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Menopause and hot flashes have a very unfortunately relationship: that is, nearly every woman going through menopause experiences hot flashes at some point. Many women suffer them on a regular basis.

And it’s not just about feeling hot… hot flashes can be extraordinarily uncomfortable. They can upset social situations. And perhaps worst of all, they can rob you of a good night’s sleep.

Most of the advice out there for hot flashes is vague and unhelpful, and doesn’t really address the root of the problem.

But with a keen eye towards the underlying physiology of hot flashes, you can use your brain, your diet, and some lifestyle changes to manage menopause and hot flashes like a pro.

Menopause and hot flashes: What are hot flashes

Hot flashes are an uncomfortable surge of a  “too hot” feeling that can occur at random times, and are known to occur increasingly during perimenopause and menopause, in nearly 75% of women.

There is intense warmth, sometimes flushing, sometimes sweating, and maybe a tingling feeling all across the skin over the body. Sometimes they occur at night while you are sleeping, and you can wake up an intensely hot, sweaty mess.

Menopause and hot flashes: Standard internet and medical advice

Most of the articles you read on the internet about menopause and hot flashes will tell you that hot flashes are a result of “changing hormone levels.”

While true – hot flashes are caused (though not solely) by hormonal changes – this is not exactly a helpful response. How do you treat a problem that no one can give you a precise description of?

Most websites then advise you….

1) that Estrogen Replacement Therapy and Estrogen/Progesterone  Hormone Replacement Therapy have been helpful for treating women’s symptoms,

2) that a variety of practices like sleeping in a cool room and avoiding caffeine could help

and 3) that you could perhaps take some supplements thought to regulate hormones like black cohosh to help with the hot flashes. Maybe.

I am here to give you more answers, and better advice.

Menopause and hot flashes: What causes hot flashes?

It is true – the exact cause of hot flashes is not nailed down by science.

But  digging into the literature a little bit at least gives us some good clues.

So far as I can best tell, hot flashes are the result of sharp changes to blood vessel dilation. Sometimes people experience this just in the head (along with some other factors), and it can cause headaches. But a hot flash occurs when blood vessels all over the body expand in sharp, punctuated periods of time.

Now of course, blood vessels constrict and dilate in the body all of the time. This happens differently in menopause however because estrogen plays a key role in blood vessel management. When estrogen levels are low, blood vessels become somewhat more sensitive to other factors that may influence them.

One such factor, and the one which I believe is the primary one, is adrenaline release. When adrenaline is released in a period of consistently low estrogen levels, blood vessels dilate excessively and rapidly – more than they normally would, causing a hot flash. Adrenaline release can be triggered by caffeine, by sleep deprivation, by blood sugar fluctations, by inflammation, or by stress, to name a few examples.

Menopause and hot flashes: Estrogen and blood vessels

Estrogen receptors are found all over the body in tissues that you would never expect to find estrogen in, like the skeletal structure, the gut, the skin, and, very importantly, blood vessels.

Estrogen helps dilate blood vessels. How? It stimulates the synthesis of nitric oxide (as well as reduces concentrations of LDL!) which causes coronary dilation. Like so:



So we find that estrogen helps maintain flexible, free-flowing blood vessels. In women of reproductive age with relatively stable estrogen levels, blood vessels stay nice and relaxed all the time.

In women who are undergoing menopause, blood vessels become more constricted generally, and more sensitive to vasodilators and other stimulants.

We also find that estrogen has a general cooling effect on the female body. Estrogen lowers the temperature ‘set point,’ in part because it has a tendency to increase blood flow to the skin and decreases heat production. We can see this effect in the normal menstrual cycle –  body temperature rises during ovulation and high progesterone periods, and it decreases estrogen-high periods.

Both of these facts help keep the skin relatively cool.

Estrogen, other hormones, and hot flashes

Estrogen can also affect hot flashes via it’s effect on other hormones.

When estrogen levels fall, one of the body’s first  instinctive responses is to secrete the hormones LH and FSH. These are pituitary hormones that help trigger ovulation. When levels of these hormone rise, body temperature also rises.

So if estrogen falls in a quick drop on some random day during perimenopause or menopause, a flood of LH or FSH could cause core body temperatures to rise, at least to some degree. This probably does not happen on a regular basis for most women, but it can be a factor occasionally.

Estrogen, neurotransmitters, and hot flashes

Estrogen causes hot flashes indirectly via one more mechanism –  via its effect on neurotransmitters:

Estrogen influences levels of epinephrine and norepinephrine levels in the brain. It tends to increase them. It also tends to increase levels of serotonin and dopamine, come to think of it. (As a quick and important side note, this fact may explain part of why certain anti-depressants have been shown to have a positive effect on hot flash management.)

