When an older female patient enters my office for the first time, wiping sweat from her brow and asking me to open the window in mid-December, the first thing I do is unpack the factors contributing to her perimenopausal symptoms.
Our hormonal milieu is a tangled web: if you pull one thread, the entire structure is altered. A change in levels of estrogen (a female reproductive hormone), can have profound effects, causing a change in mood, metabolism, stress tolerance, energy levels and temperature regulation, among other things. One of the most upsetting perimenopausal symptoms is hot flashes, which occur when the change in hormone levels affect the body’s ability to regulate temperature.
The gold standard treatment for hot flashes is hormone replacement therapy; however, due to numerous safety concerns with hormone replacement, especially synthetic hormones, many women are seeking alternative treatments for perimenopausal symptoms like hot flashes.
Hot Flashes and the Adrenal Glands
Our adrenal glands are mainly responsible for producing the hormones that respond to stress. After menopause, when the ovaries stop producing estrogen and progesterone, the adrenal glands take over production of these important hormones.
For many women this can be problematic; our adrenal glands are already balking under the pressure of keeping up with the demands of our stressed-out society. Adding the responsibility of producing two more hormones is often more than they can effectively handle.
One study found that women who experienced hot flashes had common symptoms of adrenal dysfunction: low cortisol in the morning and elevated cortisol in the afternoon. These women also experienced sleep disturbances, which is a common symptom of stress hormone imbalance.
As a clinician, it’s important for me to look for signs of adrenal dysfunction in every female patient who has symptoms of perimenopause:
- How is she sleeping?
- Does she wake rested?
- How is her daytime energy?
- Is she experiencing cravings for sweets or salt?
- Does she make time for leisure and fun?
- How demanding is her job?
The connection between stress and hot flashes may explain why yoga, which has the capacity to reset the stress response, calming the body and mind, has been shown to help manage perimenopausal symptoms.
Phytoestrogens and Omega 3 Fatty Acids
It’s also important that I ask my overheated female patients about their diet. Leafy-green vegetables, such as spinach, chard, kale, and collard greens, contain plant compounds that promote a healthy estrogen balance. I also inquire about the consumption of healthy fats, such as fatty fish, olive oil, nuts and seeds. Omega 3 fatty acids, such as those present in fish, chia and flaxseed, can regulate estrogen levels in women who experience hot flashes.
One study found that hot flash symptoms decreased and quality of life improved when perimenopausal women consumed ground flaxseed for 12 weeks. In addition to being a good source of the omega 3 ALA, flax is a phytoestrogen, which can balance estrogen levels and ease the hormonal fluctuations that characterize the transition into menopause.
3 Herbal Therapies for Hot Flashes
In addition to lifestyle and dietary changes, there are some evidence-based herbal remedies that can help to manage symptoms of hot flashes. These include:
1. Black Cohosh
Several studies show that black cohosh, Cimicifuga racemosa, is as effective as estrogen-replacement therapy. Black cohosh doesn’t contribute to a risk of hormonal cancers or stimulate changes in the uterine lining, which makes it a safe alternative to hormone replacement.
Sage, or Salvia officinalis, can decrease the frequency and severity of hot flashes in perimenopausal women. Sage is also useful for promoting cognitive function; it can be consumed daily as a tea or an herbal supplement.
Melatonin, best known for its function as a sleep-inducing hormone, is a powerful antioxidant. It can help reset the adrenal glands by promoting restful sleep, and research suggests it can help manage hot flashes.
Managing Hot Flashes — A Whole-Body Approach
As a naturopathic doctor, I ensure that my patients who are experiencing hot flashes are sleeping right, moving right and eating right. Working together, we come up with comprehensive ways to manage their stress levels and promote self-care. These strategies might involve spending more time in nature, practicing yoga, meditating, or simply carving out more leisure time.
A diet high in green vegetables and omega 3 fatty acids is important for managing hot flashes, promoting healthy hormone balance, and lowering inflammation, which can reduce the risk of numerous health conditions associated with aging. I often recommend aiming for at least one cup of leafy greens and two tablespoons of ground flaxseed per day to women who experience hot flashes and other symptoms of perimenopause.
Finally, women with persistent hot flashes may benefit from supplementing with herbs such as black cohosh or sage, and from supplementing with antioxidants, such as melatonin. Talk to your naturopathic doctor about individualized strategies to help you find your ideal hormone balance.