Hot Flashes Protocol: A Resource for Practitioners


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by Fullscript’s Integrative Medical Advisory Team

According to a publication in Mauritas, the official journal of the European Menopause and Andropause Society (EMAS), approximately 1.2 billion women worldwide are expected to be menopausal or postmenopausal by 2030. (9) Menopause is a transitional period leading to cessation of menses that women typically experience between the ages of 45 and 52. (10) Unfortunately, for many women, menopause is often associated with a number of symptoms that negatively impact the quality of life. Over half of menopausal women turn to complementary and alternative treatments, such as dietary supplements, to address menopausal symptoms. (10)

This article provides an overview of hot flashes, a common symptom of menopause, as well as an integrative protocol for the treatment of hot flashes.

What are hot flashes?

Menopause is characterized by changes in hormone levels, which results in a cessation of menstruation and loss of childbearing function. (14) The hormonal changes include a decrease in estrogen, cessation of cyclical progesterone production, as well as an increase in the gonadotropins follicle-stimulating hormone (FSH) and luteinizing hormone (LH). (15)

Throughout menopause, most women experience symptoms, which may vary by individual, such as breast tenderness, vaginal dryness, (5) sleep disturbances, mood disorders, cognitive decline, sexual dysfunction, and weight gain. (10)

Hot flashes, also known as hot flushes, are another symptom commonly experienced during menopause. Approximately 80% of women in menopause experience hot flashes and night sweats, known as vasomotor symptoms. (10)

woman blowing air in her shirt to cool down

Hot flashes are commonly experienced by women during menopause.

Causes and risk factors

While menopause is a normal physiological event that occurs in women, certain factors may be associated with an increased risk of vasomotor symptoms, including:

  • Ethnicity: highest rates of vasomotor symptoms are reported by African American women
  • Menopausal status: transition to late perimenopause
  • Higher body mass index (BMI)
  • Older age
  • Lower education level
  • Smoking
  • History of premenstrual symptoms
  • Depression and anxiety (8)

Hot flashes may be exacerbated by emotional stress, alcohol intake, and exertion. Menopause may be precipitated by medical treatment (e.g., chemotherapy, antiestrogens for breast cancer and endometriosis), as well as certain surgeries (e.g., hysterectomy). (14)

Signs, symptoms, and complications

Hot flashes are characterized by a sudden onset of feelings of warmth, often in the face, neck, and chest, and may be accompanied by sweating, irritability, and panic. (5) If left untreated, vasomotor symptoms will dissipate after approximately 7.4 years. (14)

Integrative protocol for hot flashes

An integrative protocol for hot flashes may involve hormonal replacement therapy (HRT), mind-body practices (e.g., cognitive behavioral therapy), exercise, and dietary supplements such as vitamin E, isoflavones, and evening primrose oil. (5)(10)

Flat-lay of nuts, avocado, olives in olive oil, and softgel capsules on a wooden table.

Vitamin E may improve symptoms of menopause by reducing oxidative stress.

Vitamin E

Vitamin E is a group of fat-soluble compounds including alpha-, beta-, gamma-, and delta-tocopherol and alpha-, beta-, gamma-, and delta-tocotrienol. Vitamin E has immunomodulation, antiplatelet, and antioxidant effects in the body. (11) Food sources of vitamin E include seeds (e.g., pumpkin, sunflower), nuts (e.g., almonds, hazelnuts), peanuts, leafy greens (e.g., turnip greens, spinach), and tomatoes. (17)

During menopause, estrogen levels decline, which may increase oxidative stress in the body as estrogen acts as a natural antioxidant. Research suggests that vitamin E, a free radical scavenger, may neutralize oxidative stress. Vitamin E has been shown to improve hot flash symptoms and reduce the risk of cardiovascular disease. (5)

Research findings:

  • Severity score and frequency of hot flashes was significantly improved compared to placebo (1)(18)

US: Search for Vitamin E in the Fullscript catalog.
CAN: Search for Vitamin E in the Fullscript catalog.

Isoflavones

Isoflavones are a class of phytoestrogens found in legumes, such as soybeans, chickpeas, fava beans, and peanuts. (16) Phytoestrogens, plant-based compounds that are structurally similar to estradiol, (12) possess estrogen-like properties as they have the ability to bind to estrogen receptors in the body. (3)(13)

Isoflavones may exert either an estrogenic or antiestrogenic effect on the body, when circulating levels of estrogen are either low or high, respectively. An association between high dietary intake of phytoestrogens and lower incidence of menopausal vasomotor symptoms in Asian women has prompted research examining the effects of supplemental phytoestrogens for these symptoms. A meta-analysis examining the efficacy of phytoestrogens on symptoms of menopause found phytoestrogens to be effective and safe, without a significant difference in side effects between groups receiving treatment versus placebo. (3)

Research findings:

  • Hot flash frequency and intensity was shown to be decreased compared to placebo (3)(7)
  • Supplementation for at least 48 weeks is required in order to obtain 80% of the maximum effect (12)

US: Search for Isoflavones in the Fullscript catalog.
CAN: Search for Isoflavones in the Fullscript catalog.

