Dear Carrie: Hot Flashes

From time to time, my wife Carrie pops in to answer questions from readers requesting a Primal woman’s perspective. Today, we’re updating a post she a while back regarding hot flashes and menopause. This topic continues to generate a lot of interest, so we wanted to ensure that the info here is up to date. Enjoy!

Hi, everyone! Thanks for the opportunity to offer my perspective on living Primal. I love this community and always enjoy contributing!

Mark and I both get a lot of questions about how our Primal lifestyle has helped us navigate the ups and downs of getting older. Women often want to know, specifically, how I’ve fared during menopause. Let me tell you, it’s not always an easy road. Although there is a lot to appreciate about reaching “a certain age,” the physical, mental, and emotional symptoms of menopause aren’t always pleasant, to say the least. If you’re in the throes of menopause yourself, I bet you can relate. 

For today, I thought I’d take up reader Barb’s question about hot flashes and sleep:

I’ve just been looking for information regarding hot flashes increasing on the Primal diet for peri and menopausal women. Based on my research, it seems like I am not alone and am wondering if you could do a more pointed column on this? I am dying from no sleep – up every night between 12 and 5 cycling through hot flashes.  For the first time in 17 months on the Primal lifestyle, I feel like crap, and it’s all from the sleep deprivation. I’d like to make one last valiant effort with diet, lifestyle and supplements before I go the bioidentical hormone route. Hoping you might have some suggestions?

Thanks to Barb for the great question. Since some three-quarters of women experience hot flashes during the menopause transition, it’s a subject well worth exploring.

What Causes Hot Flashes?

For those of you unfamiliar with the experience, hot flashes occur when blood vessels in the head and neck suddenly expand. They can come during the day or night with or without sweating and other symptoms like dizziness, faster heart rate, or headache. Hot flashes start in the years leading up to menopause (aka, perimenopause) as estrogen levels sharply drop. They often resolve themselves over time but can linger for some women well into their postmenopausal years.

Scientists believe hot flashes are a result of the hormonal changes that occur during the menopausal transition. Hot flashes are associated with both the withdrawal from estrogen hormones women experience in the perimenopausal and menopausal years as well as the “surges” of luteinizing hormone that occur during this time.¹ It may be that the body’s internal thermostat (regulated by the hypothalamus) needs time to recalibrate with ongoing hormonal changes, and that dysregulation is what causes hot flashes.

That said, the exact causes are still something of a mystery. Although they are probably related to estrogen, for example, women with the biggest drops in estrogen don’t reliably get the most hot flashes. Talk to a dozen women who regularly experience hot flashes, and you’ll find that each of them has identified different triggers (foods or activities that tend to bring on a hot flash). That’s if there’s any rhyme or reason at all. There are also interesting cross-cultural differences where women in some cultures tend to sail through menopause with few unpleasant symptoms, and nobody knows for sure why.  

Hot Flashes and Sleep

Women with severe hot flashes (in terms of both intensity and frequency) can have their sleep regularly disrupted and are at risk for chronic insomnia, like Barb has been experiencing. Given that some women can experience several a night that may last up to thirty minutes each, a good night’s sleep can be next to impossible. 

The effects can be grueling over time. To compound the problem, women are also at a higher risk for other sleep disorders like sleep apnea during and following menopause because of the shift in hormones.²

For that reason, impeccable sleep hygiene is a must. It won’t stop the hot flashes, but at least it gives you the best chance of otherwise getting some rest. You probably know all the usual advice for dealing with mid-night hot flashes:

• Sleep in a cool room with a fan or open window
• Avoid caffeine, alcohol, and spicy foods at night
• Wear lightweight, moisture-wicking pajamas
• Run cold water over your wrists or place cool packs on the back of your neck when you feel a hot flash coming on

Those might help to an extent. They certainly can’t hurt. Chances are you’ve already tried them, though, and need something more.

What You Can Do to Help Reduce Hot Flashes

Although most women will experience some degree of hot flashes during menopause, certain factors like obesity, smoking, and inactivity can put you at higher risk. 

Barb asked specifically about whether eating Primally might make hot flashes worse, but I don’t know why that would be the case. Some women find that caffeine, alcohol, sugar, and spicy foods exacerbate their hot flashes, but I’ve seen no evidence that a Primal/paleo way of eating would be detrimental. If anything, cutting back on the sugary desserts and getting healthier in general should help.

Still, you know your body best. Look for patterns between what you eat and your hot flash frequency. Some of my friends do better when they eliminate nightshades or when they add more soy, but it’s all very individual. (I know soy isn’t technically Primal, but there’s a case for making an exception here.)

Mind-body Therapies

As for alternative remedies, I would give acupuncture a chance. The research looks pretty good as a whole,³ and I can say it’s had a positive impact for me personally. It took a few sessions before I started noticing the effects, though.

Exercise and relaxation techniques also help many women cope with both the hot flashes themselves and the resulting sleep deprivation. Even if your hot flashes don’t decrease noticeably, it’s always a good idea to practice gentle movement and mindfulness. They can improve your overall mental well-being, especially when you’re feeling uncomfortable in your body. Likewise, there’s some evidence that cognitive behavioral therapy (CBT) helps some women deal with the effects of menopausal symptoms even if it doesn’t reduce the hot flashes themselves.⁴

Herbs and Supplements for Hot Flashes

In terms of herbs, you could try black cohosh or chasteberry, both of which are used in Europe for managing menopausal symptoms. Other common options women try include evening primrose oil,⁵ red clover,⁶ and maca root.⁷ Personally, I haven’t had great luck with herbal remedies, but some of my friends have. Again, it’s highly personal. 

Although your best bet for menopause nutrition is an all-around nutrient-dense diet, you might try increasing your intake of vitamin E, along with vitamin C to aid the absorption of vitamin E.⁸

Bioidentical Hormone Replacement Therapy

Although I think lifestyle and nutrition should always be top priorities for any health-related concern, I also want to offer a word of support for Barb and other women who are looking at bioidentical hormones. Mark and I have both been open about our own choices to explore hormone therapies at different points in our lives. They can be a game-changer, especially if you aren’t getting relief from natural means. 

Years ago, I gave bioidentical hormones a try (a low-dose mix of estrogen, progesterone, and testosterone) when I exhausted the possibilities of various herbs and supplements I could find at the time. For me, it was more memory issues than hot flashes. Although the hormonal combination didn’t help my memory situation, it eased a lot of other symptoms I was having. I felt great in ways I hadn’t for a long time. 

Even if you decide to go the hormone route, I’d still encourage you to explore alternative mind-body approaches that you can use in conjunction with whatever your doctor prescribes. The benefits of yoga, acupuncture, and meditation are widespread with no real downsides.

Hang in There!

Hot flashes and sleep deprivation can be terrible, there’s no sugar-coating that. For those of you who are currently struggling, my heart goes out to you. Don’t give up on trying to feel better! I strongly believe that my menopausal transition has been mostly manageable thanks in large part to our Primal lifestyle. Nutrition, movement, sleep hygiene, stress management, and having a strong network of friends and family all helped me during the occasional turbulent times; but I also went through a lot of trial and error to address the worst symptoms. 

There’s an element of luck in finding the thing (or combination of things) that works for you. Let your fellow readers know in the comments what you’ve tried. Maybe your experience will help someone else!

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