Menopause Flushing

Most women experience flushes around the menopause. They can be the earliest sign, so you can have them while your periods are still quite regular. In fact a survey showed that 41% of women whose periods were still regular, but who were over the over the age of 39, had flushes. They usually go on for 2–3 years – but 1 in 4 women have them for 5 years, and an unlucky 1 in 20 have them for the rest of their lives.

A flush is an unpleasant sensation of heat which begins in the face, head or chest. Often, there is sweating and visible redness of the skin. It usually passes after 1–2 minutes, leaving a feeling of coldness. Some women have just the flush without the sweating, while others sweat profusely but hardly flush.

Flushes may occur frequently, even several times an hour, or just occasionally. Some women find that any slightly stressful situation will bring on a flush, or that flushes are more likely to occur when they are warm (e.g. in bed, in an over-heated room, on holiday in a warm place). The flushes and sweats disturb sleep – some women wake covered in sweat – and this results in lethargy and irritability during the day.



Try increasing your intake of plant oestrogens.
Some fruits and vegetables contain oestrogen-like substances known as ‘phytoestrogens’.

The food that is richest by far in phytoestrogens is soybeans. A typical three-ounce serving of tofu, for example, contains about 23 milligrams of isoflavones (the major group of phytoestrogens). About a half-cup of shelled peanuts, on the other hand, has less than a tenth of a milligram. Menopausal supplements made from herbs like black cohosh, red clover, and dong quai may contain soy-like levels of plant estrogens.

Not enough research has been done on phytoestrogens, so we don’t know exactly what they do, but it is possible that eating these foods could help menopausal symptoms such as flushing. Phytoestrogens are very much weaker than human oestrogens, so it is unlikely that they would deal with really troublesome flushing, but you might find they help a bit.

The easiest way to take phytoestrogens is to add a pint of soya milk to your daily diet, or to switch to a phytoestrogen-containing bread.

Some women find that taking extra phytoestrogens makes their flushes worse. This could be because menopausal women still have some oestrogen, made from other hormones (androgens); the phytoestrogens might interfere with this conversion process.

Are phytoestrogen powders and pills safe to take?
British researchers last year found that eating about two ounces of soy powder containing 45 mg of isoflavones each day for just two weeks stimulated the proliferation of epithelial breast cells in premenopausal women.

An earlier U.S. study found an increase in breast cell proliferation in more than a quarter of women given a daily soy protein beverage with 38 mg of isoflavones. Anyone who has had breast cancer should stick to soy foods (like tofu), not supplement pills or powders.

Consider black cohosh, which you can buy as tablets from health food stores. Black cohosh is a plant from the buttercup family, Cimcifuga racimosa. There is some evidence (Therapeuticon 1987;1:23-31) that it really can help menopausal symptoms such as sweating and flushes. However, it can cause gut symptoms, headache and dizziness, and you should avoid it if you are taking medication for high blood pressure.

Nutribread for Women is available from Waitrose supermarket. It contains phytoestrogens, calcium and evening primrose oil, and is low in salt. Manufacturer: William Jackson Bakery.

Other herbal remedies are heavily promoted to menopausal women, but there is no good scientific evidence that they are effective.

• Dong quai is a Chinese plant, Angelica sinensis. A study gave it to some menopausal women, and gave others a dummy tablet. There was no difference in effect between dong quai and the dummy tablet (Fertily and Sterility 1997;68:981-6). It can act like a blood thinner, so you should avoid it if you are taking anticoagulants, aspirin or similar drugs
   
• Evening primrose oil was tested in a study in which women some women were given dummy capsules and some were given the primrose oil. There was no difference in flushes and night sweats between the dummy capsules and the evening primrose oil (British Medical Journal 1994;308:501-3).
   
• Red clover is claimed to relieve the symptoms of the menopause, but good evidence for any effect is lacking. Some studies have shown no effect at all. Other studies claim to show an effect, but were flawed so cannot be relied on. (Menopause 2001:8:333-7). It can act like a blood thinner, so you should avoid it if you are taking anticoagulants, aspirin or similar drugs.
   
• Ginseng is a herb form China and Korea. 384 women who had menopause symptoms were given either ginseng or a dummy tablet for 4 months. There was no difference between the effect of ginseng or the dummy tablet (International Journal Clinical Pharmacology Research 1999;19:89-99). Ginseng can have some serious side-effects in some people.

What your doctor can do

Hormone replacement therapy (HRT) is the most effective treatment for menopausal flushing. It consists of oestrogen and (unless you have had a hysterectomy) a daily dose of progesterone for 14 days of the month. It may be a few weeks before the flushes disappear.

Doctors are still arguing about how long women should stay on HRT. You might imagine that when you stop taking HRT the falling levels of hormones will make the flushes reappear. This does sometimes happen, but not in all women. When you stop HRT, the dose can be reduced very gradually so that the body becomes used to the falling levels.

Paroxetine and venlafaxine are drugs that can help if you are unable to take HRT and have really troublesome flushes. They are mainly used to treat depression, because they change the way that cells in the brain handle transmitter chemicals, such as serotonin and noradrenaline. These chemicals may also be involved in hot flushes, so it is not surprising that these drugs reduce flushes. A study of venlafaxine, published in the medical journal The Lancet in 2000, found that it reduced hot flushes by 61%.


Recommended books for further reading:

Eat to Beat the Menopause

A recipe book by Linda Kearns for those wishing to increase their intake of phytoestrogens. It includes a ‘menopause cake’ recipe.







The Menopause Cookbook

A book full of great advice and over 125 wonderful recipes to add estrogen naturally to your diet.

Some women either cannot tolerate hormone replacement therapy or do not feel it is right for them. Adding phytoestrogens, natural estrogens found in food-as well as calcium and antioxidants to one's diet for all the benefits of estrogen without any of its worries.

Eat Smart Beat the Menopause

There have been many scares recently about the long-term effects of HRT treatment and so today many women are looking for alternatives to HRT as a way of dealing with the symptoms of the menopause. Jane Frank has devised this book for women who, like her, prefer not to be obliged to take HRT.