Hot , flashes and night sweat.. Ohmyy.


[00:00:00] Good morning. Have a Saturday. Um, okay, we're gonna talk about hot flash runs. It's not fun ladies. Interestingly, it's mostly a GYN topic. There are my puppies back there, by the way. But it does apply a little bit to you ladies who are postpartum. Because you also get hot flashes postpartum, though I don't know if the same mechanism as far as what can help, it will help. 

So ignore that part. But in the future, people get hot flashes. Why do we get hot flashes? Nobody exactly knows the mechanism, but when your estrogen levels start decreasing during perimenopause, do you remember that term? So quick recap of terms. Menopause is a year with no period. Menopause typically occurs at 51. 

For most women. Perimenopause is that nebulous annoying time that surrounds menopause or leads up to menopause, and it can last 10 years. Do you remember me saying that? 10 years. So anyone walking into my office at 40 41 who said, you know, I'm having a little bit of flashes and sweats and [00:01:00] moodiness, and my boobs hurt and my ovaries hurt, these are all signs of perimenopause and they're. 

We're not getting into the whole details of perimenopause, menopause, cuz that's a whole nother topic. But suffice to say it's, um, something that gradually occurs and can be asymptomatic or have a variety of symptoms. Most commonly women will have hot flashes. So certainly postmenopausally, many women will have hot flashes if you go into natural menopause, meaning you drift into it, which the majority of women. 

Your hot flashes will hopefully only last anywhere from a couple of years to five years at most. And not everybody has them do not feel like death and destruction. Everyone's gonna get 'em, but if you get 'em, we can try to fix it. If you go through what we call surgical menopause, which is what I went through, so at. 

46, I had ovarian cancer. They removed my ovaries, which meant literally not even overnight, like that day, I woke up in the recovery room. My ovaries were gone, my estrogen levels were zero, and I had hot flashes like bam. I described those hot flashes [00:02:00] and hopefully you'll never have this type because these are the dramatic kind. 

I described them as anxiety running through my veins because it literally felt like this. Um, creeping heat that all of a sudden came up and didn't just make you hot and pink and rosy and not attractive, pink and rosy, but felt like a little, um, nervous reaction through your veins. It's the only way to describe it if anyone knows what I'm talking about. 

Give me a holla. So that was short-lived in my case. I gave myself permission for those several weeks after my surgery while I was, um, recuperating from surgery and then going through, um, chemotherapy to be liberal with things like Xanax, which I don't typically advocate for. But for those couple of weeks, I really needed them to help sleep and calm down because when you have hot flashes, sleep can also be disturbed. 

Now I've managed my hot flashes completely. Medication, which I am, I don't wanna say proud of because I don't think there's anything wrong with medication, as you all know. I am a massive [00:03:00] advocate for Western and integrative medicine, so complimentary stuff. I love me, some western stuff as I joke. I took my toxic chemotherapy, but I also did integrative things at the time, like acupuncture. 

So let's talk about the hot flashes and what can be done. You can do very Western techniques primarily. hormone replacement therapy, H r T. So that means estrogen and if you have a uterus, progesterone, because estrogen can thicken the lining of the uterus. And so you need progesterone to combat that so that you don't end up with endometrial or uterine cancer. 

Okay, so if you're taking hormone replacement, you need to be taking estrogen and progesterone if you have a uterus. Estrogen alone. If you don't have a uterus, will it help your hot flashes? Hell yeah. I mean, God, those hormones are potent and strong and they make people feel good. Um, with a host of other good side effects that we actually enjoy bone health, it helps our skin. 

It helps our colon decreasing the risk of colon cancer. There's potentially Ari, an improvement in brain brain health and decreasing risk of [00:04:00] Alzheimer's and dementia. Um, unfortunately, what else comes with hormone replacement is the possible risk of breast cancer. Possible risk of stroke and heart attack and blood clot. 

Well, that sounds terrible. Who would want that? Well, the answer is it depends on you. If you're having hot flashes all day, every day, and we've tried other things that don't help, you're gonna want your hormone replacement. And many women would accept that risk because a life that does not have good value each day. 

