Hot Flashes close to Menopause

Hot flashes during menopause

Hot flashes are a hallmark symptom for many women navigating menopause or perimenopause, often accompanied by night sweats, mood swings, and disrupted sleep. These sudden waves of heat and sweating can be disruptive, affecting quality of life and emotional well-being. While conventional treatments like hormone replacement therapy (HRT) are common, these may have significant risks.  Functional medicine offers a holistic perspective, addressing root causes and incorporating personalized solutions like bioidentical hormone replacement therapy (BHRT). In this blog, we’ll explore hot flashes, their causes, and how functional medicine and BHRT can help women find relief.

Understanding Hot Flashes

Hot flashes are sudden sensations of intense heat, typically affecting the face, neck, and chest, often followed by sweating and sometimes chills. They can last from a few seconds to several minutes and may occur multiple times a day or night (night sweats). Hot flashes are most common during perimenopause (the transition to menopause) and menopause (when menstruation ceases), affecting up to 75-80% of women.

Why Do Hot Flashes Happen?

Hot flashes are primarily linked to hormonal fluctuations, particularly declining estrogen and progesterone levels, which disrupt the body’s thermoregulatory system in the hypothalamus. Contributing factors include:

• Hormonal Changes: Drops in estrogen and progesterone during perimenopause and menopause affect the brain’s temperature regulation, triggering hot flashes.

• Stress: Chronic stress elevates cortisol, which can exacerbate hormonal imbalances and trigger or worsen hot flashes.

• Lifestyle Factors: Poor diet, lack of exercise, smoking, or excessive alcohol/caffeine intake can intensify symptoms.

• Nutrient Deficiencies: Low levels of magnesium, vitamin D, or B vitamins may impair hormone balance and stress resilience.

• Environmental Toxins: Exposure to endocrine disruptors (e.g., BPA, phthalates) can interfere with hormone regulation.

• Other Triggers: Spicy foods, hot beverages, or warm environments can act as external triggers.

Functional Medicine Approach to Hot Flashes

Functional medicine takes a root-cause approach

Functional medicine takes a root-cause approach, addressing the underlying imbalances that contribute to hot flashes rather than just masking symptoms. It emphasizes personalized care, considering genetics, lifestyle, and environmental factors. Here’s how functional medicine tackles hot flashes:

1. Comprehensive Assessment:

   • Hormone Testing: Salivary or blood spot tests measure estrogen, progesterone, testosterone, and cortisol levels to identify imbalances accurately. Testing Thyroid  assess its function, as it influences menopausal symptoms.

   • Nutrient Status: Blood panels check for deficiencies in vitamin D, magnesium, B vitamins, or omega-3s, which support hormone balance.

   • Lifestyle Review: Evaluating diet, stress, sleep, and exercise helps pinpoint triggers and areas for improvement.

   • Gut Health: The gut microbiome influences estrogen and progesterone metabolism and increase inflammation that can worsen symptoms.

2. Dietary Interventions:

   • Anti-Inflammatory Diet: Focus on whole foods like leafy greens, fatty fish, berries, and nuts to reduce inflammation and support hormone balance.

   • Avoid Triggers: Limit spicy foods, caffeine, alcohol, and processed carbs, which can exacerbate hot flashes.

   • Nutrient Support: Ensure adequate intake of:

     • Magnesium: Found in spinach, almonds, and dark chocolate, it supports relaxation and hormone regulation.

     • Vitamin E: Found in sunflower seeds and avocados, it may reduce hot flash severity.

     • Omega-3s: Found in salmon and chia seeds, they reduce inflammation.

3. Lifestyle Modifications:

   • Stress Management: Practices like yoga, meditation, or deep breathing (10-15 minutes daily) lower cortisol and improve symptom control.

   • Exercise: Moderate activities like walking, swimming, or strength training (3-5 times per week) stabilize hormones and improve mood without overtaxing the body. Avoid over strenuous exercising.

   • Sleep Hygiene: Aim for 7-9 hours of quality sleep in a cool, dark room to reduce night sweats and support recovery.

   • Temperature Regulation: Wear breathable clothing, use cooling bedding, and keep rooms well-ventilated to minimize triggers.

