For those of a certain age, when menopause – a time when menstruation ends and fertility ceases – begins to set in, suddenly feeling flushed and hot can be a common occurrence. “Hot flashes affect up to 80% of women during menopause,” says Nichole Dandrea-Russert, the nutritionist behind purelyplanted.com and the author of “The Fiber Effect.”
Hot flashes are just one in a series of symptoms that develop in those approaching and entering menopause. Grouped under the term vasomotor symptoms, or VMS, hot flashes dissipate heat in the body.
“It’s a widespread dilation of blood vessels throughout mostly the upper body that causes your skin temperature to raise and feel hot,” explains Dr. Corinne Menn, a board-certified OB-GYN and medical director of Alloy Women’s Health, a menopause treatment products company based in New York City. Hot flashes cause sudden sweating and an uncomfortable sensation of being too hot all at once.
When they occur at night, hot flashes may be referred to as night sweats, and many people wake up feeling very warm and covered in sweat, especially around the neck and upper body. “It’s the most bothersome and most common symptom of menopause,” Menn says.
You’ll feel hot flashes all over, but the source of the issue is based in the brain. “There are thermoregulatory centers in the brain in the hypothalamus,” Menn explains. When the levels of estrogen in the body plummet dramatically, as transpires when someone enters menopause, the estrogen receptors on neurons in the brain are disrupted. In the hypothalamus, this leads to a dysregulation of the brain’s ability to keep your body at a constant temperature.
This disruption also leads to changes in the interplay between serotonin and dopamine, two neurotransmitters that regulate how you feel. It can also lead to inflammation in the small blood vessels of the body, which is a real concern because it can increase the risk of cardiovascular disease, insulin resistance, higher cholesterol and higher blood pressure, Menn explains.
“The duration of a flash usually ranges from one to five minutes, but some flashes last up to 60 minutes,” Dandrea-Russert says. Hot flashes tend to be worse when someone first enters menopause and become less frequent and less intense over time. However, Menn says that on average, these symptoms last for seven years. That’s a long time to be uncomfortable and at an increased risk of heart disease.
It’s Inevitable But Not Unmanageable
While menopause may be unavoidable, there are ways to make its symptoms more tolerable. One such way involves diet.
According to a recent study in the journal Menopause, a plant-based, whole foods diet reduced hot flashes associated with menopause by a whopping 88% — certainly an attention-grabbing report that would seem to indicate that food might be the key to solving this common and unpleasant problem.
But as Menn notes, “the devil is in the details.” She says that this small, short-term study excluded women who had undergone premature menopause, which can occur after events such as surgery to remove the ovaries. “There’s a significant portion of women every year who have their ovaries out for benign reasons,” she says. This study, however, didn’t look at their experience. Menn points this out because women with surgical menopause are the ones who are most at risk of cardiovascular problems related to that early menopause.
The study also included women who had just two or more hot flashes per day, which is considered relatively mild, Menn says. While those with milder effects of VMS did see a benefit from a plant-based diet, it’s not clear whether women with more severe symptoms would garner as much relief.
In addition, the study looked at a very strict vegan diet, which may not be tolerable for all consumers. The study was made up primarily of “white, super-educated women on a strict vegan diet for 12 weeks who had mild hot flashes,” Menn summarizes. “Yes, they saw a big decrease, but my guess is that if you put the average woman in that study, they wouldn’t be able to stick with it for 12 weeks, much less six months or a year or two. And my guess is if someone was having seven hot flashes a day, which is the more typical amount, they probably would not have nearly the same positive effect as what we’ve seen in this small cohort.”
What to Eat to Reduce Hot Flashes
That doesn’t mean diet can’t help, Menn hastens to add. “This is great evidence that it may help you a little bit,” no matter how severe your symptoms are. Certain foods seem to be supportive of health during this time of transition, including:
- Soy products. Tofu, soy milk, edamame and other products derived from soy may have an outsized impact on vasomotor symptoms such as hot flashes. Soy contains phytoestrogens, a compound that can mimic the effects of estrogen in the human body. Adding these compounds via food can help decrease the severity of symptoms because the body thinks there’s more estrogen available to regulate temperature.
