You’re standing there, going about your daily life as usual when suddenly your face and chest feel hot, your pores dilate, sweat beads appear on your hairline, upper lip and maybe even all the way down your legs…. You feel as if you are Mount Vesuvius about the explode with molten lava covering your upper regions…. And then after a few seconds – which feel more like an eternity – everything stops as suddenly as it started. Welcome to your first hot flash.
This is during the day. Where at best you’ll manage with a handkerchief and a few deep breaths, maybe a glass of water, and at worst you’ll need to change your shirt.
At night though, oh at night! You’re peacefully sleeping, maybe happily dreaming away when suddenly you wake up in a bath of sweat. You throw back the bedsheets but even though it is about 17 degrees centigrade in your room your nightgown is soaked through, the bed feels more like a bathtub than a bed, and your eyes are wide open. You drag yourself to the bathroom, splash some cold water all over, change into clean, dry pyjamas and hop back into bed hoping you’ll manage to fall back asleep without any further disruptions. That was your first night-time hot flash.
More of both are in store in the coming weeks, months and perhaps years! Say hello to Perimenopause which is about to become your closest companion. But it doesn’t have to be this way!
Oh and no, Hormone Replacement Therapy (HRT), is not the answer and should be seen as the last resort. Before that you have a wide array of options at your disposal.
Brace yourself, this is going to be a long article. In fact, it is a complex issue and if you’re reading this it is because you have probably had a hot flash already. But before I embark on the long journey and explanation into the solutions, this topic requires some preliminary information. Get that cup of herbal tea and make yourself comfortable.
Hormone cycle basics
Let’s take a few steps back. With the onset of puberty most girls begin their periods, some without a glitch, others with ongoing problems, unease, cramps and moodiness and a host of other symptoms caused by the hormonal changes and imbalances. The fact is, once the transition phase is over everything should go smoothly. It should, but it doesn’t necessarily do so. It is accepted part of a woman’s life, especially in the West, that periods are a nuisance for most. However, as I wrote in one of my very first blog posts, this does not mean it is normal.
Homeostasis (the medical name for balance and health in the body, where everything is functioning as it should), is normal and what we should all be striving for. Any pain, unease, discomfort, is the body’s way of signalling there is trouble in paradise ie. there is an imbalance somewhere. Unless this is caused by an external factor, such as an accident, (if you fall and break your arm, your body will hurt and ache as it heals, and we all understand the source of that) then you should attempt to understand what your body is trying to tell you.
The tricky part is identifying exactly where and what the signals are trying to tell us. This is by no means a simple task when we are dealing with hormonal changes. Why? For starters hormones fluctuate, secondly, sometimes the signals appear to be the same for diametrically opposed diagnosis. Whoever said our body was simple?
The second major transition phase in a woman’s life comes at the time periods cease, or are about to come to an end. This is what we’re going to focus on. The important thing to bear in mind is that, as for all transitions, there are stages to this.
The different stages of perimenopause leading up to menopause
1. As you reach your late 30’s or, more commonly, your early 40’s, many women start noticing changes in their periods. The symptoms can be varied, may keep changing, and are not the same for everyone. Your cycles might be shorter, or longer, heavier or lighter. At first they don’t appear to be significant and might pass by unnoticed (especially if you are busy and not particularly tuned into your body) but over time you may begin to start realizing that something is changing. In medical terms, the period when changes begin to occur in the lead-up to menopause is called PERIMENOPAUSE and can last up to 13 years (yeah, that’s right).
2. By your mid to late 40s you may have experienced other symptoms, like erratic periods. You may start skipping a period or two (or more) in a row, then things may go back to normal again. Only to skip periods again a few months later. This cycle can happen multiple times.
3. By the late 40s to mid 50s your periods stop altogether. After 12 consecutive months of no periods, then doctors are allowed to call this menopause.
Perimenopause and dropping hormones
STAGE 1: Without going into great technical details, the first change that occurs during perimenopause is that the levels of progesterone drop. This is the hormone that regulates things in the second phase of the cycle after ovulation (whether or not you are still ovulating at this stage makes little difference). You’ll notice this by the shorter cycles as well as: heavier periods, sore breasts, longer PMS, lowered libido, mild depression, weight gain, the formation of cysts and fibroids….
STAGE 2: After the progesterone drops you will probably still experience periods. However, during the second stage your oestrogen levels will also drop, until there is insufficient oestrogen to bring on a period. The drop in oestrogen is accompanied by rising FSH (Follicle Stimulating Hormone) levels. This is typically when hot flashes start.
Why the hot flashes?
