Hot Flashes and Thyroid Health
Hot flashes are a common symptom among those with thyroid and autoimmune thyroid conditions. Just as is the case with any other symptom, the severity of hot flashes can vary greatly from person to person. For those women who experience hot flashes, sometimes these are very mild. On the other hand, in some women the hot flashes are severe and might interfere with their daily life, and even make it difficult to sleep at night. The goal of this article is to discuss some of the common causes of hot flashes, and discuss some of the treatment methods which can help with them.
I’d first like to mention some of the common symptoms of hot flashes, as these can include the following:
- A feeling of warmth throughout the upper body and face
- Sweating on the face, neck, and chest
- A flushed appearance
- Rapid heartbeat
What Causes Hot Flashes?
Although hot flashes are common in perimenopause and in postmenopausal women due to the decline in estrogen, some cycling women experience hot flashes as well. Dysfunction of central thermoregulatory centers caused by changes in estrogen levels at the time of menopause has long been postulated to be the cause of hot flashes (1). Although taking estrogen can help greatly with many cases of hot flashes, low estrogen levels alone are not responsible for hot flashes, as estrogen levels do not differ between symptomatic and asymptomatic women (2) (3). And even when low estrogen levels are the culprit, there are risks involved with taking bioidentical estrogen. So while taking bioidentical estrogen is an option to be considered, in most cases it shouldn’t be the primary option.
The symptoms of hot flashes women experience are due to spikes of epinephrine (adrenaline), and this is a hormone secreted by the adrenal glands. In addition, as women get older, the adrenals become a greater source of the sex hormones. As a result, if someone is dealing with chronic stress, this can result in lower estrogen levels. While later in this article I’ll discuss some nutrients and herbs which can help with hot flashes, in many cases chronic stress is the culprit.
I know this might be frustrating to some people reading this, as stress seems to be related to every condition. And sometimes stress is used as an excuse by some healthcare professionals with certain conditions when they don’t know what’s causing the problem. With regards to hot flashes, I think most healthcare professionals would agree that there is a physiological component involved, but of course chronic stress doesn’t just lead to emotional disturbances, as it also affects the physiology. And if someone is dealing with a lot of stress over a prolonged period of time, this can lead to decreases in both estrogen and progesterone, which can be a contributing factor when it comes to hot flashes.
Low levels of the neurotransmitter serotonin also can be a factor in hot flashes. Estrogen modulates the serotonin receptors in the brain (4) (5), and so the low estrogen levels can in turn cause low serotonin levels. This is why numerous studies have shown that serotonin-reuptake inhibitors can help with hot flashes (6) (7). I don’t recommend taking medication to manage hot flashes, but there are natural options to help increase serotonin levels, which I’ll discus later in this article.
Can Soy Be A Solution For Hot Flashes?
There is evidence that soy isoflavone supplements derived from extraction or chemical synthesis can help to reduce both the frequency and severity of hot flashes (8). I’ve seen this work with some of my patients, as while I don’t personally recommend soy isoflavone supplements, I’ve had a few patients take these on their own, and they do seem to help in some cases. However, other studies show that soy isoflavones don’t help with hot flashes, and in some cases might even lead to an increase in hot flashes (9). The reason why soy can potentially help some women is because it contains the compounds genistein and daidzein, which are phytoestrogens, and thus can mimic the action of estrogen. However, these compounds also can have anti-estrogenic effects.
Although soy might benefit some people with hot flashes, I’d be cautious about taking soy supplements or consuming large amounts of foods which contain soy. First of all, most of the soy is genetically modified. Second of all, soy is a goitrogen, and so eating a lot of soy can potentially inhibit thyroid function, which might not be an issue for those with hyperthyroidism and Graves’ Disease, but it can be problematic for those with hypothyroidism and Hashimoto’s Thyroiditis. Third, soy also contains anti-nutrients such as saponins, phytates, and protease inhibitors, which can affect digestion. Fourth, there is evidence that the phytoestrogens genistein and daidzein can stimulate breast cancer growth (10). However, this is controversial, as other sources claim that these compounds are potent anticancer agents and inhibit the growth of cancer cells through the modulation of genes controlling cell-cycle progression (11). While there can be some health benefits to eating organic fermented soy, I would still try to minimize one’s consumption of these foods. And as I mentioned earlier, while soy seems to help some women with hot flashes, in other cases it actually worsens them.
What’s The Relationship Between Thyroid Health And Hot Flashes?