A bottle of evening primrose oil with flowers and seeds.

Evening primrose oil is derived from the seeds of the plant.

Evening primrose oil

Evening primrose oil (EPO) is derived from the seeds of the evening primrose plant (Oenothera biennis). EPO is a source of the omega-6 fatty acids gamma-linolenic acid (GLA) and linoleic acid. The benefits of EPO may be a result of the effects of omega fatty acids on immune cells, and their indirect effects on the production of eicosanoids, (2) bioactive signaling lipids involved in the inflammatory response. (4) EPO supplementation has been studied for its anti-inflammatory potential in various conditions, such as eczema and rheumatoid arthritis, as well as for menopausal and premenstrual symptoms. (2)

Research findings:

  • Frequency and severity of hot flashes compared to placebo were significantly improved (6)
  • HFRDIS (Hot Flash Related Daily Interference Scale) was ameliorated especially regarding social activities, relations with others, and sexuality score (6)

US: Search for Evening Primrose oil in the Fullscript catalog.
CAN: Search for Evening Primrose oil in the Fullscript catalog.

The bottom line

Menopause is a natural physiological event that occurs as women age. Hot flashes, a vasomotor symptom of menopause, may be addressed with certain dietary supplements, including vitamin E, isoflavones, and evening primrose oil. A protocol using natural supplements can be used therapeutically on its own or as an adjunct to existing treatment. If you are not an integrative healthcare provider, we recommend speaking with one to learn whether these supplements are ideal for your wellness plan.

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript!

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Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

  1. Barton, D. L., Loprinzi, C. L., Quella, S. K., Sloan, J. A., Veeder, M. H., Egner, J. R., … Novotny, P. (1998). Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. Journal of Clinical Oncology, 16(2), 495–500.
  2. Bayles, B., & Usatine, R. (2009). Evening primrose oil. American Family Physician, 80(12), 1405-1408.
  3. Chen, M. N., Lin, C. C., & Liu, C. F. (2015). Efficacy of phytoestrogens for menopausal symptoms: A meta-analysis and systematic review. Climacteric, 18(2), 260–269.
  4. Dennis, E. A., & Norris, P. C. (2015). Eicosanoid storm in infection and inflammation. Nature Reviews Immunology, 15(8), 511–523.
  5. Doshi, S. B., & Agarwal, A. (2013). The role of oxidative stress in menopause. Journal of mid-life health, 4(3), 140–146.
  6. Farzaneh, F., Fatehi, S., Sohrabi, M.-R., & Alizadeh, K. (2013). The effect of oral evening primrose oil on menopausal hot flashes: A randomized clinical trial. Archives of Gynecology and Obstetrics, 288(5), 1075–1079.
  7. Ferrari, A. (2009). Soy extract phytoestrogens with high dose of isoflavones for menopausal symptoms. Journal of Obstetrics and Gynaecology Research, 35(6), 1083–1090.
  8. Gold, E. B., Colvin, A., Avis, N., Bromberger, J., Greendale, G. A., Powell, L., … Matthews, K. (2006). Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: Study of women’s health across the nation. American Journal of Public Health, 96(7), 1226–1235.
  9. Hill, K. (1996). The demography of menopause. Maturitas, 23(2), 113–127.
  10. Johnson, A., Roberts, L., & Elkins, G. (2019). Complementary and alternative medicine for menopause. Journal of Evidence-Based Integrative Medicine, 24.
  11. Kemnic, T. K., & Coleman, M. (2019). Vitamin E deficiency. In StatPearls [Internet]. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK519051/
  12. Li, L., Lv, Y., Xu, L., & Zheng, Q. (2015). Quantitative efficacy of soy isoflavones on menopausal hot flashes. British Journal of Clinical Pharmacology, 79(4), 593–604.
  13. Mostrom, M., & Evans, T. J. (2011). Phytoestrogens. In Reproductive and Developmental Toxicology (pp. 707–722). Academic Press. Retrieved from https://www.sciencedirect.com/science/article/pii/B9780123820327100529
  14. Peacock, K., & Ketvertis, K. M. (2019). Menopause. In StatPearls [Internet]. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK507826/
  15. Perna, S., Peroni, G., Miccono, A., Riva, A., Morazzoni, P., Allegrini, P., … Rondanelli, M. (2016). Multidimensional effects of soy isoflavone by food or supplements in menopause women: A systematic review and bibliometric analysis. Natural Product Communications, 11(11).
  16. Thrane, M., Paulsen, P. V., Orcutt, M. W., & Krieger, T. M. (2017). Soy protein: Impacts, production, and applications. In Sustainable Protein Sources (pp. 23–45). Academic Press. Retrieved from https://www.sciencedirect.com/science/article/pii/B9780128027783000020
  17. USDA. (n.d.) USDA Food Composition Databases. Retrieved from https://ndb.nal.usda.gov/ndb/
  18. Ziaei, S., Kazemnejad, A., & Zareai, M. (2007). The effect of vitamin E on hot flashes in menopausal women. Gynecologic and Obstetric Investigation, 64(4), 204–207.