How to Tame a Hot Flash

​​1. Lifestyle changes

“First and foremost, you should start with lifestyle and behavior changes,” says Alyssa Dweck, M.D., adjunct assistant professor of obstetrics and gynecology at New York Medical College.

She often advises patients to try the Mediterranean diet, as there is some evidence that women who follow this healthy eating plan are less likely to have hot flashes and night sweats (which are hot flashes that happen while you’re asleep).

There’s also some reason to believe that eating more soy might be beneficial. One small recent study, published in the journal Menopause, found that women who ate a vegan diet that included half a cup of soybeans daily had a significant reduction in hot flashes. Some participants even found that this symptom disappeared.

Even if you have no plans to overhaul your diet, watch out for common hot flash triggers, including caffeine, alcohol and spicy foods, says Dweck. Meanwhile, aim to get plenty of exercise and practice stress-reduction techniques, and safeguard your sleep; research suggests that these moves may reduce the intensity and frequency of hot flashes.

To lower your chances of having night sweats, keep your bedroom “as cold as you can tolerate,” says Mary Jane Minkin, M.D., clinical professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine.

2. Hormone therapy

It’s the gold standard because it works. The North American Menopause Society says hormone therapy is the most effective hot flash treatment and that the benefit-risk ratio is most favorable for women younger than 60 or within 10 years of menopause onset.

You may be surprised to learn that hormones are totally off-limits for very few women, says Minkin, though those who’ve had a hormonally driven breast cancer or a serious blood clot are generally advised to pass on them. If you’re unsure if you’re a good candidate, your doctor — who would ideally be a certified menopause clinician — can help you weigh the pros and cons.

If you decide to opt for hormones, steer clear of the compounded bioidentical variety, which are custom-blended for each patient at a compounding pharmacy. These formulations are not regulated the way that standard prescription drugs are, so the quality, safety and even dose can be off, warns Faubion.

FDA-approved hormone therapy for menopausal symptoms generally comes in pill or patch form. Both are relatively safe, says Minkin, though the patches carry a slightly lower risk of blood clots. (If you go the oral route, she says, the risk of having a blood clot is about 2 in 1,000.)

Years ago, women who used hormone therapy were advised to take the shortest dose for the shortest duration possible, but that’s no longer the rule. “What we say now is ‘take the appropriate dose for the appropriate amount of time,’ ” Faubion says. You and your doctor can decide when it’s time to taper off.

If you’re perimenopausal, you might instead choose low-dose birth control, which also helps with hot flashes, says Minkin. Bonus: Oral contraceptives will even out or eliminate your irregular periods and help you avoid a surprise pregnancy.

3. Non-hormonal medications

There are also several non-hormonal prescription medications that may help, at least half of the time. (By contrast, hormone therapy helps hot flashes 90 to 95 percent of the time, according to Faubion.)

Officially, paroxetine (Brisdelle), an antidepressant in the SSRI class, is the only FDA-approved non-hormonal prescription medication for hot flashes. But doctors say other antidepressants, like citalopram (Celexa) and escitalopram (Lexapro), might work just as well.

Oxybutynin, a drug originally developed for incontinence, is sometimes used off-label to alleviate hot flashes, as is gabapentin, an anti-seizure medication.

4. Herbal remedies

Prefer a more natural approach? First, keep in mind that natural doesn’t always equal safer, says Minkin. That said, there are a few herbal remedies that doctors say can be beneficial. Those include Remifemin, which contains black cohosh and is manufactured and often used in Germany, where herbal supplements are closely regulated; and Relizen, which contains a pollen extract and is often recommended by oncologists in France, Minkin notes.

Another herbal supplement worth considering is Equelle, Minkin says. This is a soy-based product, so it contains weak, plant-based estrogen. It originally launched in Japan before coming to the U.S.

If you decide to go the herbal route, it’s wise to consult your doctor to make sure a given supplement won’t interfere with any other supplements or medications you’re taking. But in general, Minkin says, the above-mentioned options are relatively safe and well tolerated. As with prescription options for hot flashes, she advises waiting three months to determine whether a given therapy is working for you.