By MayoClinic.com

You're in a meeting. Your forehead dampens with perspiration, and your colleague notes that your face is getting red. As you feel the familiar wave of heat creep through your body, you brace yourself for what's becoming an all-too-common and uncomfortable occurrence. You're having a hot flash.

Hot flashes can come on at almost any time — whether it's in the middle of the night or in the middle of the produce aisle at the grocery store. Living with them is another adjustment you may have to make as you approach menopause.
For some women, lifestyle changes are enough to bring hot flashes under control. For others, medicines or dietary supplements seem to help. Learn more about what you can do to manage your hot flashes and what the benefits and drawbacks are to some common remedies.

What are hot flashes?

When you're having a hot flash, you might experience:

• A feeling of mild warmth to intense heat spreading through your upper body and to your face
  
• A flushed appearance
  
• Red, blotchy skin on your face, back and arms
  
• A rapid heartbeat
  
• Perspiration
  
• Feeling chilled as the hot flash subsides

Hot flashes can last from 30 seconds to as long as 30 minutes, but most subside within five minutes. The frequency of hot flashes varies. You may have them every hour or have them only occasionally. Nighttime hot flashes — or night sweats — can wake you from a sound sleep. Hot flashes may be a part of your life for a year or more, or you may never experience them.

You may find that you're able to manage your hot flashes without taking medicines or supplements. Often times, simple lifestyle adjustments can provide relief. However, if your hot flashes are too much for you to handle on your own, you do have treatment options.

For mild hot flashes: Start with diet and lifestyle changes

How do you know if your hot flashes are mild? Some guidelines from the Food and Drug Administration (FDA) might provide a clue: If you have fewer than seven episodes in a day on average, you're in the mild range. However, this isn't a hard-and-fast rule. Only you can determine the severity of what you're experiencing.
Diet and lifestyle changes

• If you're experiencing mild hot flashes, start with diet and lifestyle changes. They may be all you need for relief from your hot flashes.
  
• Keep cool. Slight increases in your body's core temperature can trigger hot flashes. Dress in layers so that you can remove clothing when you feel too warm. Open a window or use a fan or air conditioner to keep air flowing through a room. If you feel a hot flash coming on, try sipping a cold drink.
  
• Be physically active. Daily exercise is very important during the menopausal years and beyond. If you aren't already exercising regularly, now is the time to increase your physical activity and add regular aerobic exercise. Try brisk walking, or a similarly vigorous exercise, for 30 minutes or more on most days of the week.
  
• Watch what you eat and drink. Hot and spicy foods, caffeinated beverages and alcohol can all trigger hot flashes. Pay attention to whether certain foods or drinks increase your hot flashes and limit your intake of these foods as needed.
  
• Relax. Some women find that meditation, relaxation exercises, stress-reduction techniques or yoga can help reduce hot flashes. Even if these approaches don't quell your hot flashes, they may ease sleep disturbances that occur with menopause.
  
• Practice paced respiration. Studies have shown that slow, controlled deep rhythmic breathing — known as paced respiration — practiced twice daily decreases hot flashes. Paced respiration may also help provide relief from a hot flash if performed as the hot flash begins.
  
• Stop smoking. Cigarette smoking is linked to increased hot flashes. If you quit smoking, you may help reduce hot flashes as well as your risk of many serious health conditions, such as heart disease, stroke and cancer.
  Dietary supplements Scientific evidence is mixed regarding the effectiveness of dietary supplements for easing menopausal hot flashes. However, anecdotal reports suggest some women find relief from hot flashes from nonprescription remedies, such as black cohosh, soy, red clover or vitamin E.
  
• Black cohosh. Black cohosh — an herb used extensively in Europe for treating hot flashes — has become increasingly popular in the United States, but few scientific studies prove its benefit and safety. The North American Menopause Society supports short-term use of black cohosh for treating menopausal symptoms, since it seems to have a low risk of side effects when used for up to six months. But the exact effects of longer term use aren't known. Studies are underway to determine the effectiveness and long-term safety of taking black cohosh supplements.
  
• Soy and red clover. Soy and red clover are two common sources of isoflavones — plant-derived, estrogen-like compounds that behave like weak forms of your body's own estrogen. Scientists have observed that women who have an abundance of soy in their diet — such as women in Asian countries — are less likely to experience hot flashes and other bothersome menopausal symptoms. This has led to studies through the years to evaluate more specifically what effect soy products might have on menopausal symptoms.Although some individual women find that adding isoflavones to their daily diet seems to help hot flashes, clinical trials have yielded unimpressive results. In general, researchers observed only a modest decrease, if any, in hot flashes for women who regularly consume soy products or red clover supplements.Because of the estrogen-like behavior of isoflavones, there's some concern that isoflavone supplements could cause cancer. If you have had breast cancer, talk to your doctor before supplementing your diet with isoflavone pills or red clover.
  
