Hot Flushes in Menopause

Hot Flushes in Menopause

A recent survey across five European countries found that hot flushes were ranked the most common symptom of the menopause, affecting approximately 85% of menopausal women (Constantine, G. D. et al. 2016) (Bansal & Aggarwal, 2016).

What is it?

Despite its prevalence and how greatly they can impact the quality of life of some women, the exact cause of hot flushes is still not fully understood. Clinically speaking, they are known as a ‘vascular condition' (Constantine, G.. et al., 2016). 

The most well-documented cause of the hot flush is the reduction of the hormone oestrogen being produced. This hormonal shift may give some cause, unfortunately, this doesn’t capture the whole picture. In fact, there is a lack of evidence that these symptoms are directly due to oestrogen deficiency (Bruce & Rymer, 2009) One recent study showed the levels of estrogens do not appear to correlate with hot flushes at all (Andrikoula & Prelevic, 2009).

Interestingly, research is highlighting just how differently women from across the globe experience hot flushes. It seems there are stark contrasts in symptoms, including some being asymptomatic altogether. For example, the student of Women’s Health Across the Nation (SWAN) shows that African American women tend to get more frequent and severe hot flushes (Ellen, 2006). But they also are the most likely to get hysterectomies relatively early in life as a contraceptive choice which means their menopause is more sudden and earlier in life. Many menopausal women in Malaysia and Thailand saw no need to consult a doctor about their menopausal symptoms (Punyahotra, S & Limpaphayom, K, 2020). The Mayan people don’t report hot flushes at all (Beyene and Marton, 2001).

The menopause is a natural event where hormonal and nervous systems undergo profound changes but the way we experience it is perhaps not-so-natural, affected by our race, culture, class and more (Romm, 2018). This is a time for increased personal power, embracing a normal transition in phases of womanhood. 

What does it feel like?

Often described as a sudden sensation of intense heat, excessive sweating, flushing, anxiety and/or chills.” For some women, the menopause can be mildly irritating to absolutely devastating” (E. Devereux, 18/8/22).

Socially, they can cause immense embarrassment as well as physical discomfort, aggravating insomnia and related problems such as anxiety and depression (Romm, 2018).  

How often will someone get them?

The actual duration of a ‘flush’ normally lasts 1–5 minutes, their frequency varying from occasional attacks in a week to once or twice each hour. Most people will experience them for 1 to 2 years but may persist for 5+ years. A study in 2014 found the average timeframe that someone will experience them is 10.2 years (Bansal & Aggarwal, 2019).

Who’s most likely to get it?

Race, geography and culture have a lot to do with the way someone experiences the peri-menopause. For instance, white European women are very likely to experience hot flushes, but African Americans suffer with it even worse (. It may be no surprise that research shows that those exposed to increased allostatic load (wear and tear on the body) brings about earlier menopause too (Santoro, 2011). Stress in the years preceding perimenopause has also been shown to increase the severity of hot flushes in those already predisposed. Whereas, Chinese women often don't report hot flushes at all, and many Japanese women do the same (Muir, 2022). 

Top 3 phytoestrogenic herbs

  1. Red Clover (Trifolium pratense) is rich in phytoestrogens, named isoflavones. Isoflavones are a type of phenolic phyto-oestrogen and these bind with the beta-oestrogen receptor. There are two types of oestrogen receptors, alpha and beta. While the alpha receptor is activated in ovarian cancer and oestrogen receptor positive breast cancer, the beta receptor protects against breast cancer development, promotes greater bone density, gives cardiovascular protection and helps reduce menopausal symptoms (Morito,, 2001) (Messina & Wood, 2008). These phytoestrogens all bind with the beta receptor (Bryce-Ytsma, 2021). Recent trials demonstrated this herb can successfully relieve symptoms of hot flushes (Myers & Vigar, 2017) and is being tested as a safe alternative treatment to HRT (Fisher, 2018).  
  2. Black Cohosh (Actaea racemosa) a herb that has been used for 40 years to treat menstrual and menopausal symptoms (Fisher, 2018) has been shown to reduce Luitinising Hormone (LH) which is linked to the succession of hot flushes (Reilly, 2021). 
  3. Sage (Salvia officinalis) is considered cool and dry, known to support menopausal night sweats. A clinical study showed the combination of Sage and Alfalfa to be an effective treatment for excessive sweating (Fisher, 2018). Sage may also influence neural pathways and serotonin receptors, lifting the mood (Tober & Schoop, 2019). We use sage in our new Cool + Calm tea and clary sage in our Cool + Calm spritz.

