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Hot Flashes Relief: 3 Solutions, 4 Myths
by Dr. Daniel J. Heller
While the go-to treatment for menopause symptoms is often hormone replacement therapy (HRT), as we discussed in Introduction to Hot Flashes, many women are seeking out natural solutions to hot flashes. There are a number of reasons you may want to pursue a natural approach: you may have concerns about the potential risks of HRT, or perhaps simply because natural solutions better fit your beliefs or lifestyle.
A number of natural products show promise in helping to mitigate hot flashes. Unfortunately, none so far have proven as effective as HRT. The truth is that HRT is now considered by medical officials to be a safe treatment for menopause symptoms for up to three years among women at a low risk for breast cancer. Still, it is likely that natural products are even safer, although research has yet to confirm this.
The most common natural approach to combating hot flashes is the use of foods and herbal extracts that contain phytoestrogens, which research has shown may be an effective treatment.
Phytoestrogens are compounds that are found in a number of common fruits, vegetables and whole grains. Phyto means plant, so like other phytochemicals, these are compounds found in plants that have an effect on human health. Of course, these compounds are called estrogens because they are chemically and structurally similar to human estrogen, and have an estrogen-like effect.
Women's Health Myth #1: Phytoestrogens Increase Breast Cancer Risk
As is true in many areas of natural medicine, myths abound regarding natural treatments for hot flashes. We’ve already discussed one of the biggest ones, bioidentical hormone treatment.
Perhaps the myth most oft-repeated in the medical profession holds that phytoestrogens increase your breast cancer risk. While it seems surprising that doctors and health professionals would also be guilty of misunderstanding or not understanding science and biochemistry, in this case it appears to be true. Phytoestrogens are more likely to block excessive and harmful estrogens than to augment the effects of harmful estrogens, and research on Japanese women who consume large amounts of soy phytoestrogens (and who produce S-equol) shows they have low rates of breast cancer, not higher rates.
The key here is that unlike human or drug estrogen, phytoestrogens are very weak. They have only a small effect, but they are able to block the effect of too much estrogen. So, in the case of PMS which may be caused by an excess of estrogen, phytoestrogens can blunt the excess. Because some cancers are stimulated by estrogen, food phytoestrogens may be able to help prevent breast, ovarian, and uterine cancers. They may also have a role to play in the prevention of osteoporosis, certain cancers and heart disease.
Studies have also shown that phytoestrogens may help prevent and treat the symptoms of menopause. Common phytoestrogen dietary supplements include red clover extract, soy isoflavone extract, black cohosh extract, and flaxseed. A balanced diet of healthy hormone foods will contain many of these beneficial phytoestrogens, as well as other phytochemicals that support women’s health, and can help you maintain hormonal balance.
Native Americans were the first to use the herb black cohosh to treat a variety of hormonal imbalances. Now, research is being conducted into whether black cohosh is truly an effective treatment for hot flashes. As of yet, there is no consensus on this issue, and further study is needed to confirm black cohosh’s effectiveness. In the meantime, it is widely used throughout the world to treat hot flashes, and many women swear by it.
PMS Comfort Herbal is an excellent source of Black Cohosh purified extract. It contains the exact strength of the preparation that has been used in the majority of studies.
Women's Health Myth #2: Black Cohosh is Dangerous
In the past several years, many doctors and researchers reported that black cohosh causes hepatotoxicity, or liver damage. It turns out that this handful of case reports had made the cardinal scientific error of confusing correlation and causation. A more thorough investigation since then has proven that these allegations are false, and that black cohosh is in fact safe and does not cause liver damage.
This raises a bigger issue, though: it is always safer to buy and use herbal extracts that are standardized and purified, such as PMS Comfort Herbal. For instance, our Chastetree and Passionflower extracts are standardized to vitexin, while our black cohosh extract is standardized to 2.5% triterperpene glycosides, which is the industry standard. Standardized herbal extracts are guaranteed to be made from the correct herb, rather than one that has been misidentified. Standardized extracts are also guaranteed to be potent. A simple powdered herb product may have sat on a shelf somewhere for several years, losing its potency and medicinal value.
Soy shows great promise as a superfood for women’s health, including for the prevention and treatment of the hot flashes. Soy isoflavones, particularly genistein and S-equol, are a particular chemical extract from soy. As dietary supplements, they may reduce the frequency of hot flashes in menopausal and perimenopausal women. Dietary soy also can help with these symptoms, and is an excellent source of fiber, magnesium, and other essential nutrients.
