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Massage Today
July, 2006, Vol. 06, Issue 07

Are You Feeling Hot, Hot, HOT?

By Elaine Stillerman, LMT

Humorously referred to as a "power surge" or "my own private Florida," hot flashes are no laughing matter. They probably are the number one symptom of menopause in Western societies. It's interesting that these sweats are not as common in some Asian countries or Mexico where only about 10 percent of menopausal women suffer from hot flashes.1 One theory postulates the reason Japanese women have such low rates of hot flashes is due to their high fiber, low fat and high consumption of soy diet.

It's estimated that anywhere from 50 to 90 percent of American women of a certain age experience hot flashes; referred to medically as vasomotor flushes.2 Nobody really is sure what causes them, but there are a number of speculations.

The most common explanation is that lower estrogen levels and declining ovarian function are causative. (This also can explain the profuse sweating a postpartum woman experiences when her estrogen levels dramatically drop after the baby is born.) But this theory cannot apply to women with low levels of estrogen who do not have hot flashes or women with estrogen excess who get them. The fact that almost 30 percent of women treated with placebos have an improvement in hot flashes also might indicate there is more involved than estrogen.

Other factors that might trigger hot flashes can be explained by the complex neuroendocrine reactions to thoughts and emotions. Spicy food, hot drinks, alcohol, sugar, caffeine, stress, heated environments and tobacco also might be triggers.

Another theory suggests they are brought on by a dramatic, sudden downward normalization of the body's internal core temperature. Since estrogen and progesterone are significant in regulating temperature, a decrease in their levels might contribute to a shift in the body's ability to control temperature. Studies with both natural progesterone creams and prescription estrogen show a significant reduction in hot flashes.3

As our clients reach peri-menopause, menopause and post-menopause, these flushes or hot flashes can be very uncomfortable, not to mention embarrassing. They seem to occur at the most inopportune times and can be very disruptive of restful sleep. They start as mild to intense heat that spreads through the upper body and face. Red blotchy skin might appear on the face, arms and back or the face might appear flushed. Cardiac rate increases and often copious amounts of perspiration appear, followed by a chill as the hot flash subsides.4 

They can be short, lasting only a few seconds or as long as 30 minutes, although most diminish after 5 minutes. They can occur every hour or occasionally. They can disturb sleep at night or creep up at any time during the day. And they can drag on for years, well into menopause.

Lifestyle changes are an integral part of any natural approach to treating hot flashes and the massage therapist's first line of defense in treating hot flashes is a soothing massage that increases endorphins and allays stress. Pressing Spleen 3, found at the medial aspect of the feet, posterior and inferior to the head of the first metatarsal, can help balance hormones. Your client should discuss all these suggestions with her doctor before deciding which suits her best.

Some medicinal plants have been used for centuries as female tonics. (Author's note: It's essential that your client discusses any herbal remedies with a naturopathic physician or some medical authority with a knowledge of herbs who can determine which herbs are beneficial and at what doses. Herbs are medicines and it's outside the scope of our practice to diagnose and prescribe medicines.) Herbs that have palliative, soothing effects on the female reproductive system and endocrine glands are black cohosh, motherwort, chaste berry tree, blue cohosh (can potentially raise blood pressure to dangerously high levels when too much is taken; must be avoided by any woman with high blood pressure); red clover, ginseng, dong quai (rich in estrogen), licorice, sarsaparilla and false unicorn.5

The effects of black cohosh in treating menopausal symptoms has not received extensive research in the U.S., although the herb has
been used often in Europe. The North American Menopause Society condones the short-term use of black cohosh - for use up to 6 months - since it has a low risk of side effects. Long-term effectiveness has not been studied.6

Soy and red clover have plant-derived, estrogen-like compounds called isoflavones that mimic a weak form of the body's estrogen. This might explain why women who consume soy-rich diets have fewer hot flashes. Clinical trials in the U.S. have yielded inconclusive results. There also is a concern that isoflavones could cause cancer and those women with breast cancer, or who have had breast cancer, should discuss the efficacy of taking isoflavones with their doctor.

Simple lifestyle changes include wearing layers of loose clothing made of natural fibers; exercising daily; sipping a cool drink at the onset of a hot flash; avoiding excess alcohol; avoiding spicy food and caffeine; employing stress reduction techniques such as yoga, meditation or a massage; quitting smoking; taking vitamin E; increasing soy intake; taking evening primrose oil capsules; sleep in a cool room; drinking plenty of water throughout the day.

There are many women who choose hormonal therapy when natural approaches are unsuccessful or symptoms are extremely severe. Estrogen or progesterone therapy can relieve symptoms, but personal risks and benefits have to be considered. Taking certain antidepressants might decrease hot flashes, especially when they are from a class known as selective serotonin reuptake inhibitors (SSRI). Brand names might include Paxil, Prozac, Celexa, etc.7

An off-label use of the medication Gabapentin (Neurotonin) that is FDA-approved to treat epileptic seizures and the pain
associated with shingles, is known to effectively treat hot flashes.8 One in 3 women who took a small dosage of gabapentin (300 mgs) and 1 in 2 women who took 900 mgs reported a decline in hot flashes.9 This medication also requires a doctor's prescription and might not be right for everyone.

Women can't avoid menopause. Whether it was chemically or surgically induced, or just a matter of normal aging, these power surges are an annoying part of it. But women can be more in control of their bodies by adopting simple lifestyles changes and understanding that this, too, shall pass. Now, open a window. Is it hot in here, or is it me?


  1. Zapf, Holly, MD. "What is a hot flash?", 2006.
  2. Ibid.
  3. Ibid.
  4. Mayo Clinic. "Hot Flashes: Ease the discomfort of menopause,", 2006.
  5. Ibid.
  6. Ibid.
  7. Ibid.
  8. Brody, Jane, "A Chance Find, and Voila! Goodbye, Hot Flashes. Hello, Sleep." New York Times, March 28, 2006.
  9. Ibid.

Click here for previous articles by Elaine Stillerman, LMT.


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