- High-quality protein. Dr. Mary Claire Haver, a Houston-based board-certified OB-GYN and creator and founder of the Galveston Diet, a plant-based diet for women going through menopause, says that high-quality protein is also a key element to eating right during menopause. As it turns out, soy protein is considered a high-quality protein. Additional plant-based sources include other beans and legumes. Limited intake of seafood, such as salmon and shrimp, can add heart-healthy omega-3 fatty acids along with high-quality protein.
- Whole grains. High-fiber whole grain foods are a cornerstone of good nutrition that can help you manage your weight. In menopause, hormonal changes can make it difficult for women to keep off excess weight, but eating a balanced, high-fiber diet that includes whole grains can help.
- Healthy fats. Healthy fats, such as olive oil and avocado, can make you feel full for longer, which can support maintaining a healthy weight as well. Healthy oils also contribute omega-3 fatty acids, which are important for supporting heart and brain health.
- Fruits and vegetables. Eating a rainbow of fresh, whole fruits and vegetables each day is a surefire way of getting all the micronutrients you need, including vitamin C, calcium and fiber. The brighter the color of the produce, the higher it is in antioxidants, which may lower inflammation throughout the body and support heart health.
- Flax seeds. Dandrea-Russert says that flax seeds are a good source of phytonutrients (plant-based nutrients) and lignans, a type of plant compound that’s a precursor to phytoestrogens. “One study showed that women experiencing at least 14 hot flashes per week who added 4 tablespoons of flax meal per day to their diet for six weeks decreased daily hot flash frequency by 50%, and intensity dropped by 57%,” she says.
- Oils and supplements. There is some evidence that certain herbal compounds, including black cohosh, evening primrose oil and ginseng, can help alleviate some menopause symptoms, according to 2018 and 2022 studies. Menn, however, says the results are similar to placebo.
Haver notes, “Declining estrogen levels during menopause mean that women’s bodies have different nutritional needs than earlier in life. You’ll have to tweak your diet a little to support feeling well, but the good news is that good nutrition can help reduce hot flashes, improve sleep, improve cardiovascular health, increase bone density and muscle mass and maintain a healthy weight.”
Dana Ellis Hunnes, a senior clinical dietitian at UCLA Medical Center, assistant professor at UCLA Fielding School of Public Health and author of “Recipe For Survival,” agrees that diet can make a big difference to how you feel during menopause. “Staying fit and healthy can go a long way, weight management can go a long way, and diet – specifically a whole, plant-based diet – can go a really long way,” she says.
Don’t Fear Soy
“Previously, it was believed that soy products increased the risk of breast cancer. However, consuming moderate amounts of soy products does not raise the risk of developing breast cancer or other cancers,” Haver says. Consuming one to two servings of soy products per day is considered a moderate amount.
What’s more, “in countries where higher quantities of soy products are consumed, there are lower rates of breast cancer,” Hunnes points out. She believes that the the soy–breast cancer association has been debunked many times over, except in cases of estrogen receptor-positive breast cancers, which she says needs further research to determine the role of soy. In short, our evolving nutritional understanding is that “soy is associated with lower risk of breast cancer in most cases (and) soy and plant-based diets are associated with lower risk of cancer (not prevention) and healthier, longer lives. Soy is a healthy food and should be consumed without fear,” Hunnes says.
Menn says fears around soy products and any potential link to breast cancer have been proven erroneous and were based on misinterpretation of data from a large study called the Women’s Health Initiative in the early 2000s. That research suggested there was a correlation between soy consumption and an increased risk of developing breast cancer; the estrogenic compounds in soy were thought to potentially elevate the risk of developing the disease in some people. But those findings have since been proven incorrect.
In fact, Haver says, more recent studies have shown that a diet full of soy products actually lowers the incidence of breast cancer in women. However, this protective benefit is less pronounced in those who consume less soy or those who begin consuming it later in life.
“Soy can actually lower the amount and severity of hot flashes and night sweats while actually lowering breast cancer risk in some cases,” says Dr. Felice Gersh, a board-certified OB-GYN and founder/director of the Integrative Medical Group of Irvine in California and the author of “Menopause: 50 Things You Need to Know.”
She adds, “Except in cases of true allergy, soy can provide an excellent source of fiber, protein, micronutrients, and phytoestrogen.” All of these can contribute to overall health and wellness and may help alleviate hot flashes to some extent.
