In the middle of a meeting, a hot flash creeps into the face and it’s clear that this is the start of a hot flash. For some, hot flashes, also known as vasomotor symptoms, are mild annoyances, while for others, hot flashes make them break out in sweat and then experience terrible chills. Most women, 80%, will experience hot flashes when they reach perimenopause, and they can last seven to 10 years.
Often women suffer from hot flashes and do not seek help. But there are several treatment options available that work to reduce hot flashes, including a recently FDA-approved treatment Veozah (fezolinetant). While many might think that hot flashes are just part of being a woman, they are linked to serious health issues.
Why Women Have Hot Flashes
Estrogen helps regulate body temperature and when these levels drop, changes occur.
“Our temperature control occurs in the thermal regulation area of the brain and there are basically a number of mechanisms that keep the thermal regulation area functioning and one of them is these neurons, the KNDy neurons, NK 3 neurons,” said Dr. Lauren Streicher, professor. at Northwestern University, and host of “Dr. Streicher’s Inside Information: The Menopause Podcast,” TODAY.com tells. “One of the pathways that control KNDy neurons is estrogen. So when you lose your estrogen, you lose that controlling factor.
When estrogen drops, KNDy neurons “become hypertrophic” and “go into overload.” They also stop working and fail to properly regulate body temperature. Although there are several pathways that contribute to body temperature, which could explain why some people don’t experience hot flashes, Streicher says.
3 treatments against hot flashes
“Hot flashes are associated with cardiovascular disease, Alzheimer’s disease, bone loss,” says Streicher. “It’s not just that lack of estrogen, but the hot flashes themselves (that contribute to it).”
Treating hot flashes could make women more comfortable and less likely to have other health problems. Streicher shares evidence-based therapies that work to ease hot flashes:
“Estrogen is the first-line drug. It has been around for a long time. We know it’s safe. We know it’s effective,” says Streicher. “We know it has benefits beyond just reducing hot flashes.”
When people start taking estrogen to treat hot flashes — or other symptoms of menopause — it’s something they probably have to take for life, she adds. With hot flashes, estrogen works by binding to KNDy neurons “and re-regulating them.”
Estrogen also offers many other benefits, including stronger bones, potentially less cognitive decline, strengthened cardiovascular function and better vaginal health, she says.
However, many people are afraid to take estrogen because they think it increases the risk of breast cancer. A study published by the NIH Women’s Health Initiative 20 years ago on hormone replacement therapy (HRT) showed that the treatment increased certain health problems, including breast cancer. These results deterred women from taking hormones. A new look at the data reveals that HRT is safe for many. TODAY’s Maria Shriver spoke with Dr. Janine Austin Clayton, director of the NIH Office of Women’s Health Research in a segment that aired May 17.
“There is a lot of new evidence. Discussions like the ones we have are the right way for us to get as many women as possible,” she told Shriver. “I understand this has raised concerns about menopausal hormone therapy. We now know that for women close to the menopausal transition, hormone therapy can be safe and effective in relieving menopausal symptoms. The benefits may outweigh on the risks.
Streicher agrees that most people can take estrogen without harming their health.
“We know that not only does it not increase breast cancer risk, but it appears to decrease breast cancer risk by about 18% and reduce all cause mortality by 30%,” says Streicher. “But the message is not getting through.”
She adds that she is not surprised that women fear taking estrogen because they receive “misinformation”.
“The majority of people, if you ask them… ‘Is estrogen safe or will estrogen increase the risk of breast cancer?’ They’re going to say it increases your risk of breast cancer,” she says. “This message is still being spread even though it is misinformation.”
According to the FDA, some people cannot take estrogen to manage their menopausal symptoms and they include people who have:
- Certain cancers, such as breast cancer
- A history of blood clots
- Heart attack or stroke
- Vaginal bleeding
- liver disease
Fezolinetant also acts on KNDy neurons, much like estrogen.
“This tricks the KNDy neurons into believing that there is estrogen binding to these KNDy receptors,” says Streicher.
Right now, doctors only have 52 months of data on this new treatment. Still, it seems to be almost as effective as taking estrogen.
“They can have up to an 80 percent reduction in hot flashes, which is essentially as good as taking estrogen,” says Streicher. “It’s a welcome option for women who really can’t take estrogen or have chosen not to.”
She adds that it doesn’t seem to have any intolerable side effects either.
“The side effect profile was really very minimal,” says Streicher.
According to the FDA, side effects include:
- stomach pain
- Back ache
- Hot flashes
- Liver injury
“If you have someone who has liver disease, you probably don’t want to use fezolintant,” says Streicher.
S-equol is an over-the-counter supplement that uses a soy metabolite to manage hot flashes. According to an article in the journal Current Developments in Nutrition, only 20-30% of the US population produces equol, so it’s not a natural benefit for most people.
“Not everyone is generally able to metabolize soy, which is why (eating) soy doesn’t work for everyone,” says Streicher. “S-equol would be the over-the-counter or botanical supplement worth trying for women – especially if they have mild hot flashes.”
Streicher says that for many, S-equol just doesn’t work as well for easing hot flashes. People with moderate to severe hot flashes – hot flashes that range from removing layers of clothing to profuse sweating and then “freezing cold” – may not notice any change after taking S-equol.
“If someone has moderate to severe hot flashes, it may reduce them a bit, but it won’t clear them up the way estrogen or fezolinetant does,” says Streicher.