4. Supplements:

   • Magnesium: 200-400 mg/day (e.g., magnesium glycinate) supports relaxation and hormone balance.

   • Vitamin D: 1000-2000 IU/day supports overall hormone health, especially if deficient.

   • Adaptogens: Ashwagandha or rhodiola may help balance cortisol and reduce stress-related symptoms.

   • Black Cohosh: A herbal remedy that may reduce hot flash frequency and severity (but has been implicated in post-menopausal abnormal bleeding and cancer)

   • Always consult a practitioner before starting supplements to ensure safety and proper dosing.

5. Address Toxins: Reduce exposure to endocrine disruptors by using BPA-free products, choosing organic produce, and opting for natural personal care items.

Bioidentical Hormone Replacement Therapy (BHRT)

BHRT involves using hormones that are chemically identical to those produced by the body, typically estrogen, progesterone, or testosterone, to restore balance and alleviate menopausal symptoms like hot flashes. Unlike conventional HRT, which often uses synthetic hormones (e.g., conjugated equine estrogens), BHRT is derived from plant sources and tailored to individual needs.

How BHRT Works for Hot Flashes

• Customized Dosing: BHRT is often compounded by pharmacies based on hormone tests and symptoms, delivered via creams, gels, patches, or pellets.

• Progesterone: Micronized progesterone (bioidentical) supports sleep, reduces anxiety, and balances estrogen’s effects.

• Estrogen Therapy: Replenishing estrogen can significantly reduce hot flash frequency and severity. It’s often combined with progesterone to protect against overstimulation and future risks.

• Testosterone: In small doses, it may improve libido and energy, which can be affected by menopause.

Benefits of BHRT

• Effective Symptom Relief: Studies show BHRT can reduce or resolve hot flashes.

• Personalized Approach: Dosing is tailored to individual hormone levels, reducing risks compared to one-size-fits-all HRT.

• Improved Quality of Life: BHRT may also alleviate mood swings, foggy thinking, libido, vaginal dryness, skin/hair issues and sleep disturbances.

Risks and Considerations

• Side Effects: BHRT may cause bloating, breast tenderness, or mood changes, especially if dosing isn’t optimized.

• Long-Term Risks: Unlike conventional HRT, BHRT may not carry risks of breast cancer, blood clots, or stroke. Long-term data is limited.

• Not FDA-Approved: Compounded BHRT is not regulated by the FDA, so quality varies. Work with a reputable provider.

• Requires Monitoring: Regular hormone testing and follow-ups ensure safety and efficacy.

Functional Medicine and BHRT

Functional medicine practitioners often integrate BHRT with lifestyle changes and supplements for a holistic approach. They may:

• Use BHRT temporarily to stabilize symptoms while addressing root causes (e.g., stress, gut health).

• Monitor liver and gut function to ensure proper hormone metabolism.

• Adjust dosing based on ongoing testing and symptom feedback.

Who Should Consider BHRT?

BHRT may be suitable for women with:

• Moderate to severe hot flashes or night sweats.

• Other menopausal symptoms (e.g., low libido, mood swings, or insomnia) not relieved by lifestyle changes.

• Confirmed hormone imbalances via saliva or blood spot testing.

• A preference for personalized hormone therapy.

Women with a history of breast cancer, blood clots, or liver disease should avoid mainstream hormones and only consider BHRT if cleared and managed by practitioner experienced in BHRT.

When to Seek Professional Help

If hot flashes disrupt daily life or persist despite lifestyle changes, consult a healthcare provider. A functional medicine practitioner can:

• Run comprehensive hormone and nutrient tests.

• Rule out other conditions (e.g., thyroid dysfunction, adrenal issues) mimicking menopausal symptoms.

• Prescribe BHRT or other therapies tailored to your needs.

• Monitor progress to optimize treatment and minimize risks.

Conclusion

Hot flashes are a common/severe but manageable challenge for women in perimenopause or menopause. A functional medicine approach—combining a nutrient-dense diet, stress management, exercise, and targeted supplements—addresses the root causes of symptoms. For those needing additional support, bioidentical hormone replacement therapy offers a personalized solution to reduce hot flashes and improve quality of life. Work with a qualified practitioner to create a plan that aligns with your unique needs and take control of your health with confidence.