Introduction
When women enter menopause more than 75% of them (USA) experience hot flashes. On average these troublesome symptoms may last in total 4-7 years. Hot flashes are caused by a dysfunction in thermoregulation and is mediated by a brain structure called hypothalamus. Reduction in estrogen during menopause is thought to cause a narrowing of what is called the thermoneutral zone. Prior to menopause women usually tolerate an increase in body temperature of about 0.4C before activating mechanisms to dissipate heat (hot flashes). However, during menopause this mechanism is activated during smaller body temperature changes
Lifestyle related risk factors for hot flashes
There are certain lifestyle related risk factors for developing menopausal hot flashes. Living a generally healthy lifestyle seems to prevent hot flashes to some degree. The most important lifestyle related risk factors are
- Obesity
- Smoking
- Physical inactivity
Symptoms of hot flashes
During hot flashes there is vasodilatation of the peripheral blood vessels which causes blood to flow to the skin in larger amounts, particularly in the upper part of the body and face. Women may typically experience hot flashes in the range of once per day to once per hour. The most common symptoms are
- Feeling of heat for a few minutes at a time, particularly in the upper part of the body and specially in the face
- Profuse perspiration
- Palpitations
- Chills
- Shivering
- Anxiety
- Reduced sleep if hot flashes appear during night
Quality of life may be reduced among women who experience hot flashes. There is also increased risk of postmenopausal bone loss and increased risk of cardiovascular disease in women with more severe menopausal hot flashes.
Treatment of hot flashes
While mild hot flashes that do not affect daily activities are not generally treated, moderate to severe hot flashes are usually treated with hormones and/or certain medications such as antidepressants (SSRIs) and gabapentin (100-900 mg/day). Hormone replacement therapy and medications for treating hot flashes may have significant side effects and 50-75% of women experiencing menopausal hot flashes use alternative treatments in management of menopausal symptoms.
Natural treatment of hot flashes
If as many as 50-75% of menopausal women use alternative therapies for managing hot flashes, it is important to know what natural treatments do work and which do not. In addition there are diet and lifestyle related factors that can aggravate hot flashes that we want to be aware of.
The best foods for fighting hot flashes
A low fat plant based diet with added 1/2 cup (86g) of cooked soybeans
In 2021 the “Women’s Study for the Alleviation of Vasomotor Symptoms” was published. It was a randomized controlled study lasting 12 weeks examining the effect of a particular plant based diet on menopausal hot flashes. The results from this study far surpass any other study on natural treatments for hot flashes that I have come across during my career as a lifestyle doctor. We will now take a closer look at the diet that the participants ate, and the amazing results they got.
The diet that the treatment group were eating consisted of three main factors
- A Whole food plant based diet: Focus on whole plant foods such as fruits, vegetables, legumes, nuts, grains, and avoid animal products such as meat, dairy, fish and eggs.
- Low in fat: Avoid or limit plant foods high in fat such as nuts, oils, olives, avocado
- ½ cup (86g) of cooked soybeans daily: You may try roasted soybeans as an alternative.
Why did the scientists choose this particular diet?
First, they noted that back in the 1980s hot flashes were much more common in western countries, compared to Japan and other Asian countries. The traditional diets in the Asian countries centered around plant based foods including rice, vegetables, and some places also soy. However, since the 1980s menopausal women in the Asian countries have experienced an increase in hot flashes. Among Japanese menopausal women hot flashes had doubled between 1980 and the end of the last century. At the same time the diet in Japan and other Asian countries changed to a more western eating pattern
Secondly, the researchers were aware that certain soy products showed favorable effects on hot flashes in randomized controlled trials. Certain isoflavones in soy products can be metabolized by gut bacteria into equol, a compound that can bind to estrogen receptors and in this way mimic estrogen.
They concluded that a combination of a plant based diet in addition to soybeans would do better than either of the two ingredients alone.
The results
Total flashes decreased by 79% in the group that ate low fat plant based diet with added soybeans, and 49% in the control group.
Moderate to severe hot flashes were reduced with 84% among the participants to ate low fat plant based foods with added soybeans (42% reduction in the control group).
During the 12 weeks that the study lasted more than half (59%) of the participants stopped having moderate or severe hot flashes, while no participant in the control group became free from moderate to severe hot flashes during the 12 weeks.
The researchers concluded that the combination of a low fat plant based diet with added soybeans (½ cup or 86g) reduced both the severity and frequency of hot flashes and also improved quality of life in the area of social, mental, sexual and physical health.
Below is a link to an inspiring video with testimonies from some of the study participants who share how this particular diet helped them reduce hot flashes.
VIDEO: “This was a life saver for me”, says study participant about switching her diet
Update: In 2023 the authors repeated the study, partly because the previous study was done during fall time and that a colder climate could explain the positive effects seen among the study participants.
The results in the second study were mostly similar to the findings in the first study:
- 88% reduction of moderate to severe hot flashes in the intervention group vs. 34% reduction in the control group
- 50% of the participants in the intervention group reported no moderate or severe hot flashes after 12 weeks
- The lower the fat intake and the higher the fiber and carbohydrate intake the greater was the reduction of severe hot flashes
- Reduction in weight was associated with reduction in number of moderate to severe hot flashes
Foods that MAY aggravate hot flashes
There are certain factors that have some, or weak evidence for aggravating hot flashes.
- Spicy foods
- Alcohol
- Tobacco
- Hot beverages
- Caffeine
If you suffer from menopausal hot flashes and you regularly consume some of the items on the list above you may try to stop using them to assess whether this may improve hot flashes
Weight loss
As mentioned earlier obesity is a risk factor for menopausal hot flashes. Studies on the effect of weight reduction on hot flashes indicates that weight loss improves hot flashes
Manage stress
Stress can trigger hot flashes, so it’s important to find healthy ways to manage stress. Address the root cause of stress as far as possible. In addition you may implement general stress reducing activities such as exercise, spending time in nature and relaxation.
Conclusion
Menopausal hot flashes affect up to 75% of all women, and may last on average 5-7 years. They are caused by changes in temperature regulation due to reduction of estrogen levels in menopause. For moderate and severe hot flashes hormone replacement therapy and certain medications may be used to manage symptoms. However there are several promising lifestyle strategies that can prevent or reduce hot flashes. One of the most promising treatments is to change your diet to a low fat plant based diet with ½ cup (86g) soybeans daily. In a recent randomized controlled study half of the participants became free from moderate or severe hot flashes within 12 weeks, and total hot flashes were reduced by about 80%.
If you are interested in changing your diet to a plant based diet, but does not know how to prepare plant based meals I have attached a link to an electronic book with 300 plant based recipes.
If you wonder how to include soybeans into your diet, here is a link to a website with not only recipes with soy foods, but also explains more about the plant foods and soybean study.
Other lifestyle factors that you may consider are losing weight if overweight, managing stress, avoid caffeine, spicy foods, alcohol, tobacco and hot beverages.
For more lifestyle tips about how to manage hot flashes, see our Lifestyle prescription database
References
Barnard, Neal D., et al. “The Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women.” Menopause (New York, NY) 28.10 (2021): 1150.
Barnard, Neal D., et al. “A dietary intervention for vasomotor symptoms of menopause: a randomized, controlled trial.” Menopause (New York, NY) 30.1 (2023): 80.
www.uptodate.com/contents/menopausal-hot-flashes
Faubion, Stephanie S., et al. “Caffeine and menopausal symptoms: what is the association?.” Menopause 22.2 (2015): 155-158.
