If I asked 1,000 women what the most troublesome and annoying symptoms of menopause were, the majority would no doubt answer hot flashes. By no means a scientific survey, all I have to do is remember my own and look around me. Every time I see that familiar look (red face, beads of sweat, clenched teeth) and watch those familiar body movements (wildly fanning with whatever object is within reach, throwing windows open, stripping off layers of clothing), I silently commiserate.

To the three-quarters of North American women who suffer from menopausal hot flashes: I feel your pain and discomfort. We who suffer are desperate to find solutions, especially since the latest research finds that hot flashes can last 11 years or more (sorry, ladies!).

As someone who hates the cold weather and is always freezing once the temperature outside gets below 60, being married to a man with the opposite type of thermostat has been a challenge. That is, until menopause hit. That’s when I finally moved over to his side: go ahead and throw the windows open even though it’s winter outside; keep the thermostat low. My winter sweaters got packed away, and I stocked up on short-sleeved T-shirts to get me through numerous long winters.

Understanding hot flashes is tough. Not even the experts can fully figure out what causes them or how to eliminate them. Diana Bitner, MD, recently named NAMS Certified Menopause Practitioner of the Year by the North American Menopause Society (NAMS), explains it this way:

Hot flashes are complex, triggered by more than just low estrogen. To understand, it helps to go back to the physiology. In our brain, we have a thermostat, similar to the thermostat in your home, detecting when our body is too hot or too cold. The thermostat’s job is to get the body to heat up in response to cold (by shivering) or to cool off (hot flashes, sweating).

Many women turn to hormones to cool their flashes, but what about those who can’t use hormones for medical reasons, or choose not to?

Fifty percent to 80 percent of women turn to non hormonal therapies. There are plenty of products and techniques touted for taming hot flashes. But questions about their safety and effectiveness remain. The trouble is that many women experiment or continue to suffer because there is little out there telling them what actually does work.

A NAMS statement says that one survey showed that nearly half of all women feel confused about their options for managing menopause symptoms. Another survey showed that 75 percent don’t feel fully informed about herbal products.

Wouldn’t it be nice to know the real deal?

To answer that vexing question, NAMS convened a panel of experts to examine the evidence and reach some recommendations for the suffering masses. Those findings were recently published online in the journal Menopause.

More Natural Remedies For Hot Flashes

Menopause: The heat is on

Flushing. Flashing. Power surge. Night sweats. Personal summer. The lexicon for hot flashes is as varied as the women they affect. And while hot flashes are, without a doubt, the most troublesome symptom of menopause and the most common menopause symptom to send women to their doctor’s office they are by no means unavoidable.

What determines whether you experience this milestone of menopause lies partly in your weight (overweight women are more likely to experience hot flashes), your ancestry (African American and Latino women tend to have the most flashes, Asian women the least), and your diet and lifestyle (if you’re a yoga aficionada, you may be spared the worst; if you smoke, get ready to sweat).

We wish we could tell you exactly what causes hot flashes and exactly how to banish them. Unfortunately, even the experts in the field still haven’t figured out the underlying cause, although they do know that estrogen loss alone doesn’t fully explain them. But really, does it matter exactly why you’re flashing? All you really want to know is how to cool yourself.

Turns out there are several natural options that go beyond hormones. Some are lifestyle changes, and some involve complementary and alternative medicine such as herbs, vitamins, and mind/body techniques. These 14 natural remedies will need weeks, not hours, to begin working, but over time they should help relieve your hot flashes.

Breathe slowly and deeply

Paced breathing, also called diaphragmatic breathing, involves breathing in slowly through your nose for at least 5 seconds and out slowly through your mouth for at least 5 seconds. You’ll know you’re doing it right if you see your abdomen rise with each breath in and feel your lungs inflate. You’ll find it quite a contrast to your normal tight, tense, shallow breathing. Like other mind-body therapies, paced breathing calms the sympathetic nervous system and enhances circulation.

One study of 33 women with frequent hot flashes compared the effects of eight sessions of paced breathing training, muscle relaxation, and biofeedback. Women doing the breathing exercises had half as many hot flashes as those doing biofeedback. They also breathed more slowly overall.

The key to getting benefits from paced breathing is practice. Although the women in this study spent 15 minutes a day, twice a day, practicing paced respiration, we think you can break it into smaller time slots, say, 5 minutes at a time, six times a day. Good times to practice are when you’re in the car (particularly if you’re stuck in traffic), watching TV, or checking e-mail.

Focus on the positive

Are you a catastrophic thinker? You are if, for instance, your flight is canceled and you freak out about missed meetings and a destroyed career. Or if, at the first tingle of a hot flash, you immediately focus on how miserable you’re going to feel because you know you just know you’re going to be drenched in a few minutes, lose your train of thought, and require an hour or more to return to your “normal” self.