Other top herbs include Hops (Humulus lupulus) which are effective in reducing hot flushes associated with ovarian insufficiency (Reilly, 2021). NB. Hobs are contraindicated for anyone who has had oestrogen positive cancer.

One study showed that oestrogen levels were not as important as the stress experienced in the years preceding menopause in predicting the severity and prevalence of hot flushes.

Top 4 Diet/Lifestyle tips 

  1. Eating a diet rich in EFAs (oily fish, flax, nuts, olive oils etc) and high levels of fruit has been proven in cohort studies to decrease symptoms whereas the consumption of a high fat and sugar diet increased the hot flush symptoms (Herber-Gast, G. M. & Mishra, G.D. 2013). 
  2. Soybeans (Glycine max) are again, especially rich in phytoestrogens. Studies on including soybeans in your diet have been shown to support hot flushes, night sweats and more (Reilly, 2020). There is ongoing research to support soy as an alternative treatment to HRT (Messina, M. 2014) In fact, in Asian countries where soy bean consumption is high in diet, studies reveal menopause symptoms are fewer and less severe. For example, Asian women have a low incidence of hot flushes. Chinese women are not found to report hot flushes at all (Punyahotra, S & Limpaphayom, K, 2020).
  3. Stress is a major factor in most cases of imbalance in the body, so gentle calming relaxants such as passionflower, chamomile, lemonbalm and motherwort may support the body’s response to stress. Other herbs that may help; adaptogens for burnout, ashwagandha, a cooling herb that promotes sleep, decreases muscle tension and enhances thyroid function (Winston, 2019). Others include liquorice, rhodiola. We’ll cover more of this in future blogs.
  4. Wear natural fabric layered clothing and natural fibre bedding, make up your bed with two sheets and a waterproof layer in between so you can whip off the top two layers to reveal a fresh sheet underneath if you have an intense night sweat) 

When should I seek out a herbalist/doctor?

If you have a personal or family history of ostrogen-related cancer, seek advice from a herbalist or health adviser before you decide to eat phytoestrogen foods more than three times a week due to some studies correlate phytooestrogens and breast cancer growth (Nicholle & Bailey, 2013). 

A herbalist can support you in curating a specific herbal medicine tonic, specific to you. They can also advise nutritional changes and lifestyle moderations to help you thrive.  

Final thoughts - time to reframe the menopause? 

Although science and attitudes have moved along from the time of ‘Lifespan Theory’ now disproved along with the negative rhetoric of Wilson, a US gynaecologist who published ‘Feminine Forever’ in the 1960s, argued that the menopausal woman was ‘an unstable oestrogen starved’ woman. 

There are a host of factors that can influence a person’s experience of the menopause. Stress being a huge player. Perhaps there is more to the social stigma around menopause in the West that’s creating such imbalances? There’s much work to be done to change the rhetoric and the perspective around the menopause. There must be other factors involved apart from oestrogen otherwise wouldn’t all women experience the same when the hormones dip?

We still have much work to do to change the ingrained negative bias lens on the menopause and hot flushes, shifting from a problem to perhaps more of a gift. 

I hope you feel that we’ve provided enough evidence to show this is the case and welcome dialogue and updates of research in the comments below.


By Claire Goulding - Medical Herbalist (MNIMH)



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1 comment

Beautifully written, and easy to understand even for a novice like me. Really interesting.


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