Can an imbalance of thyroid hormone lead to hot flashes? Well, although I can’t say that all of my patients with hypothyroid or hyperthyroid conditions have their hot flashes improve upon balancing the thyroid hormones, many times this is the case. There aren’t many studies looking at hot flashes in people with thyroid conditions, although one study consisting of 350 women with different menopausal symptoms showed that a marked improvement in the menopausal-like symptoms occurred after treatment of the thyroid dysfunction (12). This study involved both women with hypothyroidism and hyperthyroidism.
Natural Treatment Solutions for Hot Flashes
Although taking bioidentical hormones such as estrogen and progesterone might be considered by some people to be a natural solution for hot flashes, I would recommend using these as a last resort. Before resorting to hormones, even if they are natural, I would recommend trying the following:
1. Improve your stress handling skills. I’m not suggesting that this alone will always help to get rid of hot flashes, but if you deal with a lot of stress and do a poor job of managing it then this can cause a decrease in the sex hormones, which as I mentioned earlier can lead to an increase in hot flashes. I did come across a study which showed that participation in a mindfulness-based stress reduction program might be a significant resource in helping women cope with hot flashes and night sweats (13). Another study involving 54 late perimenopausal women showed that yoga can help to reduce hot flashes (14).
2. Support the adrenals and the HPA axis. Since problems with the HPA axis and weakened adrenals can cause low levels of the sex hormones, giving some support in these areas is sometimes necessary. Although supplements and herbs which specifically support the adrenal glands might be beneficial, it usually is a good idea to support the HPA axis, and this can be done through adaptogenic herbs such as ashwagandha, eleuthero, rhodiola, and maca. I’m not suggesting that you need to take all of these, as taking one or two of these herbs usually is fine. Glandulars to support the hypothalamus and pituitary gland can also be helpful.
3. Increase serotonin levels. As I mentioned earlier, low serotonin levels can be a factor with hot flashes. I also discussed how serotonin-reuptake inhibitors can help with hot flashes. I’m definitely not suggesting that those with hot flashes take these drugs, but they might want to consider taking the precursors of serotonin, such as tryptophan or 5-hydroxytryptophan (15). This is especially true if the person with hot flashes is also experiencing sleeping difficulties, as serotonin is a precursor to melatonin. As a result, if serotonin is low, there’s a good chance melatonin is also low, which in most cases will cause sleep issues.
4. Balance the thyroid hormone levels. Most people reading this have a thyroid or autoimmune thyroid condition. While your hot flashes might be unrelated to your thyroid health, there is also a chance that there is a connection. And if this is the case, balancing the thyroid hormone levels might lead to significant relief. Obviously if someone has an autoimmune thyroid condition then the goal should be to improve the health of the immune system, but there are many cases when taking thyroid hormone or antithyroid medication is necessary while trying to address the cause of the condition. Since hyperthyroidism and Graves’ Disease involve an increase in the metabolic rate, many women with hyperthyroid conditions feel as if they are experiencing hot flashes when it’s actually related to the increased metabolism.
5. Eat a healthy diet. This probably should have been listed first, but I figured I’d briefly discuss this right before listing some of the specific herbs and nutrients which might be beneficial in women with hot flashes. Regardless of whether you are experiencing hot flashes or not you of course want to eat a healthy diet which consists of mostly whole foods, while minimizing the refined foods and sugars. Eating regularly in order to keep the blood sugar levels in balance might be a factor, as there is evidence that an increase in hot flashes are experienced when blood glucose falls between meals (16). So this is yet another reason to consider eating every two to three hours after awakening, although there are some healthcare professionals who disagree with this, and feel that you shouldn’t eat every few hours.
6. Nutrients and herbs. I already mentioned the pros and cons with soy, as while soy does help some women with hot flashes, I would prefer supporting the adrenals and HPA axis first. Earlier I discussed how taking adaptogenic herbs can help, and here are some additional herbs and nutrients which some people with hot flashes might find to be beneficial:
Black Cohosh. This herb can sometimes help with hot flashes, although the results are mixed. Some clinical trials suggest that black cohosh might help to reduce hot flashes (17), while other studies show that black cohosh isn’t effective in reducing hot flashes (18) (19). Black cohosh was once thought to be estrogenic, but it appears that it doesn’t bind to the estrogen receptor, up-regulate estrogen-dependent genes, or stimulate the growth of estrogen-dependent tumors (20). It seems that this herb might act on the serotonin receptors, which may in turn reduce hot flashes and cause an improvement in mood (21). The results with my patients have also been mixed, as some of my patients have claimed that black cohosh helped to reduce their hot flashes, while others didn’t notice any difference.
Red Clover. Just as is the case with black cohosh, the results of taking the herb red clover with regards to hot flashes are conflicting. One study showed that red clover (80 mg/day) significantly relieved hot flashes, mood, pain, and cognitive symptoms (22). On the other hand, others conclude that red clover extracts have as yet no clear demonstrable benefit for menopausal symptoms (23).