What if, instead of immediately leaping to the worst possible scenario when things go wrong (like hot flashes), you focused on managing the situation? Yes, you might sweat a bit, but if you take off your sweater and pull out the handheld fan you’ve been carrying for just such an occasion, you can minimize the damage.

Or you might silently congratulate yourself for throwing that spare blouse in your briefcase this morning. That type of thinking, British researchers found in several studies, can actually reduce the intensity of the flash. Conversely, thinking of yourself and the flash negatively can make it worse.

So learn to think about the positives of every flush: Your skin looks better when it’s flushed; it’s one more step on the path to no more periods; you’re burning more calories, even if just for a few minutes; and you’re saving money on heating bills. If you’re having trouble doing this on your own, try cognitive behavioral therapy, which involves learning the facts about your condition, challenging your previous thinking about it, and developing specific steps to handle it.

Relax … One muscle at a time

Progressive muscle relaxation involves tensing then relaxing each group of muscles in your body. Experts think it works for hot flashes by reducing release of the stress hormone nore pinephrine. British researchers studied progressive muscle relaxation in 150 women being treated for breast cancer. The women had severe hot flashes from their treatments but couldn’t take hormones.

The researchers assigned the women to either relaxation therapy (in which they met once with a therapist for training in deep breathing, muscle release, and guided imagery) or a discussion session about hot flashes with a nurse.

After a month, the women in the relaxation-therapy group had 20% fewer and less severe hot flashes than those in the comparison group. Although this study was done in women with breast cancer, it should work just as well in menopausal women without cancer. You can learn progressive muscle relaxation through audio recordings, books, or classes.

Or just try this: Lie down in a comfortable position, scrunch your forehead muscles together as tightly as you can while breathing in, and then let them all relax while you breathe out. Next, do the same with your nose and cheek muscles. Continue working your way down your body, one muscle group at a time, until you reach your toes.

Try yoga

Who knew that Child’s Pose could help return your body temperature to that of a 12-year-old? Yet a small study in 14 postmenopausal women who were having four or more moderate-to-severe hot flashes per day found that learning eight restorative yoga poses and taking a weekly 90-minute restorative yoga class for 8 weeks led to an average one-third drop in the number of hot flashes and in their severity. Restorative yoga focuses on relaxing the body in restful postures using props such as blankets, bolsters, and straps. The poses are usually sustained for 5 to 10 minutes each, putting you in a deep state of relaxation.

Researchers think one reason for yoga’s benefits is the sense of control it provides, a sense you learn to bring to the hot flash itself. The deep relaxation that occurs with restorative yoga also engages the parasympathetic nervous system, the part of the nervous system that controls unconscious responses such as sweating. Other types of yoga, such as Bikram, have also been shown to have similar benefits.

Mindfulness-based stress reduction

Mindfulness-based stress reduction combines mindfulness meditation with yoga and other movements. It helps you focus on your body and understand how your unconscious thoughts and feelings affect your physical and emotional health. Studies have found that it can calm numerous unconscious processes in your body, such as reducing pain and lowering blood pressure, so it makes sense that it could improve your body’s temperature control.

 Plus, it restores some of that much-needed control we’ve talked about. When researchers at the University of Massachusetts Medical School in Worcester had 15 women with frequent hot flashes learn mindfulness-based stress reduction in a weekly class for 8 weeks, the women’s quality of life improved overall as the severity of their hot flashes plummeted by 40%. It’s best to learn mindfulness meditation through a class, however, rather than on your own to make sure you’re doing it right.

Look into someone’s eyes

We’re talking hypnosis. Forget the hypnosis you’ve seen magicians and comics perform. The hypnosis we’re referring to is performed by specially trained medical professionals, often doctors. The hypnotherapist teaches you to relax and suggests mental images to focus on during a hot flash to make you feel cooler. In other words, you learn to use your mind to control your body’s reactions and to handle stress better.

In a Baylor University study of 26 breast cancer survivors who had severe hot flashes after their cancer treatments catapulted them into menopause, five sessions of hypnotherapy with a psychologist led to a 68 percent drop in hot flashes, along with less anxiety and insomnia. Preliminary data suggest hypnosis works just as well for women experiencing natural menopause. Look for a practitioner trained in “medical hypnosis.” A good source is the American Psychotherapy and Medical Hypnosis Association.

Lose a few pounds

It makes intuitive sense that the more excess weight you’re hauling around, the hotter you’ll feel—with or without menopause! And, in fact, studies have found that overweight women often have more hot flashes than healthy-weight women. This could be because excess fat traps heat, making you sweat more to cool off your body, or because the blood vessels in overweight women dilate more when they encounter heat or stress. That dilation brings more blood to the surface of the skin, making you feel hotter.

