts do not cause these side effects.

Women who are breast-feeding should only use sage in medicinal doses if they want to dry up the flow of milk. Sage should be avoided when fever is present.

Checklist for Menopause

Nutritional Supplements

Herbs

Homeopathic Remedies

Soy

vitamin E, 600

vitamin C

Bioflavonoid

Yam cream

American ginseng

Korean ginseng

black cohosh

vitex agnus castii

dong quai

wild Mexican yam

licorice root

Sage

Calcarea carbonica 6c

Graphites 30c

pulsatilla 6c

Ignatia 30c

Lachesis 6c

Sepia 30c

References:

  1. Knight DC, Eden JA. A review of the clinical effects of phytoestrogens. Obstet Gynecol 1996;87:897-904 review.
  2. perloff WH. Treatment of the menopause. Am J Obstet Gynecol 1949;58:684-94.
  3. Gozan HA. The use of vitamin E in treatment of the menopause. NY State J Med 1952;52:1289.
  4. Blatt MHG et al. Vitamin E and climacteric syndrome: failure of effective control as measured by menopausal index. Arch Intern Med 1953;91:792.
  5. CJ Smith. Non-hormonal control of vaso-motor flushing in menopausal patients. Chicago Med Mar 7, 1964.
  6. Duker EM. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. planta Med 1991;57:420-4.
  7. Kumagai A, Nishino K, Shimomura A, et al. Effect of glycyrrhizin on estrogen action. Endocrinol Japon 1967;14:34-8.
  8. Duke JA. CRC Handbook of Medicinal Herbs. Boca Raton, FL: CRC press, 1985, 42021.

Menopause 3

What is it

The word "menopause" means stopping of monthly menstruation, that is, the last menstrual period. All women will eventually experience the menopause, for this is a natural process signalling that there are biological changes in the function of the ovaries and consequent physical and psychological effects on the woman.

The age range for the menopause varies considerably. It can happen at any time from the late 30s to the early 60s. About a quarter of women will reach the menopause by the age of 45, another 40% between 40 and 49, and over 20% between 50 and 54 years.

The term "menopause" (referring to the last menstrual period) must be distinguished from "the climacteric" (from the Greek word "klimakterikos" which means "rung of a ladder") denoting that women have now reached the "change of life". It is characterised by a need to make adjustments to a whole host of physical, emotional and social changes.

What are the causes

Before reaching the menopause the ovaries produce eggs each month and also special chemicals (hormones ) called oestrogen and progesterone.

Oestrogen is produced in the first half of the menstrual cycle, reaching a peak at the time of egg release. It is responsible for thickening up the lining of the womb and for developing an increased blood supply, preparing to nourish the egg if it becomes fertilised during sexual intercourse.

progesterone is produced by the ovary after the ripened egg is released and its role is to prepare the thickened lining of the womb to receive the egg if fertilised.

In the absence of fertilisation, both hormone levels fall at the end of the month and the lining of the womb strips off to form the menstrual period.

The menopause is characterised by a failure of the ovaries to release any more eggs each month as the egg store becomes empty and there is a fall in production of the two hormones. This will cause the loss of regular menstruation and, in addition, several other changes will occur in other parts of the body.

What are the symptoms

75% of women approaching the menopause experience symptoms affecting them physically, emotionally and socially. The principal early symptoms are:

Hot Flushes: These affect most women. They can occur a few times a week or several times per hour, and last for about 3 minutes. Women experience an unpleasant sensation of heat arising in the area of the head and neck and this may also spread over the whole body. The flush may be visible as a reddening of the face and sweating of the face, neck and body. The flushes are thought to reflect the rate of fall in oestrogen levels which may affect the body's temperature control, thus explaining temperature changes of the skin. Flushes can be triggered by anxiety, hot weather, hot spicy food and alcohol.

Night Sweats: These are severe hot flushes occurring at night and can cause sleep disturbance and resultant irritability, mood swings and difficulty in concentrating.

Menstrual Disturbance: This may be a complete cessation of menstruation or irregularity of the cycle and is due to the imbalance and reduction of the hormones as ovarian function wanes.

