As a child, I remember sitting in the backseat behind my grandmother on car rides and wondering why, in the middle of winter, she would suddenly turn beet-red and roll down the window to let in the icy air.
Years later, I saw my mother, after starting tamoxifen therapy for her breast cancer, deal with even more disturbing hot flashes and drenching night sweats.
Since then, I've met hundreds of women in my medical practice and my family who have come up with creative solutions for weathering this drop in estrogen levels, whether it's been brought on naturally by menopause or as a result of surgery.
Some women pass through "the change" quite gracefully, simply by dressing in layers; others are tormented by these distressing waves of heat that can severely disrupt sleep and strain both work and personal life.
Every woman experiences hot flashes differently, so it's natural to find that some of these solutions will work for one but not for another.
For mild symptoms: I suggest dressing for the flash by wearing layers, preferably in breathable cottons. Lay out a change of clothes at your bedside. Carry pre-moistened towelettes in your purse - or even a wet washcloth in a plastic bag - to soothe heated skin and wipe away beads of sweat.
For moderately bothersome symptoms: Consider taking non-hormonal medications. Soy - either in the form of soy milk or supplements - has mild estrogenic qualities and can reduce the severity of symptoms.
Many over-the-counter supplements include black cohosh, which also may be effective. (One word of caution: Herbals like black cohosh and soy supplements are not FDA-regulated as drugs, so their quality, safety and efficacy are not monitored.)
Among prescription medications, SSRI antidepressants have been shown to reduce hot flashes, worth considering if you're also feeling depressed or short-tempered. Interestingly, the medication gabapentin, currently approved for the treatment of seizures and nerve pain, has shown promising results in reducing the frequency of hot flashes. And the blood pressure medication clonidine may also be helpful.
Severe symptoms: For the woman incapacitated by hot flashes, supplementation with estrogen works extremely well and consistently. Unfortunately, the myth that estrogen therapy was a panacea collapsed after the Women's Health Initiative study found that this type of hormone-replacement therapy also increased the risk of heart attacks, strokes, and breast cancer in women in the study.
The current recommendation is to use estrogen for severe symptoms at the lowest effective dose for only as long as needed. If you understand these risks, then you can choose to use estrogen therapy if you feel your symptoms are too severe or persist despite the alternative treatments.
The one thing you shouldn't do is suffer in silence while being afflicted with severe symptoms. Talk with your doctor and keep your ears peeled for new therapies on the horizon!