• Vitamin E. Vitamin E — ingested in quantities up to 400 international units (IU) daily — occasionally provides relief from mild hot flashes for some women. However, scientific studies haven't proved its overall benefit in relieving hot flashes.
  Because no serious side effects are associated with the short-term use of these dietary supplements — if they're taken in the proper dosage — the North American Menopause Society supports their use, either alone or in combination with lifestyle changes.

You may have heard of — or even tried — other dietary supplements, such as dong quai, licorice, chasteberry, evening primrose oil and wild yam (natural progesterone cream). Although some might swear by these remedies, scientific evidence of their safety and effectiveness is lacking.

'Natural' isn't always best

A word of caution if you decide to try a dietary supplement: Just because herbal supplements claim they're "natural" doesn't mean they're safe. All supplements have potentially harmful side effects. Supplements may interact with medication you're taking for other medical conditions. Always review what you're taking with your doctor.

For moderate to severe hot flashes: Try hormone therapy or other medications

Again, you're the best judge of what you're experiencing. But as a point of reference, the FDA suggests hot flashes might be in the moderate to severe range if you're having at least seven or eight episodes in one day — or about 60 per week — on average. If you're experiencing moderate to severe hot flashes — and strategies for managing mild hot flashes aren't helping — your doctor may recommend a prescription medication, such as hormone therapy, antidepressants, gabapentin or clonidine.

Hormone therapy: Estrogen or progesterone may provide relief

Work with your doctor to evaluate your personal risks and benefits of hormone therapy given your circumstances.

Two different kinds of hormone therapy are:

• Estrogen therapy. Estrogen therapy remains the most effective treatment for moderate to severe hot flashes. The key is to take estrogen in the lowest effective dose for the shortest amount of time needed for relief of symptoms. But estrogen therapy carries with it potentially significant health risks. These include blood clots and a slight increase in the risk of breast cancer when estrogen is taken along with progesterone. They also include a slight increase in the risk of heart attacks and stroke when taken by older women. If you experience moderate to severe hot flashes, and you haven't had blood-clotting problems, breast cancer or ovarian cancer, estrogen therapy may be an option for you. Your doctor can help you weigh the pros and cons related to your situation.
  
• Progesterone therapy. As an alternative to estrogen, some doctors occasionally prescribe progesterone treatment to control hot flashes. One such medication is megestrol acetate, a hormonal treatment for breast cancer that also helps reduce hot flashes.
• Beyond hormone therapy: Other medicines may help If the risks of estrogen or progesterone therapy outweigh the benefits for you, promising alternative treatments for hot flashes include medicines originally developed to treat depression, seizures and high blood pressure.
  
• Antidepressants. Taking certain antidepressants in low doses may decrease hot flashes. Venlafaxine (Effexor XR) is one such medication. Antidepressants from a class of medications known as selective serotonin reuptake inhibitors (SSRIs) — including paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa) and others — also show promise. SSRIs were found to relieve hot flashes in some small clinical trials. Most doctors now consider antidepressants the treatment of choice if you can't — or choose not to — take hormone therapy. However, these medications aren't as effective as hormone therapy for severe hot flashes and may cause unwanted side effects, such as nausea, dizziness or sexual dysfunction. Talk with your doctor about whether the benefits outweigh the potential side effects for you.
• Gabapentin. Gabapentin (Neurontin) is a medication approved for treating seizures and pain associated with shingles. It's also increasingly used to treat chronic pain. Some studies have found that gabapentin is moderately effective in reducing hot flashes. Women participating in clinical trials took low doses of the medicine and tolerated the drug relatively well. It's now sometimes prescribed for menopausal hot flashes when other treatments don't work or aren't an option. Side effects include drowsiness, dizziness, nausea and swelling.
  
• Clonidine. Clonidine, a pill or patch typically used to treat high blood pressure, may significantly reduce the frequency of hot flashes, but side effects such as dizziness, drowsiness, dry mouth and constipation are common.
  Re-evaluate your options regularly

For most women, hot flashes fade over time. If you've chosen to take medication or a supplement to help ease symptoms, it's a good idea to periodically re-evaluate your need for continuing it. Hot flashes tend to subside over time on their own, making medication or supplements unnecessary.

Menopause is a natural transition in your life. It's perfectly OK to opt not to take anything at all for your hot flashes. The wide availability of medicines and supplements you could take to relieve symptoms doesn't mean you have to take anything.

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