Flushing at the Menopause

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Most women experience flushes around the menopause. They can be the earliest sign, so you can have them while your periods are still quite regular. The most common time for hot flushes to occur is approximately 1 year after menopause, but the overall duration of hot flushes is unclear. Generally, it is stated that the duration of hot flushes for most women is approximately 6 months to 2 years.
A flush is a sensation of heat that begins in the face, head or chest. Often, there is sweating, visible redness of the skin, palpitations and a feeling of weakness. It usually passes after 1–2 minutes, leaving a feeling of coldness. Some women have just the flush without the sweating, while others sweat profusely, but hardly flush. Flushes may occur frequently, even several times an hour, or just occasionally. Some women find that any slightly stressful situation will bring on a flush, or that flushes are more likely to occur when they are warm (e.g. in bed, in an overheated room, on holiday in a warm place). The flushes and sweats disturb sleep – some women wake covered in sweat – and this results in lethargy and irritability during the day.

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Common-Sense Ways to Help Menopausal Blushing and Flushing

Remember that the flush may not be as noticeable as you think. You may be very aware of sweat on your forehead, but other people may not notice.

Wear suitable clothing. Avoid clothes made from synthetic fibres (acrylic, polyester, nylon) and clothes that will show sweat (such as plain-coloured silk shirts). Instead, choose natural fibres that will absorb and hide sweat (e.g. cotton T-shirts). A cotton bra (such as a sports bra) will absorb sweat better than a nylon one. Wear several layers of light clothing, instead of one thick item, so you can easily peel something off.

Avoid trigger foods and drinks. Alcohol, coffee and spicy foods can provoke flushes.

Keep your bedroom cool. Buy a summer-weight duvet and use it all year or use sheets and a blanket. Choose pure cotton sheets.

Take exercise. Some research suggests that regular exercise reduces menopausal flushes.

Stop smoking and lose weight. The more you smoke and the heavier you are, the greater the likelihood of troublesome flushes (Obstetrics and Gynecology 2003;101:264–272).

Try acupuncture. Some scientific research indicates that acupuncture reduces hot flushes by 50% (Maturitas 2008;60:42–49). Although most of this research is of poor quality, and better research is needed, acupuncture might be worth trying.

Increase your intake of plant oestrogens. Phytoestrogens are naturally occurring compounds that can be found in plants. When eaten, phytoestrogens have been shown to have effects in the body similar to female human oestrogens. The most common groups are isoflavones and ligans – these can be found in the diet in foods such as soybeans, chickpeas and green legumes. The commonly sold supplement ‘Red Clover’ also contains isoflavones.
Researchers became interested in phytoestrogens when they noticed that East Asian women had lower rates of cardiovascular disease, osteoporosis and menopausal symptoms. They believed these findings could be attributed to a diet high in soy. Since then, many studies have investigated the relationship between menopausal symptoms and phytoestrogens.

Foods that contain phytoestrogens

VegetablesAlfalfa
Broccoli
Carrots
French and green beans
Peas
Fennel
Beans and pulsesSoy beans
Tofu and miso (both made from soya)
HerbsParsley
Sage
Garlic
Fresh fruitApples
Cherries
Dates
Pomegranates
Seeds and grainsLinseed
Sesame seed
Oats
Rye
Wheat
OtherBreads containing soya and linseed
Liquorice

Herbal Remedies for Menopausal Flushing

The menopause is big business for the many companies that produce herbal remedies and vitamins. These products are heavily promoted to menopausal women, but there is no good scientific evidence that they are effective, and some may be harmful. Don’t think that just because they are ‘natural’ and are not HRT, they must be safer.

  • Black cohosh is a herb native to North America. It is a member of the buttercup family and has been used by women for the menopause and painful periods for many years. However, as the current evidence supporting its use is limited and conflicting, more research is needed before doctors can consider recommending it to patients. In addition, there are concerns about safety, with several cases of liver toxicity reported, and conflicting results about its effect on hormone-sensitive tissues such as breast and the womb.
  • Dong quai is a Chinese plant, Angelica sinensis. A study gave it to some menopausal women and gave others a dummy tablet. There was no difference in effect between dong quai and the dummy tablet (Fertility and Sterility 1997;68:981–986). It can act like a blood thinner, so you should avoid it if you are taking anticoagulants, aspirin or similar drugs.
  • Evening primrose oil was tested in a study in which some women were given dummy capsules, and some were given the primrose oil. There was no difference in flushes and night sweats between the dummy capsules and the evening primrose oil (British Medical Journal 1994;308:501–503).
  • Red clover is claimed to relieve the symptoms of the menopause, but good evidence for any effect is lacking. Five out of six scientific studies have found no improvement in hot flushes (Maturitas 2008;60:42–49). Red clover can act like a blood thinner, so you should avoid it if you are taking anticoagulants, aspirin or similar drugs.
  • Ginseng is a herb from China and Korea. In a study, 384 women who had menopause symptoms were given either ginseng or a dummy tablet for 4 months. There was no difference between the effects of ginseng and the dummy tablet (International Journal of Clinical Pharmacology Research 1999;19:89–99). Ginseng can have serious side effects in some people.
  • Vitamin E is a popular ‘natural’ treatment. The only proper scientific study found it reduced the number of flushes by just one per day, which was no better than dummy capsules (Journal of Clinical Oncology 1998;16:495–500).
  • Sage is sometimes recommended, although it has not been assessed scientifically. It is taken by infusing some sage leaves in boiling water.

What Your Doctor Can Do

Hormone replacement therapy (HRT) is the most effective treatment for menopausal flushing. Depending on whether you have a womb or not, this may include oestrogen, or oestrogen and progesterone. It may take a few weeks before the flushes disappear. Whilst it has many benefits, there may be some associated risks with HRT use, such as breast cancer, deep vein thrombosis and stroke. Speak to your GP for more information about whether this could be a safe option for you. Some women may find that their hot flushes return on stopping HRT.

Tibolone is a hormone drug similar to that of HRT. Whilst not as effective as HRT, it can help with hot flushes and other symptoms of menopause like low sex drive. Similar to HRT, there are potential risks associated with it, e.g. stroke and breast cancer, so speak to your GP to fully understand the risks and benefits.

Non-Hormonal Options
Antidepressants, e.g. paroxetine and venlafaxine, are drugs that can help if you prefer not to take HRT and have really troublesome flushes. They are mainly used to treat depression, because they change the way that cells in the brain handle transmitter chemicals, such as serotonin and noradrenaline. These chemicals may also be involved in hot flushes, so it is not surprising that these drugs reduce flushes. However, they do not get rid of the flushes entirely and can have side effects.

Gabapentin is a promising treatment that is being investigated. It is normally used for seizures (epilepsy) or as a pain medication but it has been shown to have a moderate improvement on hot flushes (Menopause 2008;15:310–318). It can however be associated with side effects such as dizziness and drowsiness.

 

First published on: embarrassingproblems.com
Reviewed and edited by: Dr Anna Cantlay
Last updated: October 2020

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