Norepinephrine and epinephrine (adrenaline) are vasodilators. They dilate blood vessels. When maintained at a somewhat consistent level their effect on blood vessels is not extreme, but constant. This helps keep blood vessels open and smoothly flowing in women of reproductive age. However, when estrogen levels fall during menopause epinephrine and norepinephrine levels may also fall to a lower baseline level – leaving blood vessels more susceptible to spikes of adrenaline and other stimulants.

Over time, blood vessels appear to adjust to lower baseline levels of estrogen and quite possibly serotonin, dopamine, and adrenaline, too, but perimenopause and menopause require patience while the body adjusts.

What about progesterone? Progesterone and hot flashes…

What about progesterone?

Progesterone and hot flashes

For many decades, estrogen was seen as the cure all for hot flashes. It was the only hormone that anyone ever studied for managing hot flashes, despite the fact that progesterone is also a critical player in menopause and women’s health generally.

Estrogen Replacement Therapy has been demonstrated to help with hot flashes and menopausal symptoms  greatly – but it has also come under fire because it has a questionable relationship with female cancers like breat cancer and endometrial cancer. Does it increase the risk of them? The medical community has yet to come to a consensus on that question.

Fortunately for them a different solution has presented itself.

Enter progesterone.

In the last couple of decades researchers have looked into progesterone for hot flashes, and have found that progesterone supplementation alone can help mitigate hot flashes. Many women take both estrogen and progesterone supplements, which may be the most certain way to help alleviate symptoms, yet progesterone itself does appear to have hot flash-mitigating effects.

The question, however, remains as to why. 

Progesterone does not have the same cardio-protective effects as estrogen. Estrogen strengthens and dilates blood vessels. Progesterone does dilate blood vessels, but it can also constrict them. The physiology of it all is complicated though if you’d like to read more in this article please be my guest.

My best hypothesis at this point is that progesterone supplementation simply helps keep everything stable. If body temperature is elevated slightly from progesterone, then a hot flash won’t occur… you are already hot on the inside! Moreover, progesterone  supplementation helps stabilize estrogen levels, because estrogen and progesterone act as balances to one another in the blood stream. So even if estrogen levels are not high during menopause, they may at least be more stable.

Progesterone also may help reign in the production of stress hormones epinephrine and norepinephrine, which would prevent the blood vessels from dilating and constricting so abruptly and causing hot flashes to occur.

And, of course, the most effective supplementation for managing all menopause symptoms including hot flashes has been shown to be both estrogen and progesterone combined… though you must not forget that the long-term health effects of continued HRT are questionable.

Menopause and hot flashes: Summary takeaway points

-Sudden blood vessel dilation is probably the main culprit in hot flashes

-Low levels of estrogen and drops in estrogen can cause hot flashes due to their effect on blood vessels

-Spikes in sympathetic (fight or flight) nervous sytstem activity and stress hormones like cortisol and adrenaline can cause hot flashes

-Hot flashes have been shown to improve with estrogen replacement therapy

-Hot flashes have been shown to improve with progesterone replacement therapy

-Hot flashes have been shown to improve best with both estrogen and progesterone replacement therapy

Hot flashes and menopause: paleo for women solutions

What to do now with this information? There is actually plenty! Here are some options for you:

1) Consider estrogen replacement therapy or combined estrogen/progesterone replacement therapy.

I mention this one first just to get it out of the way. It is of course an option. It might not be the best one but it is definitely an option.

So far as the medical literature is concerned, short-term use for management of menopause symptoms (say, several months to a couple years) is not a significant health threat.

These options have been shown to help with symptoms, and may even help protect against cardiac events, which are both great things. But estrogen therapy may be associated with an increased risk of breast and uterine cancers.

If you choose to experiment with these options, consider taking very low dose pills, or taking some time off from your supplementation like a week or two every few months in order to give your body a chance to detox excess estrogen.

2) Consider experimenting with phytoestrogen intake

Phytoestrogens are molecules in plants that resemble but are not identical to human estrogen, and which are a perfectly natural part of the diet that everyone consumes on a regular basis.

Some plants have more estrogens than others. Broccoli, for example, has some estrogen, but very, very little.

Most other vegetables and fruits are about the same.

Foods that do contain significant amounts of phytoestrogens are legumes and nuts. For most people on a Standard American Diet, the phytoestrogenic effect of these foods is probably negligible, because the SAD contains high amount of phytoestrogens all over the place, largely due to its reliance on soybean oil.

Yet if you have been legume, bean, pea, and nut free on the paleo diet for quite some time, adding some of these foods back into your diet may have a greater effect for you than they do for other women, because you are more sensitive to them now.

Even more powerful than legumes, beans, peas, and nuts are soybeans (and all soy products), chia seeds, and flaxseeds, which contain significant amounts of phytoestrogens. Whether you experiment with these or not is completely up to you and to the specifications of your own history and body. If you think you will not be sensitive to the legumes and nuts, experimenting with these is a perfectly viable option.