The good news, according to a study published in the Archives of Internal Medicine in 2010, is that losing weight could help you lose your hot flashes. Researchers at the University of California, San Francisco, put 226 overweight or obese women with an average age of 53 on an intensive weight loss program and compared them with 112 women of similar weight and age. About half the women in each group had bothersome hot flashes.

The women in the weight loss group had 1-hour sessions with nutrition, exercise, and behavioural change experts; were supposed to get at least 200 minutes a week of physical activity like brisk walking; and were told to follow a 1,200-to 1,500-calorie-a-day diet. After 6 months, the weight loss group dropped an average of 17 pounds, while the control group lost only 4. The more weight the women lost, the more their hot flashes improved. Overall, every 11 pounds lost reduced the number of hot flashes by about a third.

Hit the gym

Even if the most exercise you’ve done in the past 20 years was carrying in bags of groceries from the car, it’s not too late to start, particularly given the possibility that working out could cool your flashes. Spanish researchers evaluated 48 women, ages 55 to 72, all of whom suffered similarly from hot flashes.

During the study, half of them exercised 3 hours a week for a year, and half continued their couch potato ways. By the end of the study, just a third of the women who worked out still had bad hot flashes, while two-thirds of the non exercisers still rated their symptoms as severe. The women who exercised on a regular basis also reported that they felt better overall, both physically and mentally.

Munch on soy foods

If you like tofu, edamame, and miso; prefer soy milk to cream in your coffee; and sub out ground beef for TSP (textured soy protein), you’re in luck. There’s a good chance that your love of this low-fat protein may protect you from hot flashes. Soy contains powerful estrogen-like compounds called phytoestrogens, which bind to estrogen receptors and mimic some of estrogen’s effects in your body. The most prevalent phytoestrogens in soy are the isoflavones genistein, daidzein, and glycitein. Daidzein is believed to be the one with the greatest impact.

After eating soy, certain bacteria in your gut convert daidzein into an estrogen-like compound called S-equol. We know from studies in Japanese women that those who produce S-equol after eating soy have fewer and milder menopausal symptoms than women whose bodies make less S-equol. How much your body produces depends both on the type of bacteria in your large intestine and on the amount of soy you eat, but researchers estimate that about half of Asians and about a third of people of North American and European descent can make S-equol.

Supplements of equol (the synthetic equivalent to the S-equol your body makes) are even being marketed as an alternative to soy. In a study presented in October 2010 at the North American Menopause Society (NAMS) annual meeting, equol supplements cut hot flashes by 50% or more for up to 42% of women who tried them. Equol also relieved muscle and joint pain and showed evidence that it may help maintain bone density.

Sprinkle some flaxseed

Like soy, flaxseed is high in estrogen-like phytoestrogens, particularly lignans, which could account for its benefits. Studies are mixed, but when Mayo Clinic researchers had 29 women with annoying hot flashes eat 1.5 ounces of crushed flaxseed daily for 6 weeks, they found the average number of hot flashes dropped by half and their severity fell by 57%.

The women also said their mood improved and that they had less joint or muscle pain, fewer chills, and less sweating. Flaxseed is a great source of insoluble fiber, which can help control your weight and cholesterol levels. Since there doesn’t appear to be any danger from adding flaxseed to your diet, it’s worth a try. However, the therapeutic dose of 40 grams, or 4 tablespoons, of ground flaxseeds comes along with 16 grams of fat and about 200 calories.

So make sure the flaxseeds are taking the place of unhealthy fats, not being added on. To get the full benefits, crush the flaxseeds before eating. An easy way to do this is with a coffee grinder. Keep the ground seeds in your refrigerator and add a few tablespoons to your oatmeal or yogurt every day.

Pop a vitamin E pill

While vitamin E is known for its antioxidant properties, it can also help your arteries work better and reduce inflammation all of which could improve hot flashes. In an Iranian study published in Gynecological and Obstetrical Investigations in 2007, 51 women experiencing severe hot flashes took 400 IU of vitamin E every day for 4 weeks or a placebo.

After a week without either vitamin E or the placebo, they switched; the vitamin E group took the placebo, and the placebo group took vitamin E. When the women took the vitamin, they had significantly fewer and less severe hot flashes, leading the researchers to conclude that vitamin E was a good option for women with hot flashes. If you decide to try vitamin E, stick to a supplement that supplies 400 IU a day; higher amounts could slightly increase your risk of dying early.

Try black cohosh supplements

Black cohosh, a member of the buttercup family, is one of the most researched herbal options for hot flashes. The herb is thought to act like estrogen in the body, decreasing luteinizing hormone (a hormone that’s secreted by the pituitary gland and that may play a role in hot flashes) and affecting serotonin receptors, which are also involved in hot flashes.