As you may have guessed, it’s not simply a question of dropping oestrogen, otherwise presumably all women on the planet would have hot flashes. What happens is that the hypothalamus, responsible for regulating your (perceived) body temperature, gets a bit confused and lost. In fact, even though you may feel like you are a ball of fire during the hot flash, your core temperature is hardly going to change, if at all. Think of it like this, a hot flash is when your body’s internal thermostat has gone bezerk.
Hot flashes are not the only symptoms of (peri)menopause. Typically, symptoms of dropping progesterone levels can include weight gain, yeast infections, hairloss, problems sleeping and “fuzzy brain” or “brain fog” at times. It may become more difficult to focus.
Hot flashes, on average, occur between 2 to 3 years. Some women don’t experience them at all, some do for a brief period, others may continue for longer. The thing to remember is WE ARE ALL DIFFERENT. We all started the journey at different times, and experienced it differently. Why should the end of the road be the same for all? I know you know, but there is a reason I am insisting on this point. Everything that follows from here on will very much depend on each person, what stage they are at in their journey and their uniqueness. The good news is that some things hold true for everyone.
The basic anti-Hot Flash regimen
Your initial anti-hot flash regimen list is as follows. Every single thing in this list is important. At this stage every minor change will have an impact. A short trip, changing the brand of water you drink, changes to sleep patterns or foods, and especially, lack of constancy, may throw you back off balance in no time. Sensitive is a word you need to familiarize yourself with. Slow and steady wins this race!
1. Drink lots of water. Hydration is a must – hot flashes are the body overheating. A dry body overheats more quickly. Remember those 2 to 3 liters a day? There is no time like now to put that into practice. Nothing like starting a good habit to keep you in good stead for your sunset years down the line when you need to drink but your body forgets to make you feel thirsty!
2. Sleep - Get 7 to 8 hours sleep. Rest is very important. Without enough restorative rest your cortisol levels go up and throw all other hormone levels off balance. Those all nighters partying you used to pull off? No can do. Time to face up to the fact you’re not in your 20s no more. The body doesn’t forgive anymore!
3. Diet- this is all important at any stage in your life, and truth be said, you should have been preparing for this moment since you were born. The difference between Asian women who follow a traditional diet, and younger Asian women who have transitioned to a more western diet is that the latter, for the first time, are beginning to increasingly experience and report hot flashes, something unheard of by previous generations. Diet could be the basis of an entire blog post, but for the sake of being comprehensive let’s summarise the main elements:
ii. Avoid alcohol. It’s warming nature can result in an immediate hot flash.
iii. Avoid extremes. Whether very hot, or very cold, the environment you are in as well as foods and drinks can trigger hot flashes. Any shocks to the system, including chilli and hot spices, can make things worse almost immediately.
iv. Avoid sugar, sweets, fruit juices and any foods such as white breads and pasta, which will lead to an insulin spike and which will feed your hot flashes.
v. Eat a plant-based diet (remember the Eatwell plate?) with plenty of phytoestrogens (more of which in a forthcoming blog post). Foods rich in phytoestrogens are broccoli,
Tofu, legumes and flax seed.
vi. Eat regularly, light, nutrient-dense meals. Don’t skip on the protein!
4. Exercise- regular daily exercise will help you expel excess heat, and help balance hormone levels. It also helps with weight management (see point 5 below). Strength training, stretching and weight bearing exercises all help keep the mature woman’s body flexible, strong and help in preventing osteoporosis (which is caused in part by dropping oestrogen levels). If you’re not a fan of exercise, incorporate walking into your every day routine.
5. Lose weight- excess oestrogen in the body is stored in fat cells. It follows that the more overweight you are the more likely it is your hormones will be imbalanced. This is true for all ages, but especially crucial in older women as it can lead to other more serious problems such as the growth of fibroids, cysts, breast cancer and so forth.
6. Stress management- Stress never helped anyone, anywhere, to be healthy. However, one thing I have personally noticed is that, the number one cause of my hot flashes is stressful thoughts. I had an aha moment when I realized that hot flashes occurred as a direct result of a thought, whether conscious or not, that caused (me) emotional stress. So, meditate, read a book, go for acupuncture sessions, watch happy films, practice yoga, sew, climb Everest, bake healthy foods… do whatever you have to do to reduce and manage that stress.
Natural ways to balance hormones
There are a myriad of approaches you can take to balance your hormones during this transition phase and to manage your hot flashes. Here are some different approaches you can discuss with your doctor, naturopath or other natural healthcare provider.
In stage one of perimenopause (with dropping progesterone) you can use a combination of the following essential oils, which help to naturally increase progesterone.
