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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
Vegetables
  • Alfalfa
  • Broccoli
  • Carrots
  • French and green beans
  • Peas
  • Fennel
Beans and pulses
  • Soy beans
  • Tofu and miso (both made from soya)
Herbs
  • Parsley
  • Sage
  • Garlic
Fresh fruit
  • Apples
  • Cherries
  • Dates
  • Pomegranates
Seeds and grains
  • Linseed
  • Sesame seed
  • Oats
  • Rye
  • Wheat
Other
  • Breads 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, 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

Hormone replacement therapy (HRT) is the most effective treatment for menopausal flushing. It consists of oestrogen and (unless you have had a hysterectomy) a daily dose of progesterone for 14 days of the month. It may be a few weeks before the flushes disappear. However, HRT can increase your risk of breast cancer and stroke, so you should take it only if your flushes (or other menopausal symptoms) are intolerable, and not long term. Unfortunately, when you stop taking HRT, the flushes will probably return.
 
Tibolone is a hormone drug that is being investigated as a treatment for menopausal flushes. It is not yet clear whether it increases the risk of breast cancer. It does not reduce the number of flushes that you experience, but they are much less severe (British Journal of Obstetrics and Gynaecology 2005;112:228–33).
 
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 by about 60% (Lancet 2000;356:2059–63, Journal of American Medical Association 2003;289:2827–34). 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), but it has another effect – it halves the number and severity of hot flushes (Menopause 2008;15:310-18). Dizziness and drowsiness are the main side effects, but these often wear off within a few weeks.

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Thursday, October 23rd 2014

 


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Comments on this article

Posted by marcos on 14/07/2017 at 12:09

Very informative. Thanks for sharing.

Posted by Optional on 21/11/2012 at 07:28

I've taken HRT off and on for 14 years and have now been forced to stop altogether by my doctor. Hot flushes/sweats returned with a vengeance as always and go on relentlessly. 20 to 30 a day all requiring removing as much clothing as possible, going outside even in severely cold weather (when I have felt the cold badly all my life). Most flushes last 2 to 4 minutes which is a long time especially if out shopping or in the office but through the night can simmer on for 10 to 30 minutes. Doctor has no sympathy. I take Gabapentin (for nerve pain), and find it makes no difference whasoever to my flushes (contrary to the article claiming that it halves the number and severity of flushes). HRT simply delayed the evil day when I would have to deal with flushes so I wish I'd never taken it. No other female in my family has had this problem and I don't personally know anyone else who suffers in the way I do. I have lost some weight and am just over 10 stone now, I got to Pilates and walk to work everyday, do all the housework etc. I really don't know what else I can do to proactively make a difference. I will not be coming back as a woman!

Posted by Liz on 18/11/2011 at 09:00

Hi, This is the best informative article I have read about menopausal flushes, and I thank you. But what can I do next? Hopefully you can help. I have extremely severe flushes, dozens per day & they are so debilitating that I dread going out, in fact I have zero social life. They are so bad sweat runs down my back into my underwear and my top is soaking wet! I wear light natural clothing, and carry a fan at all times (it helps to cool down before the flash becomes severe). Night sweats occur when I turn in bed. Electric fan by my bedside helps. But some days when they are bad, I end up crying as I feel so helpless. I have recently lost weight & would like to lose more. I also don't smoke & don't drink. The most important fact is that I had breast cancer in 1995 & have had no further problems. I know that some breast cancers can be oestrogen receptive & that is is why HRT can't be prescribed. But I firmly believe that my cancer was due to major stress, a marriage break-up that I could not deal with & went into meltdown. I have tried all the usual health supplements on the market & nothing helps. My GP tells me they are part life for a woman, no sympathy there then! Please, please help! Regards, Liz

Posted by Optional on 13/08/2011 at 08:31

not the menopause, have racing puse but beta blockers havent stopped flushes and really bad night sweats, having to dry pillow in tumble dryer and have to replace them regularly as they smell really bad.

Posted by Optional on 16/03/2010 at 04:58

I have been going through menapoase now since 2003 - I have had several FSH blood tests - mainly after 4/5/6 months without a period - only to start shortly after. Last year I had three periods - March, July and November and yet again I am awaiting whether this year will be the year for the final period. My hot flushes mean I have to change the beds at least 2xweekly - wearing sleevesless tops even in the coldest of weather. I am off work at the moment due to a number of changes at work, at home and I was becoming quite paranoid about the slightest thing - I decided I needed to take time out and think about me - I am not on any medication for menapause and keep perserving with the symptons. Sometimes things are calm and quiet, sometimes little things seem to blow up from know where. I sometimes cry for ages, not knowing why, whats causing it and whats wrong. I have a good life, good family and friends but here I am thinking that I am going mad. Each year I keep my fingers crossed that this is the year - to go nearly to the full 12 months and then have a period is so devastating as it means I have to start all over again. Tired. I am vegetarian and therefore each plenty of pulses, soya etc., I exercise regulary, even training for the London Marathon - plus other events. I know I am lucky but sometimes its feels like its all too much.

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Fascinating facts

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)

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