While some comedians make light of menopausal hot flashes, for the 85% of perimenopausal women who experience these storms of intense heat frequently accompanied by sweating, chills, anxiety, or palpitations lasting for up to 30 minutes, these episodes are no joke. Although hot flashes eventually resolve on their own, the condition is unrelenting and chronic, with meta-analyses finding a mean duration of 4 to 7.4 years. Even a decade after menopause, approximately one third of women still reported having hot flashes, and one study found that about 8% of women struggle with these symptoms as long as 20 years after menopause. Hot flashes at night can prevent restful sleep, causing sleep deprivation with fatigue which can lead to other serious healthcare challenges.*
Hormone Replacement Therapy
Like so many medical conditions which affect women, hot flashes have historically been under researched, and treatment options have been limited. The first, and still most effective, pharmaceutical treatment is hormone replacement therapy (HRT). HRT was first developed in the 1940’s and gained popularity in the 1960’s as a way to manage menopausal changes. HRT not only reduces hot flash episodes; it can also help prevent accelerated bone density decline as well as other conditions related to the drop in estrogen.
Unfortunately, HRT can also raise the risk of breast and endometrial cancers. From lessons learned early on, estrogen is now routinely combined with progesterone, improving safety. Subsequent to the tragic outcomes with unopposed estrogen, however, the Women’s Health Initiative (WHI) study found significant cancer risk with HRT remained, resulting in a marked nationwide decline in prescriptions. Although more recent research has challenged the findings of the landmark WHI study, the website for M.D. Anderson Cancer Center, the nation’s premier cancer hospital, states that HRT can raise the risk of cancer and advocates screening for all candidates.
Antidepressants
Researchers theorize that selective serotonin reuptake inhibitors or SSRI’s—primarily utilized to treat depression—reduce the severity and frequency of menopausal hot flashes by modulating the brain’s thermoregulatory center. Compared to HRT, SSRI’s deliver faster relief from hot flashes but do not offer the same benefits for bone density or the other conditions which occur during menopause. Furthermore, many patients have considerable difficulty stopping antidepressant medications, with rates of AWS (antidepressant withdrawal syndrome) ranging anywhere from 15% to 56%. Not surprisingly, use of these drugs can also lead to emotional and mental side effects, including mood swings and emotional blunting.
NK Inhibitors
Elinzanetant (Lynkuet) and fezolentant (Veozah) are two newer drugs designed to treat menopausal hot flashes. Both medications inhibit neurokinin receptors, which helps to normalize the regulation of sleep and temperature. Although more effective than placebo in managing hot flashes, approximately 20% of the study participants in the Lynkuet clinical trial reported the adverse effects of headache, fatigue, and dizziness, while the most common side effects with Veozah were abdominal pain, diarrhea, and insomnia. Reminiscent of HRT, animal studies of Lynkuet show an increased risk of cancer. Although no cancer risk was found with Veozah, the FDA mandates that the drug include a black box warning for potential liver damage or failure.
Understanding Menopausal Symptoms in Chinese Medicine
According to Chinese medical theory, the organs of the human body mature by age 5 or 6 and begin producing abundant resources—storing a significant portion for physiological changes of puberty. From the age of 14 for girls and 16 for boys until age 35, our bodies function at the peak level needed to procreate. Once we arrive at the watershed age of 35 (corresponding to the Western designation of advanced maternal age), nature decelerates to a glide, and the creation of bodily resources gradually decreases. Finally, by age 40, slowing function reaches the kidney system—the foundation of physiological activity in Chinese medicine—and we embark upon the quieter, golden years of middle age.
For women, the decade from age 40 until 49 typically brings about a major life change. Unable to sustain fertility and monthly blood loss due to the age-related changes, the innate intelligence in a woman’s body will either abruptly cease menstruation or begin skidding to a stop, sometimes smoothly but more often irregularly. The systemic deficiency of blood and other basic resources can act similarly to insufficient water in a radiator, resulting in episodic hot flashes and thermal dysregulation. Chinese medical strategies to reduce the severity and duration of persistent menopausal hot flashes include supplementing insufficiencies and heat dissipation.
Chinese Treatment of Hot Flashes
ACUPUNCTURE
Although acupuncture is not considered first line therapy in China for menopausal hot flashes, multiple studies have demonstrated that acupuncture is capable of effectively tempering hot flashes and improving sleep duration and quality. As a nonpharmaceutical treatment, acupuncture avoids the potential risks of liver damage, drug dependency, and cancer. Research has demonstrated that acupuncture can disperse heat, and acupuncture sessions can be optimized to simultaneously address other concerns, like stress or chronic pain. For best results, begin with two or three treatments each week (similar to the frequency of treatment used in studies) and adjust the number of visits as your symptoms improve.
When combined with Chinese formulas, acupuncture is even more beneficial. If your budget allows, begin with a custom prescription for the best effect. Alternatively, our sister business Serenity Herbs can provide you with a natural, over-the-counter capsule or tablet based on our clinical assessment which offer convenient support for your acupuncture care.
CHINESE FORMULAS
Chinese medicinal formulas have been used for thousands of years to help ease the transition into menopause. In most cases, the emphasis of these formulas is nourishing the yin, adding to the reservoir of cooling fluids to keep body temperature in check. Due to the interdependency of yin and yang, however, some patients need additional support for yang function—especially those women who experience decreased libido, cold feet, or nighttime urination—while patients experiencing unusually high levels of stress may require formulations which break up both emotional and physical stagnation. It is the job of Chinese doctors to comprehensively assess each patient in order to create bespoke prescriptions, based on classic formulas, which are modified to meet specific needs and deliver targeted care.
Some patients express interest in learning more about the scientific chemistry of Chinese formulas. This is an enormously complex topic, as formulations are comprised of many components, and each single ingredient may feature a significant number bioactive constituents (Coptis chinensis, for example, has over a hundred). Common formulas modified for treating hot flashes contain natural phytoestrogens (plant estrogens), but the concentrations are low. Surprisingly, some of the substances used in Chinese medicine have notably complicated chemistry which can regulate hormones depending on the levels in the blood—a form of dynamic therapy not normally possible with drugs.
Traditionally, Western society had suggested that women just resign themselves to menopausal hot flashes as part of the physiological burden of being female. Chinese medicine, on the other hand, not only acknowledges that menopausal women need support to manage these distressing symptoms, it has also provided safe and effective care for centuries. Fortunately, Western patients are now able to utilize these time-tested and research-proven treatments. While Chinese medicinal teas and acupuncture may not always be as convenient as drugs, they provide effective relief that is cheaper and safer; in fact, rather than causing serious, even life-threatening, adverse effects, the Chinese medical solutions for menopausal hot flashes can actually benefit wellness. Side benefits rather than side effects.
If you are experiencing disruptive menopausal hot flashes, seek out a licensed acupuncturist who can prescribe custom formulas and help you experience a cooler change of life.
*These statements are provided for informational purposes and are not intended to diagnose, prevent, treat, or cure any disease. We recommend consulting a qualified Western healthcare and Chinese healthcare professional to review available treatments and choose the best care for your needs.