A number of symptoms come on gradually after the menopause. With the loss of hormones there is a thinning of the lining of the vagina. The normal vaginal secretions are reduced so that the vagina becomes dry. Consequently sexual intercourse can become painful and a loss of sexual interest can be the result. Locally applied oestrogen cream will help reverse these changes.

Lack of oestrogen may make the lining of the urinary passages thinner and more liable to infection and the bladder may become more sensitive causing a sensation of a need to pass urine urgently.

psychological problems are very common at this time. patients can become weepy and irritable, partly due to the hormonal changes, but also brought on by changes in family and social circumstances.

What are the complications

The two most important conditions which can occur following the menopause affect general health. These are the development of osteoporosis (or "brittle bone disease") and coronary heart disease.

Osteoporosis: This term describes the thinning of certain bones particularly in the back and pelvis. This is because the rate of bone loss speeds up after the menopause due to the lack of oestrogen. patients often complain of severe backache or pains around the hip and frequently pressure on the fragile bones can cause fractures.

Coronary Heart Disease: This is most frequently due to the deposition of fat containing cholesterol in the walls of the blood vessels (atheroma). Oestrogen lowers the cholesterol level and protects against heart disease. With the fall in the oestrogen level following the "change" the risk of developing heart disease increases for women to a level comparable to that seen in men.

What treatments are there

The most well known treatment is the replacement of the lost hormones (HRT) and this is most effective in treating the hot flushes and helps women to feel better generally. Many symptoms are alleviated by the administration of small doses of oestrogen. There is an increased risk of uterine cancer and a progestogen may also be used. After some years of use, there is a slightly increased risk of breast cancer.

A range of non-hormonal therapies exist which are aimed at treating different symptoms.

Symptom control: Clonidine is a drug used to reduce hot flushes and night sweats by reducing the calibre (diameter ) of the blood vessels.

Vaginal creams and lubricants may relieve the vaginal dryness and sexual difficulty. Oestrogen creams will help relieve the irritation caused by the thinned vaginal lining (so called post menopausal vaginitis).

Tranquillisers and anti-depressants may be appropriate for psychological problems prevalent at this time and it will be important to seek medical advice about this from the Gp or practice nurse.

Osteoporosis: This describes the thinning of the bones which accelerates following the menopause. peak bone mass is achieved by the age of 30 years after which there is a slow reduction in bone density. However, following the menopause women lose an average of 2-3% of their bone density a year until by the age of 70 a woman will have lost almost 50% of her bone mass. As a result of this they are at increased risk of fractures especially of the hips, wrists and vertebrae.

A healthy diet rich in calcium (e.g. milk, dairy foods) will help strengthen bones as will regular exercise. Special drugs (called diphosphonates) given in a regular cycle with calcium tablets will help stop the process of thinning of the bones. Your Gp will have more information about this.

Alternative Therapy: Some women do benefit from alternative therapy although there is no scientific evidence to support its use. Such therapy includes a range of homeopathic drugs, herbal remedies, acupuncture, and naturopathy.

What lifestyle changes are recommended

Some common sense advice will help promote a healthy lifestyle:

  • Eat a good varied diet
  • Take regular exercise
  • Stop smoking
  • Avoid excess alcohol
  • Contraception. For women over 50 years continue to use precautions for one year after the last period. Under this age, use the usual method of contraception for two years after the last period

Where can I get more information

Apart from contacting your own Gp, the following organisations may be of further help.

The Amarant Clinic/Trust
11-13 Charterhouse Buildings
London
EC1M 7AN
HRT Line: 0891 660620
Advice Line: 01293 413000 (Mon-Fri 12.00-19.00)

Menopausal Helpline
228 Muswell Hill Broadway
London
N10 3SH
Tel: 020 8444 5202

The National Osteoporosis Society
pO Box 10
Radstock
Bath
BA3 3YB
Telephone: 01761 471771
Helpline: 01761 472721 (9.30-16.30 Monday-Friday)
Email: mailto:rosit.rowe@nos.org.uk
Web page: http://www.nos.org.uk

References

BERAL, V ET AL (1997) Breast cancer and hormone replacement therapy: collaborative re-analysis of data from 51 epidemiological studoes of 52,705 women with breast cancer and 108,411 women without breast cancer, Lancet, 350, pp.1047-58.

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