Hot flushes: what can I do if I am worried about hormones?

Why do you get hot flushes during the menopause?

Falling oestrogen levels disrupt the temperature control centre in the brain (the hypothalamus). It reacts to small changes in temperature as if the body were overheating: blood vessels in the skin widen, the face and upper body flush, sweating starts, sometimes followed by chills. At night, these episodes cause night sweats and waking.

Hot flushes are the most common symptom of the menopause. They often last several years. Their intensity varies widely: some women are not bothered, while others find their sleep, work and mood severely affected.

They can also be caused by anti-hormone treatment after breast cancer. This particular situation, in which hormones are ruled out, is managed together with the gynaecological cancer care team.

Is hormone replacement therapy (HRT) really dangerous?

The fears largely stem from US studies in the early 2000s, which used hormones different from those prescribed in France, in women who were often older. Today, medical societies agree on several points:

• hormone therapy is the most effective treatment for hot flushes;
• for a woman under 60 or within 10 years of the menopause, with no contraindication, the balance of benefits and risks is favourable for treating bothersome symptoms;
• the risks vary with the type of hormone, the dose, the duration and the route; oestradiol through the skin (gel, patch) is associated with a lower risk of blood clots than tablets;
• there is a risk of breast cancer; it depends in particular on the progestogen used and the duration of treatment.

Hormone therapy is, however, still contraindicated after breast cancer and in some cardiovascular diseases. All the details are in our article menopause hormone therapy: is it really necessary?. If, once informed, you prefer to avoid hormones, that choice is legitimate and other solutions exist.

Which non-hormonal treatments for hot flushes actually work?

French guidelines (CNGOF, the French College of Gynaecologists and Obstetricians, and GEMVi, 2021) and North American guidelines (NAMS, 2023) are based on placebo-controlled trials. This is what they conclude:

Antidepressants and gabapentin are used here outside their main indication, with no link to depression or epilepsy. The choice is made during a consultation, based on your medical history and other treatments.

Which natural remedies for hot flushes do not work?

Several widely used products have done no better than a placebo in trials. French guidelines mention in particular:

• beta-alanine (sold in France as Abufène, for example);
• homeopathy;
• vitamin E, omega-3 and evening primrose oil;
• most herbal remedies and phytoestrogens: red clover, black cohosh (cimicifuga), etc. NAMS does not recommend dietary supplements, soy or soy extracts either.

Some phytoestrogens such as genistein might slightly reduce the frequency of flushes, but their content varies from product to product. Above all, all phytoestrogens are contraindicated after breast cancer. "Natural" does not mean risk-free: some plants affect the liver or interact with medicines. Always tell your doctor about any supplements you take.

What everyday steps can help with hot flushes?

These measures have not been shown to reduce the frequency of hot flushes on their own, but they improve comfort and overall health:

• dress in layers that are easy to remove, and choose natural fibres;
• keep the bedroom cool, with a fan within reach;
• identify your personal triggers: hot drinks, alcohol, spicy food, heat, stress;
• limit alcohol, which worsens flushes in some women and increases the risk of breast cancer;
• stop smoking;
• exercise regularly, which benefits sleep, mood, heart and bones, even if it does not directly reduce flushes.

How are hot flushes treated after breast cancer?

Hot flushes are often more intense after breast cancer, particularly with tamoxifen or an aromatase inhibitor. Hormones and phytoestrogens are contraindicated. Proven non-hormonal options (compatible antidepressants, gabapentin, hypnosis, cognitive behavioural therapy) should then be preferred. With tamoxifen, some antidepressants that reduce its effectiveness (paroxetine, fluoxetine) must be avoided. The decision is made with your oncologist; see also our article on follow-up after breast cancer.

What happens at a consultation for hot flushes?

The consultation is about measuring how much the flushes really affect you and choosing a treatment suited to your situation, not about imposing hormones. The doctor reviews:

• how often and how intense the flushes are, night waking, tiredness, mood, joint pain, vaginal dryness;
• your personal and family history: breast or womb (endometrial) cancer, blood clots or pulmonary embolism, cardiovascular disease, migraine;
• your current treatments and any supplements you take;
• your concerns and preferences.

Keeping a diary of your flushes for one to two weeks (number per day, night waking) helps with the decision and then with judging the effect of treatment. A non-hormonal treatment is usually reviewed after a few weeks; if it is not enough, another option can be tried.

When should I see a doctor about hot flushes?

See a doctor if hot flushes disrupt your sleep, work or mood: an effective treatment exists in most cases. Also see a doctor if they occur in unusual circumstances, as other causes are possible: thyroid disease, medicines, infection, or more rarely another hormonal condition. Night sweats with fever, unexplained weight loss or severe tiredness need prompt medical attention. Chest pain, palpitations with feeling faint or sudden breathlessness mean you should call 15 or 112 in France, or your local emergency number.

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.