Nonetheless, the data on this herb are mixed. One study showed that black cohosh reduced hot flashes by 84 percent. In another, it worked just as well as estrogen in reducing hot flashes; still others have found that the herb has little, if any, benefit. Perhaps the study that got the most attention was the Herbal Alternatives for Menopause Trial (HALT), sponsored by the National Institutes of Health (NIH) and published in 2006.

It included 351 women ages 45 to 55 who took either 160 milligrams a day of black cohosh alone; a multiherb pill with black cohosh and nine other ingredients; a multiherb pill plus counseling to increase the amount of soy in their diet; hormone therapy (estrogen with or without progestin); or a placebo. The frequency and severity of the women’s menopausal symptoms fell by about a third over a year whether the women took black cohosh or a placebo. Only estrogen therapy significantly improved their hot flashes.

Bottom line: Black cohosh is worth a try. It’s safe (the most commonly reported side effect is mild nausea), and it does work in some women. Although there were reports of liver failure in women taking high doses of the herb, a report from the NIH found no evidence that the black cohosh was responsible. Still, make sure to tell your doctor if you take it. Look for products containing the most-studied dose: an extract standardized to contain 1 milligram of triterpene glycosides, calculated as 27-deoxyactein, per 20-milligram tablet. Take 20 milligrams twice daily or 40 milligrams once a day.

Brew some sage tea

The anecdotal evidence of using sage (Salvia officinalis) to reduce sweating and hot flashes is significant, but until recently, there were no studies on its benefits. That changed in late 2010, with the publication of a Swiss study evaluating the effects of a once-daily sage tablet on 71 postmenopausal women. The researchers found that the average number of hot flashes dropped by half within 4 weeks and by 64% within 8 weeks.

Women with severe and very severe hot flashes had even greater benefits, with 79% and 100%, respectively, seeing improvements. Brew your own tea with 1 tablespoon of fresh sage leaves or 1 heaping teaspoon of dried sage per cup of boiling water. Let the sage leaves steep for 5 minutes, then strain. You can drink the tea hot or iced, and add some lemon, stevia, honey, or agave nectar to make it more refreshing.

Visit an acupuncturist

Seriously? Sticking needles in your body could really improve hot flashes? Possibly. A randomized, controlled trial of 267 women published in the May/June 2009 issue of the journal Menopause found that women who had 10 acupuncture treatments over 12 weeks had far fewer hot flashes than those who received a sham procedure. The women getting the acupuncture also reported that they slept better and had less pain. We don’t exactly know why acupuncture works when it does work.

There’s some evidence that needling acupuncture points affects the sympathetic nervous system, as well as the release of hormones such as cortisol, endorphins, and serotonin. As with many of the options listed here, you need to give this treatment time to work. It may take several sessions before you notice any improvement. A good place to find a qualified acupuncturist is the American Association of Acupuncture & Oriental Medicine.

The panel found solid evidence that a few therapies were indeed helpful.

Significantly effective:

• Cognitive-behavioral therapy combining relaxation techniques, sleep hygiene and learning to take positive, healthy approaches to menopause challenges were found help “reduce women’s ratings of hot flash problems although not their number.”
• Also recommended: Clinical hypnosis

May be beneficial, but recommended with caution because evidence is not as strong:

• Weight loss
• Stress reduction
• Soy derivative under study called S-equol
• Stellate ganglion block, a type of nerve block

May be helpful, although may not offer as much relief as hormones:

Various nonhormonal prescription medications including:

• Selective serotonin reuptake inhibitors (SSRIs). These include paroxetine (the one FDA-approved nonhormonal therapy for hot flashes).
• Serotonin nore pinephrine reuptake inhibitors (SNRIs) such as venlafaxine, gabapentinoids (gabapentin and pregabalin) and clonidine.

Do not work, but may offer other health benefits:

• Yoga
• Paced respiration
• Acupuncture

Unlikely to help:

Over-the-counter and herbal therapies such as:

• Black cohosh
• Dong quai
• Evening primrose
• Flaxseed
• Maca
• Omega-3s
• Pollen extract
• Vitamins
• Relaxation
• Chiropractic intervention

Perhaps you’ve tried some of these and found success (or not). What works for one woman may not work for another.

“It is our job to recognize the best way to counsel a patient is to understand her unique situation and offer options,” says Dr. Bitner. “Each person has barriers that make one modality more likely to fit within her daily lifestyle based on habits, beliefs and health status.

My opinion? Seek out all your options. Because menopause is complicated, some health care providers are hesitant to address its many variables and offer treatment. The data can be confusing and thorny. Another reason to be informed and empowered to be your very best health advocate.

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