Women's Health Myth #3: Soy is Bad for You
Another myth that persists on the Internet is that soy products are harmful to thyroid and general health. Countless websites, and even many professionals, continue to insist that soy negatively affects your thyroid function and has other nefarious effects. These rumors are based on decades-old test-tube and animal studies, and a misunderstanding—or non-understanding—of science, nutrition, and medicine. Soy foods and supplements are actually healthy: they appear to prevent heart disease and cancer, they have little to no effect on your thyroid; and of course they may help with hot flashes.
Although soy products are generally healthy, and have shown some effectiveness against hot flashes, they are most effective among women who metabolize soy to produce a chemical called S-equol. You only produce S-equol if you have certain bacteria in your intestines, your GI flora. By and large, Asian and particularly Japanese women have the bacteria that allow them to produce S-equol. Women throughout the rest of world do not seem as likely to produce S-equol when they consume soy. In Japan, where a large proportion of the population produces S-equol and soy consumption is high, women have lower rates of breast cancer, and soy seems to work extremely well in preventing hot flashes. If you have tried eating soy and taking soy supplements but haven’t gotten relief from hot flashes, it may be because your body doesn’t naturally produce this compound.
Currently, S-equol is not available as a dietary supplement. However, you can get soy isoflavones that are rich in genistein and daidzein, and your body may make S-equol from them. Genistein and daidzein are also available as dietary supplements on their own. If you do try a soy isoflavone supplement, try to find the one with the highest amount of genistein and daidzein, as these are much more likely to be helpful.
You can also supplement your diet with foods that contain soy, such as soymilk, tofu, tempeh, edamame, or soy protein extract with isoflavones. Delicious recipes, such as this one for marinated tofu, can make soy consumption enjoyable.
Hot flashes can be triggered or made worse by stress, anxiety, and depression. We mentioned in the first hot flashes article, the antidepressant Paxil®has been shown to reduce hot flashes. Natural approaches, such as St. John’s Wort or Passionflower for mild to moderate depression and anxiety may be safer and just as effective.
Women who suffer from hot flashes related to premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), as well as women with perimenopausal hot flashes that are accompanied by symptoms of PMS, can try PMS Comfort Herbal, which contains both black cohosh and passionflower standardized extract, as well as a synergistic blend of herbs that can help bring monthly balance.
There has been a lot of media buzz in the past several years about bioidentical hormone replacement therapy (BHRT), which has been promoted as a more natural, safer, and effective approach to hormone therapy. Unfortunately, BHRT has never been studied for safety or for effectiveness. There are reasons to think BHRT might be better than standard HRT: it is more similar to the body’s natural hormonal profile. Another way that BHRT is promoted as superior is that the prescription is based on a saliva, urine, or blood test. This is not as scientific as it appears. Your hormone levels are changing all the time, so a single test isn’t that accurate. Furthermore, your hormones only work via hormone receptors on the surface of all your cells, somewhat like a key works in a lock. There is no test for the receptors. And in fact, there are different hormone receptors on different cells: you have estrogen receptors in your uterus, your brain, your breasts—probably everywhere. Pretty much all sex hormone tests (estrogen, progesterone, and testosterone) are like trying to find the exact right key while knowing nothing about the lock.
Women's Health Myth #4: Wild Yam has Progesterone
Wild yam, which is available in both creams and pills, has been promoted as a source of progesterone. This is false, and is either, again, a non-understanding of science, or a very cynical marketing effort. While wild yam can be fermented to yield progesterone, a regulated hormone drug, the creams and lotions available online and at health food stores do not contain progesterone—because the wild yam in them has not been fermented. Since progesterone is a regulated hormone drug, products that contain fermented wild yam should be located behind the pharmacy counter with other hormone drugs, where they would be available by prescription.
Until research proves otherwise, women should think of BHRT pretty much as they would regular HRT: among women who have a low risk for breast and other hormone-dependent cancers, BHRT may be used for three years or less to address symptoms of menopause, including hot flashes. Women at a high risk of these cancers should avoid all HRT. And, BHRT has not been proven any more safe or effective than conventional HRT.
Finally, BHRT, while possibly a little more natural than regular HRT, isn’t really natural. What is natural is menopause—with its symptoms, trials, and tribulations. Taking hormones in a pill or cream form is not, in fact, natural.
Natural solutions are available and effective for managing hot flashes, whether they are from menopause, perimenopause, or PMS or PMDD. And, for most women whose hot flashes are simply too disruptive and unmanageable, a short course of hormone replacement therapy is usually safe and effective.