And again, it sounds dramatic to say that, but if you have been riddled with hot flashes 20, 30, 40 times a. You would agree with me that you couldn't live that way. Quality of life is just too altered. Um, and the risk of breast cancer was unfortunately, Overblown, especially in, um, I don't wanna say the media, but just the way it was portrayed. 

There was a very big study called the w h I, the Women's Health Initiative, when they were proactively prospectively studying women who were on hormone replacement to see what the risk was. And they were looking at all parameters. How did they feel? How was their bone health, their vaginal health, um, what happened with the cancer risk? 

And [00:05:00] unfortunately, because the cancer risk was found to be higher, not astronomically high, but higher, slightly. They decided to stop the study, which meant back in the day when I was a resident, and this was about 2001, I think all of a sudden, like overnight, doctors stopped prescribing hormone replacement for millions of women, which was a huge disservice because hormone replacement, like anything else, has its place despite the risks. 

So again, most Western way to treat your hot flashes. Is hormone replacement. Okay. You could also do low doses of antidepressants, so there have been antidepressants that were specifically studied not for depression, but in doses that will help with hot flashes. Ven Laine, which the brand name is Effexor, was the one that was one that was studied most though it seems anecdotally that even the other more popular ones, and I'm gonna use brand names here, Xapo, Prozac. 

Um, Wellbutrin might seem to help mostly the SSRIs, but some of the SNRIs can help with hot flashes. And let's face it, when you're going through menopause, sometimes your mood is like kind of crappy [00:06:00] anyway, so that is a very good option, especially for women who have, um, very strong risk factors and can't take hormone replacement. 

So if they've had breast cancer, if they have had heart attack or stroke, then the low. Antidepressants can work. You have to be careful with some of the antidepressants if you have had breast cancer and are on tamoxifen. So again, those are the most Western, right? So medication it works great, but there are risks. 

Completely eastern. Opposite end of the spectrum would be acupuncture, which in. Trials has literally been shown to be effective and help with hot flashes, and it's amazing. I did not know enough about acupuncture, nor do I now, but I did it during chemo and it absolutely helped. And I know that it helped because I didn't actually believe in it even during it maybe, um, for various reasons, even though I loved Dr. 

Katie, my acupuncturist, um, integrative doctor friend. But one week when I skipped it because I was working too much. I felt horrible and then when I went in to do it, it helped. So acupuncture has been studied [00:07:00] objectively and it works. The hard part is you need to have the time and sometimes the money, because insurance does not always cover it because do insurance companies care about our hot flashes ladies? 

Hell no. So acupuncture would have to do regularly, but it can help. And then there's the in between, I'd say like the extreme medical version, the extreme acupuncture version are all of the habits that we can help ourselves with. So the three most impactful things I have done to help my hot flashes, unfortunately, are really decreasing. 

Bread, rice, pasta, sugar. So I'm saying bread, rice, pasta, sugar. Because if I just say sugar to you guys, I have women say all the time, I don't eat any. Oh, okay. Great. So what did you have for breakfast? Um, I had yogurt with blueberries and honey. I'm like, okay. Mm-hmm. ? Yeah. Sugar, sugar, sugar. Uh, no, I don't even eat that. 

Okay. Well, what else do you eat? Um, toast with jam. Okay. Sugar. So again, red rice, pasta, sugar. I'm lumping them together. Those carbohydrates and sugars unfortunately have been found to stimulate hot flashes. For me, it's immediate, like, I could eat sugar or [00:08:00] bread or rice or pasta or all that stuff. I. Boom, hot flash. 

So bread, rice, pasta, sugar. Huge impact for me. Alcohol, huge impact, especially wine probably because of the sugar and, and margaritas. Sugar. If I have vodka soda, dirty martini, um, tequila with lime, I'm much better. The third is caffeine. This is, My second, maybe third, who's counting cup of coffee today. Um, I actually personally can get away with more caffeine when I'm generally decreasing my carbohydrate and alcohol burden, which is just better for my health anyway. 