- Thyme essential oil (Thymus vulgaris), which naturally increases progesterone. A safer way to use thyme essential oil if you are not familiar with how to use oils safely is to inhale them. Put a drop on a handkerchief and smell that, or a few drops in an infuser for a maximum of 3 to 4 hours a day. Avoid this oil if you suffer from glaucoma.
- Frankincense essential oil (Boswellia carterii). Frankincense is an adaptogen (it brings hormones back into balance, so if they are high it lowers them, if low it helps increase levels).
- Sweet Marjoram essential oil (Origanum majorana) – more commonly used for gastrointestinal issues, it helps balance hormones and has been used in the treatment of PCOS (see link in further reading below).
- Clary Sage essential oil (Salvia sclarea)- for (period) cramps and sore breasts. Clary sage acts on oestrogen and can be used to treat the symptoms of PMS, not just during perimenopause, but in general. It should not be used by those who have/had oestrogen dependent cancers (eg breast cancer).
- Evening Primrose Oil (Oenothera biennis)- Another oil (which can be taken as a supplement) which helps with sore breasts and to prevent vaginal dryness is Evening Primrose oil. As a supplement it comes in different dosages so you may need to try which dosage works best for you.
WARNING ABOUT ESSENTIAL OILS. Before using essential oils please consult a licensed practitioner or familiarize yourself with the dos and don’ts. I cannot stress this enough. Essential oils are very powerful and can cause more damage than you can imagine if you do not know how to safely use them. A little (1 or 2 drops) goes a looooooooong way. Overdo it and you’ll find yourself at the other end of the scale or in hospital!
Other essential oils that can help:
1. Lavender Lavandula angustifolia – to increase oestrogen and promote relaxation.
2. Peppermint Mentha x piperita – helps stabilize mood, relieves hot flashes and PMS cramps
3. Rose Rosa damascena– affects testosterone and helps with loss of libido, tonifies the uterus and regulates the menstrual cycle.
4. Rosemary Rosmarinus officinalis – helps the body to clear excess oestrogen and balance hormones and is useful for preventing cancer linked to excess oestrogen.
5. Geranium Pelargonium graveolens – it stimulates the adrenal cortex and balances hormones resulting in menopausal relief, it also a tonic and antidepressant
6. Holy Basil Ocimum Sanctum – increases oestrogen, as well as helping increase energy levels and supporting adrenal health.
7. Bergamot Citrus aurantium var. bergamia – is tonifying and helps fatigue and with headeaches. increases oestrogen, helps with insomnia, depression and anxiety. It is photosensitive so do not use it if you are going to be in sunlight.
8. Fennel Foeniculum vulgare -stimulates the production of oestrogen after the ovaries have stopped functioning. Should not be used by epileptics or those with oestrogen dependent cancers.
9. Cypress Cupressus sempervirens – regulates the cycle, stimulates oestrogen secretion and reduces abnormally heavy blood loss during perimenopause.
In stage 2 of perimenopause/menopause with dropping progesterone and the good old hot flashes things can get a little bit more complicated.
The following is a list of herbs and supplements that you should be discussing with your nearest certified naturopathic doctor and/or herbalist.
1. Dong Quai (Angelica Sinensis) – Also known as female ginseng, this root originates from China where it has been used in Traditional Chinese Medicine (TCM) for centuries to treat hot flashes and hormonal imbalances. Traditionally, the root is cooked in soups but as a supplement it is normally not used alone, rather as a basis of compounds of herbs designed to your specific needs. It is a natural blood thinner so it helps with circulation, as well as acting as a muscle relaxant. It is said to be safe to be taken indefinitely. BEWARE if you are on blood thinning medication or have any blood clotting disorders as it can interfere with medication!
2. St John’s Wort Hypericum Perforatum- usually taken against depression, helps stress levels and to regulate cortisol levels and therefore overall hormonal balance. It is said to be safe to take up to one year, perhaps more. It also supports adrenal glands and helps with sleep. The same safety warning as for Donq Quai applies.
3. Evening Primrose Oil Oenothera biennis in gel capsules can help with sore breasts and to increase oestrogen. The dosage will depend on your uniqueness.
4. Magnesium (+calcum+ zinc) supplement – Magnesium and calcium (like iron and vitamin C) should be consumed together as they help each other to be more easily absorbed by the body. Having said that, although with dropping oestrogen women might need more calcium to counteract osteoporosis, too much calcium can be counterproductive and bring on the problem you were trying to avoid in the first place. So, if your diet is already rich in (plant based) calcium, you might want to drop the multiple supplement in favour of chelated Magnesium (glycinate) alone. This type is more readily absorbed and helps sleep.