I recommend experimenting with phytoestrogens instead of pharmaceutical Hormone Replacement Therapy. These are natural methods, and the foods are extremely low dose compared to HRT.

I would start, personally, with a small bowl of chickpeas per day… coming from a paleo diet, and with a very sensitive body. If you have a less sensitive body you may wish to try a serving of edamame (soybeans) a day instead.

Phytoestrogens have also been studied for their effects on female cancers. The jury is still out on these guys, too. Do they increase the risk of female cancers? It is much less likely that plant estrogens in doses like the ones I just suggested will be problematic for you than pharmaceutical replacement therapy.

The physiological effect of phyestogestrogens is different on each women. It is possible they will have a negative effect on you and your symptom management. It could  change your estrogen levels in a way that actually exacerbates your systems. Though if you are low in estrogen then it is more likely they will have a positive effect. They may also alleviate some symptoms – like hot flashes – but exacerbate others – like mood swings. There is no way to know unless you try!

3) Avoid stimulants and stress!

Stimulants like caffeine, cigarettes, alcohol, spicy food, and heat cause secretion of stress hormones which can cause hot flashes.

Any other stimulating event can also cause a hot flash.

4) Reduce stress!

Stress causes stress hormones to be released, which can cause hot flashes.

5) Stabilize blood sugar

Blood sugar spikes will cause stress hormones to be released and therefore may cause hot flashes, especially in the middle of the night.

Stabilize blood sugar by improving gut health, for one. You can do this by avoiding potentially gut-threatening foods like grains and dairy, and by experimenting with FODMAP intake or SIBO management, and finally by supplementing with probiotics like my favorite here at Amazon or by regularly consuming fermented foods like my favorites you can get online listed here.

You can also help stabilize blood sugar by making sure to eat a diet rich in whole foods without processed sugars. A diet with moderate amounts of fat (40-60 grams a day), healthy carbs like vegetables, sweet potatoes, and fruits (75-200 grams a day) will also help.

If you are looking for a good supplement to stabilize blood sugar, I recommend magneisum. You may also wish to try zinc.

6) Exercise regularly

Good, regular exercise will help keep levels of important neurotransmitters like serotonin and dopamine as high as possible, as well as keep blood sugar and insulin levels low.

Aim for 3-4 hard (get your heart pumping) work outs every week.

Be sure not to over do it, however, because excessive exercise can cause significant stress to the body (and therefore hot flashes!). Make sure to listen to your body and only to exercise when you feel like you have the energy and strength to do it. I generally recommend women do no more than four hard, heart-thumping workouts per week.

7) Consider vitamin E

Vitamin E is rumored to help the body produce progesterone. Get good vitamin E from almonds, avocadoes, or dark leafy greens like kale or chard.

If you don’t think you get enough of those, you could try a supplement like this one.

8) Reduce inflammation as much as possible

Inflammation is a high risk factor for cardiovascular disease and poor blood vessel health. You can tell that from the image below:



Reducing inflammation may be easier said than done. Nevertheless some of the things you can do are:

-Avoid potentially inflammatory foods including ALL processed foods, omega 6 seed oils (Vegetable oils like corn oil, soybean oil, safflower oil, and the like), and perhaps grains and dairy,

-Consume a nutrient-rich diet full of varied, organic vegetables and fruits,

-Consume organ meats once or twice a month (here’s a supplement in case you do not like to eat liver)

-Consume eggs

-Eat fermented foods daily (here are my favorites)

-Get some sunlight everyday on your skin without SPF or consider taking a vitamin D supplement

-Eat wild-caught, fatty fish like salmon or sardines once a week and

-Consider taking the rockstar superfood cod liver oil which is rich in fat-soluble vitamins A and D as well as the crucial anti-inflammatory molecules EPA and DHA.

9) Booze up!

Alcohol increases estrogen levels in women, partly because it increases the aromatization from testosterone into estrogen.

Post-menopausal women who consume 3-6 drinks per week have been shown to reduce the risk of cardiovascular disease – while maintaining the same level of risk for osteoporosis or fatty liver disease. Whether alcohol, and how much of it, increases the risk of breast cancer remains to be seen.

10) And consider the practical tips

Many people recommend certain practical tips for managing hot flashes, such as

-deep breathing meditation, especially before bed

-sleeping in a cool room with light blankets

-avoiding spicy foods, caffeine, alcohol, and cigarette smoke

-avoiding hot environments

-try using a chill pillow (here’s a good one designed for hot flashes!) to stay cool at night

And… that’s a wrap for paleo, my theories (?!), hot flashes, and what to do about them. Since I have not gone through menopause I do not  have first hand knowledge of any of this, nor  have I been able to experiment with any of these ideas on my own body.

Check back with me in 25 years or so. 🙂

What do you think?! Especially if you have gone through menopause I am just dying to learn from your experiences!

(Image source: MonkeyBusinessImages)

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