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* Your hot flashes are so severe or frequent that they result in fatigue, depression or mood swings, or they interrupt your sleep.

What Your Symptom Is Telling You

Many women ease gently into menopause, experiencing only minor symptoms. Their hot flashes may call for no more than a little discreet fanning now and then. For other women, though, these episodes may seem more like close encounters with a blast furnace. Whether your own hot flashes are experienced as delicate flushes or the engulfing flames, rest assured they're normal. Hot flashes are the body's reaction to a decreased supply of the hormone estrogen, which occurs naturally as women approach menopause.

Not all women experience hot flashes, but more than half do. In some, estrogen production decreases gradually, producing few hot flashes. But for others, the ovaries stop estrogen production abruptly. Or estrogen production may stop and start a couple of times before it ceases altogether. "For these women, hot flashes can be a real roller-coaster ride," says Brian Walsh, M.D., who is an assistant professor of obstetrics/gynecology and reproductive biology at Harvard Medical School and director of the Menopause Unit at Brigham and Women's Hospital in Boston.

If you're suffering from hot flashes, you'll recognize this description from Veronica Ravnikar, M.D., professor of obstetrics and gynecology and director of the Reproductive Endocrine and Infertility Unit at the University of Massachusetts Medical Center in Boston.

"First, you may get an aura—a feeling that something strange is coming on. Then, your internal core temperature drops abruptly. In response, your skin sweats to give off heat and balance itself with the drop in internal temperature. "You may have one hot flash after another. Most occur at night, and when you do wake up, it will be a bolt upright awakening. Then you get hot and sweaty. Finally, you get so chilled you feel like you need a down comforter to get warm. Sleep is constantly interrupted."

Symptom Relief

There's plenty you can do to turn down the heat on those hot flashes.
Solve it with soy. There's a startling difference in the rate of hot flashes and menopausal symptoms between cultures. One study showed that over 50 percent of U.S. and Western European women reported menopausal symptoms, while in Japan it was only 9 or 10 percent.

A joint study done by American, Finnish and Japanese researchers singles out soy products as a possible treatment for menopausal symptoms, says Barry Goldin, Ph.D., a biochemist and associate professor of community health at the Tufts University School of Medicine in Boston. Japanese women eat much more soy than Western women do, he says, and soy foods contain a natural estrogenic compound that may serve as a hot flash reliever. Try adding soybeans, tofu, miso and other soy products to your diet, Dr. Goldin suggests. An added benefit is that these foods are low-fat. Also see Menopause Options


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Get help for bad habits. Doctors have noticed that smokers and heavy drinkers have more difficulty with hot flashes than those who don't, says Dr. Ravnikar. Talk with your doctor about support for beating these bad habits.

Cut back on coffee. Drinking more than a few cups of coffee a day can also turn on hot flashes, says Dr. Ravnikar. "Don't drink excess amounts of coffee," she advises. Any sort of chemical stimulant like caffeine can slightly raise blood pressure and heart rate—and trigger a hot flash.

Breathe them away. A recent study has shown that women given training in slow, deep-breathing exercises were able to reduce their hot flashes by 50 percent. Women participating in the study received eight one-hour treatment sessions every other week. Ask your doctor to refer you to an expert in deep-breathing relaxation techniques. (Many experienced yoga instructors can provide this kind of training.)

Try commonsense cool-downs. Anything that will make you feel cooler and more comfortable is an appropriate response to hot flashes, says June Lavalleur, M.D., director of the division of general gynecology at the University of Minnesota Hospital and Clinic in Minneapolis. "Wear cotton clothing, which leaves you feeling cooler since it won't stick to your skin," she suggests. Other relievers? Take a small fan to work to flip on when a hot flash hits, and dress in layers so you can easily shed or add clothing, says Lane Mercer, M.D., chief of gynecology at Northwestern University Medical School in Chicago.

Ease hot flashes with estrogen. If your hot flashes persist, you may want to discuss hormone replacement therapy (HRT) with your doctor. While HRT is not appropriate for everyone, there is no question that it relieves the misery of hot flashes. "Estrogen comes in pills, transdermal skin patches, vaginal creams and in pellets that can be surgically implanted under the skin of the abdomen," says Dr. Lavalleur. For women who need medical relief but can't take estrogen because of a current or past breast cancer, the prescription blood pressure medication clonidine may also bring relief, says Dr. Lavalleur.

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