Flushing at the menopause
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. A survey showed that 41% of women whose periods were still regular, but who were over the age of 39, had flushes. They usually go on for 2–3 years, but 1 in 4 women has them for 5 years, and an unlucky 1 in 20 has them for the rest of their lives.
A flush is an unpleasant 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.
The only good news about flushing at the the menopause comes from a Norwegian study. The researchers found a lower risk of death from heart disease in the following 20 years in healthy women who have menopausal night sweats (Menopause 2009;16:888-91). (However, some other studies have come to different conclusions.)
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 –72).
Try acupuncture. Some scientific research indicates that acupuncture reduces hot flushes by 50% (Maturitas 2008;60:42-9). 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. Some fruits and vegetables contain oestrogen-like substances known as ‘phytoestrogens’. These foods are listed in the table below. Not enough research has been done on phytoestrogens, so we do not know exactly what they do, but it is possible that eating these foods could help menopausal symptoms such as flushing. Phytoestrogens are very much weaker than human oestrogens, so it is unlikely that they would deal with really troublesome flushing. You might find they help a bit. The easiest way to take phytoestrogens is to add a pint of soya milk to your daily diet, or to switch to a soya- and linseed-containing bread (available from supermarkets).
Some women find that taking extra phytoestrogens makes their flushes worse. This could be because menopausal women still have some oestrogen, made from other hormones (androgens); the phytoestrogens might interfere with this conversion process.
Foods that contain phytoestrogens
|Foods that contain phytoestrogens|
|Beans and pulses||
|Seeds and grains||
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, which you can buy as tablets from health food stores, is a plant from the buttercup family, Cimicifuga racemosa, native to North America. Studies comparing it with dummy tablets have found no effect on hot flushes (Maturitas 2008;60:42-9). It can cause gut symptoms, headache, dizziness and very serious liver damage requiring a liver transplant (UK Committee on Safety of Medicines, October 2004).
- 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;68:981–6). 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;308:501–3).
- 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;60:42-9). 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
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Friday, February 1st 2013
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Flushing at the menopause
In the 18th and 19th centuries, women who blushed were regarded as very attractive
In Victorian times, flushes at the menopause were treated by applying leeches to suck blood out of the skin
A famous Victorian doctor, Brown-Sequard, recognized that flushes at the menopause were caused by shutting down of the ovaries. He recommended that women should eat a daily sandwich containing two sheep's ovaries
Sheep, primates and humans are the only animals that have menopausal flushes (Financial Times 2003; August 9)