5. Vitamin B12 – from foods or as a supplement helps not just to fight stress, but also for hairloss and to maintain adequate ferritin levels. Foods rich in B12 include meat, fish, eggs, soy and dairy.
6. Black Cohosh (Cimifuga racemosa)- Used in TCM and by Native Americans who called it “cramp bark”. It has an oestrogenic effect which helps reduce hot flashes, night sweats and stabilizes mood. It can be taken as a supplement of powdered root, powdered extract or as a tea. During perimenopause it is used to repress rising LH (Luteinizing hormone) and is used by Western medicine as an alternative to HRT under different trade names.
7. Chasteberry (Vitex Agnus Castus)- this is an adaptogenic herb originating from the Mediterranean and used to regularise and stabilise periods, help with PMS symptoms and also during perimenopause where by increasing LH and decreasing FSH it results in increasing progesterone and reducing oestrogen. So it is best suited for the first stage of perimenopause.
8. Licorice Root (Glycyrrhiza glabra)- the roots and runners of this plant are used to regulate the ratio between oestrogen and progesterone, as well as to replenish adrenal function (tired? Have some licorice!). The active ingredients include both isoflavones and lignans. It is oestrogenic, anti inflammatory, anti allergy, anti bacterial and anti cancer. But it increases blood pressure. So if you suffer from high blood pressure give it a miss!
9. Red Clover Trifolium pratense- This legume has phytoestrogenic properties. Medical studies have shown a significant decrease in the frequency and severity of hot flashes for women who took this, especially in women suffering from severe hot flashes.
10. Bee Pollen and natural honey- have also been given to breast cancer patients to relieve hot flashes. Both of these help without having an oestrogenic effect like some of the other natural remedies.
11. Herbal teas or infusions – to promote relaxation, circulation, hormonal balance e.g. licorice root tea, dong quai infusion, chamomile tea, linden tea.
My personal journey
I went from the occasional hot flash at night, to daily ones and then to a period where I seemed to have a hot flash every 5 minutes of my waking hours. HRT wasn’t a road I ever contemplated embarking on, and the bioidentical hormones, which might have been a valid alternative, were not available to me. However, I have found a regime that works for me.
During the initial stage I managed my symptoms quite effectively with thyme oil to increase progesterone naturally, as well as clary sage and frankincense essential oils to balance hormones, manage PMS, cramps and breast soreness.
When my oestrogen levels also dropped I noticed periods of brain fog, as well as most of the symptoms outlined above. After a while I found a good balance that works for me. I take St John’s Wort with breakfast, Dong Quai for lunch, and Evening Primrose Oil and Magnesium with dinner. During the worse of it, at the beginning, I also took a TCM compound of herbs and I have taken B12 on and off for a while. I am happy to report my hot flashes are now a thing of the past, although I still occasionally have the odd moment when I have broken one of the rules above or skipped a supplement too many.
It goes without saying that I am actually following all the other recommendations above, from drinking plenty of water, to getting enough sleep and following a healthy diet that supports my journey. Other things that help: Not using oils on face/body. Wearing layers and/or cooler clothes.
A final note
Bear in mind that supplements, diet and herbal remedies usually take longer to work. Don’t give up. You may notice results within days or it may take up to three months. However, it is worth being consistent and persistent, and it doesn’t have to be a journey from hell.
The good news is, hot flashes do not last forever in post menopausal women. Everything, comes to an end!
Essential oils for menopause: https://www.healthline.com/health/menopause/essential-oils-for-menopause#essential-oils
Essential oils as endocrine disruptors https://endocrinenews.endocrine.org/6839-2/
Using essential oils to balance hormones https://marcellepick.com/7-essential-oils-for-hormones/
Complementary and Alternative Medicine for Menopause : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419242/
Rosemary and cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133115/
Oestrogen and progestin activity of foods, herbs, spices https://pubmed.ncbi.nlm.nih.gov/9492350/
St John’s Wort and cortisol https://pubmed.ncbi.nlm.nih.gov/14659982/
Cortisol levels during Menopause https://www.positivepause.co.uk/all-blogs/why-does-cortisol-affect-women-in-midlife-7-easy-steps-to-balance-cortisol-in-menopause
Vitamin B12 in menopause https://www.healthspan.co.uk/advice/vitamin-b12-iron-and-getting-on-top-of-menopausal-hair-loss
Red Clover for hot flashes relief https://pubmed.ncbi.nlm.nih.gov/26471215/
Bee Pollen and Honey https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486804/