A Word About Soy Supplements
Dandrea-Russert notes that the less processed the soy is, the better. “Whole-food soy, like edamame and soybeans, or minimally processed soy, like tofu, tempeh and soy milk, can be protective against certain types of cancer, like breast and prostate cancers. In addition to reducing the risk of breast cancer, soy intake also has been associated with lower rates of heart disease and lower cholesterol, especially when it replaces meat in the diet.”
She notes that you can take isoflavone supplements, “but a food-first approach is always best since there are many other nutrients in plant-based foods that are beneficial. Isoflavones can easily be obtained from whole soy foods.” Isoflavones are compounds found in beans, legumes and some fruits and nuts that mimic the effects of estrogen.
She recommends consuming 50 to 100 milligrams of isoflavones from food per day. This is a safe amount that may help relieve hot flashes, she adds. It can also introduce nutrients, such as plant protein, calcium, iron, fiber and other essential vitamins and minerals found in organic soy, to your diet. Examples of that serving size include:
Eating right is just the beginning for supporting overall health and well-being before, during and after menopause. Other ways to feel better include:
- Exercising. Any kind of exercise is a good thing, but Menn says that weight training – and lifting heavy weights in particular – is especially helpful for keeping menopause symptoms at bay.
- Reducing stress. Meditation and other mindfulness practice can help reduce hot flashes. “Paced breathing may also reduce hot flashes,” Dandrea-Russert says. “One study found that slow, diaphragmatic breathing once or twice a day helped reduce hot flashes by slowing down the sympathetic nervous system.”
- Sleeping. Getting good sleep can be challenging, especially if you wake up frequently because of night sweats, but supporting good sleep hygiene can help alleviate the effects of VMS for some women.
- Losing weight. If you’re overweight or have obesity, it may help to shed some of that excess weight, says Dr. Eleonora Teplinsky, head of breast medical oncology at Valley Health System in Paramus, New Jersey, and clinical assistant professor of medicine at Icahn School of Medicine at Mount Sinai in New York.
- Avoiding triggers. If there are certain foods that you know trigger hot flashes, such as spicy foods, caffeine or alcohol, avoiding those can help keep these symptoms at bay.
- Keeping cool. While hot flashes originate in the brain and are based in the body, the environment around you can contribute to discomfort. Gersh recommends keeping the room cool, using a fan and drinking cool beverages. Wearing lightweight, absorbent clothing can also help, she says.
- Staying well hydrated. “Hydration becomes even more important during menopause and beyond,” Dandrea-Russert says. “To help manage hot flashes and dryness that may occur during menopause, drink plenty of water. Many plant-based foods have a high water content, which can also help with hydration.”
- Trying acupuncture. Teplinski adds that the “data for acupuncture is mixed, but it may be helpful for some” people going through menopause.
Consider Hormone Replacement Therapy
While these behavioral modifications can be helpful in addressing symptoms of menopause, Menn notes that it’s not an either-or proposition when it comes to hormone replacement therapy (HRT). “Our understanding of hormone replacement therapies has really evolved,” she says, adding there are many options that you can discuss with your doctor.
“I think it’s really important for women to think about feeling your best during menopause,” Menn continues. “There is no one perfect fix. You have to think of it as a complex, multifaceted thing. But if you’re in your first 10 years of menopause and you’re symptomatic and it’s affecting the quality of your life, HRT is the gold standard and far outweighs any risks for the average woman.”
Gersh agrees that HRT is the “gold standard” to treat hot flashes. “Even small amounts of estrogen can significantly reduce the severity and frequency of hot flashes,” she says.
Lastly, Gersh notes that while menopause is an entirely natural process, it’s “definitely not beneficial to the health of women, heralding a significant metabolic shift resulting in high rates of mood disorders, insomnia, hot flashes and night sweats, hypertension, cardiovascular disease, muscle and bone loss, systemic inflammation, skin wrinkles, cognitive decline and more.”
These symptoms arise because of the dropping levels of estrogen in the body, and while consuming phytoestrogens can help, “replacing estradiol (and progesterone through HRT) remains the best and foundational approach to treating all menopause symptoms and health effects,” Gersh says.