There are times, and this is what I say to all my patients, , prove it to yourself. Get rid of alcohol, caffeine, bread, rice, pasta, sugar for a couple weeks. See how you feel. Because then when you add it back in, you know, oh, that's what it is. And my view of is, is this, part of it is psychological. If I know that I can get rid of those things, get and get rid of my hot flashes. 

And then occasionally I'm like, you know what, I'm gonna take that mar. I'm gonna have my hot [00:09:00] flashes and I don't care because it was my choice and it felt like it was in my control. And I think, again, from the mindset perspective, that's very powerful for us. Okay, so bread, rice, pasta, sugar, caffeine. 

alcohol. I think that when I do my intermittent fasting, it helps my flashes as well, but I can't say that for sure. That is not something I've studied. That is something I have anecdotally noticed, and again, better for my health as it is. Um, the other thing that was anecdotally noted in some of the literature, which goes along with what I've talked about before, is elevated vitamin D levels. 

Normally vitamin D if you look at the lab results will be normal anywhere from 30 to a. Now a lot of the new data with Western medicine even says that we should get our levels above 40. But certainly oncology data and integrative data and anecdotal data about flashes and sweats would say if your level is above 50, you're even better off. 

And I have definitely noticed that. , how do you get your vitamin D three level above that? And I'm saying D three because D two does not [00:10:00] have the same effect in our body. Um, and D two is mostly not even sold anymore in the pharmacy. So usually when you get D it'll be D three. Um, why is that? We don't know why it works, but how do you get it elevated is by taking D three. 

D three is one of those vitamins that really is like a hormone. You get it from the sun, it converts in our, underneath our skin basically. And so to get it from the sun is really. Because we're not outside cuz we're working. We're wearing clothing, we're wearing sunscreen. We don't have time to get D three from the sun. 

We can't get it from food that much. So people will say, well I don't know. I get it from my food. No you don't. You can get calcium from food. , but you cannot get that. You can't get D three from it. So you really have to take a supplement and you usually have to take a pretty big dose, and it's typically bigger than what many of the internists or what the percentage of RDA is gonna tell you. 

So I'm not advising you. I am not your doctor. I personally take 5,000 a day. I tell many of my patients to take for a thousand a day just because their intern is skeptically with 5,000. Um, but again, I got my level just above 50 [00:11:00] by taking five. , and again, I'm not even close to overdosing cuz that would be over a hundred. 

Okay. So that has been very impactful for me. Plus the vitamin D decreases breast and colon cancer, potentially other cancers, and improves your bones. Okay. I don't wanna advocate for any other brand name medication, but that said, there is an over-the-counter herbal supplement. There's actually a variety of them. 

So I will mention a couple, and I'm not being paid or endorsed by them, but there's a group of herbs, one particular called black cohosh that is in a lot of different over-the-counter medications. So you can try that. And I've had a lot of patients say, oh, it worked for a couple weeks or a couple months. 

I haven't seen as much long. Benefit from it, but black cohosh, which is in things like, um, oh my gosh, what's the name? But now I can't remember. So Black Cohosh is in, I will think of it by the end of the time that we're talking. Um, another one is Swedish Flower Extract, which is in a, in a product called Rela Zen. 

Okay, so Relain is Swedish [00:12:00] Flower Extract. Um, estro, VE E S T R O V E N, not estrogen Estro. Ven is the Black Cohosh product, but that's just one of the myriad black cohosh products that are in the market. If you go to those stores, like Whole Foods, you'll see like. Legions of them, and they're probably safe and they include a lot of other herbs. 

So black cohosh is a very popular one and there are marginal benefits to it, and it's certainly fairly harmless. And then the sweeter FL Swedish flower extract that is in Reen that you can buy online. Um, again, I don't work for them. That takes several weeks to work, but it really works well and it's very safe. 

Okay, so we talked about hormone replacement, we talked about acupuncture, we talked about vitamins like vitamin. Decreasing your food sources like caffeine, alcohol, and sugar and herbs like black cohosh or Swedish flour extract, relain. Okay, I'm gonna go watch a basketball game with a bunch of nine year old girls. 

Y'all have a good Saturday afternoon. Bye.