Dong Quai. Dong quai is commonly used for numerous complaints, including abnormal menstruation and menopausal symptoms. Although some claim that dong quai has estrogenic activity, others claim that it doesn’t have estrogenic effects and isn’t any more helpful than a placebo in relieving menopausal symptoms (24). However, more research is needed on this herb, as well as most of the other herbs I mentioned with regards to whether or not they can help with hot flashes.
Chaste tree. I recommend chaste tree (Vitex) more commonly to cycling women than those in menopause, although in some cases chaste tree can help with the early symptoms of menopause. One small study performed in perimenopausal and postmenopausal women showed that chaste tree can help with menopausal symptoms, including hot flashes (25).
DHEA. This is a hormone which decreases as we age, and since DHEA is a precursor to estrogen (it also is a precursor to testosterone, which in turn converts into estradiol), it shouldn’t be a surprise that taking DHEA can help with hot flashes. A few studies have shown that taking DHEA can help greatly with hot flashes (26) (27). Although I do recommend DHEA to my patients every now and then, I don’t recommend it frequently, as most of the time the DHEA levels are depressed due to chronic stress and HPA-axis dysfunction, and not solely due to getting older. As a result, improving one’s stress handling skills while supporting the adrenals and HPA-axis can frequently help to raise the DHEA levels, although this isn’t always the case.
Gamma Linolenic acid (GLA). This is found in evening primrose oil, borage oil, and black currant seed oil. This apparently acts on the estrogen receptors without actually increasing the estrogen levels (28). A 6-week randomized clinical trial consisting of 56 menopausal women showed that evening primrose oil may decrease the severity of hot flashes (29).
Flaxseed. Lignans are found in flaxseed, and like soy isoflavones, they are considered to be phytoestrogens. In fact, it seems that supplementation with flaxseed modifies urinary estrogen metabolite excretion to a greater extent than does supplementation with an equal amount of soy (30). Not surprisingly, the results of studies on flaxseed and hot flashes are also mixed, as some studies show that flaxseed decreases hot flash activity (31), while other studies don’t support the use of flaxseed for the reduction of hot flashes (32). I think it’s fine for most women with hot flashes to take one or two tablespoons of flaxseed oil per day.
Wild Yam. I’ve had some success using wild yam in helping women with hot flashes, although just as is the case with the other herbs and nutrients I mentioned so far, not everyone responds to this. Wild yam contains a compound called diosgenin, which has been referred to as a phytoestrogen by some sources, although a recent study showed that it does not express estrogenic activity (33). Diosgenin is actually used to synthesize cortisone, pregnenolone, and progesterone. Although I have had some success using wild yam in treating hot flashes in some of my patients, there is no research I’m aware of which shows that it is effective in doing this, although there are studies which show that while wild yam is free of side-effects, it appears to have little effect on menopausal symptoms (34).
7. Acupuncture. Many different health conditions can benefit from acupuncture. In fact, I’ve had many patients over the years see an acupuncturist and receive positive benefits. When it comes to hot flashes, a few studies show that acupuncture can cause a marked clinical improvement in hot flashes and menopause-related symptoms in perimenopausal or postmenopausal women (35) (36). On the other hand, other studies haven’t shown acupuncture to be effective in helping with hot flashes (37). However, if you are dealing with moderate to severe hot flashes then in my opinion it’s worth giving acupuncture a try.
8. Consider bioidentical hormones (usually as a last resort). Although I’m not a big fan of taking bioidentical hormones, there are times when they are necessary, which is why I listed this option here. For example, if some gets a complete hysterectomy then they very well might need to take bioidentical hormones, which in turn can help provide relief from hot flashes. Although one can argue that bioidentical hormones aren’t considered a natural treatment, it’s definitely more natural than using synthetic estrogen and/or progesterone.
In summary, hot flashes are common in both perimenopause and menopause, and also affect some cycling women. Hot flashes are due to spikes of adrenaline, and stress and HPA-axis dysregulation can be a big cause of hot flashes. As a result, improving one’s stress handling skills, along with supporting the adrenals and HPA axis can be essential in dealing with these. Balancing the thyroid hormone levels can help with some cases of hot flashes. Obviously eating a healthy diet is important, and for many people eating every two to three hours can also be beneficial. Certain nutrients and herbs might benefit people with hot flashes, and these include black cohosh, red clover, gamma linoleic acid, flaxseed, and wild yam. Some studies show that acupuncture can be effective in helping with hot flashes, and therefore should be considered in moderate or severe cases of hot flashes.