Holistic management for medically induced menopausal hot flashes.


Abbigail  Langstone –Wring. BSc  SBRCP  MAR  DHom

Director International Council of Reflexologists

Holistic management for medically induced menopausal hot flashes.              

                   A monthly Health and Wellbeing event is held for patients that have finished their cancer treatment at Dorchester County Hospital. The aim of these meetings is to help patients (and their loved ones ) move forward with their lives with the provision of information and advice from a range of professionals. My role is to introduce Complementary Therapies, and to illustrate how holistic approaches to symptom management may help to improve and maintain physical and mental health.  It was during a session that the following question was asked and echoed by several ladies:- Is there anything complementary to help with hot flashes (night sweats) associated with medically induced menopause?

                   Breast cancer patients may as part of their treatment undergo procedures that disrupt normal hormone production, this may involve ovary removal or oestrogen blocking medication. One side effect of this action is “hot flashes” these can be more severe, distressing and of greater duration in this patient group (1). Whilst researching for some evidenced based information to forward to the ladies, I came across a review of scientific literature that stated given the evidence available, complementary alternative medicine therapies having limited effectiveness for hot flashes in breast cancer patients (1). I became intrigued as to how much evidence has been produced and what influence does this have on the choices available to women in this situation.

                   As a complementary practitioner, experience has taught me that nothing in the body functions in isolation. There exists a symbiotic relationship between emotional and physical symptoms. Although experienced independently these symptoms can become part of a wider cycle affecting more of the body’s organs and systems. Creating further symptoms for already vulnerable individuals to cope with. Holistic strategies help patients develop a deeper understanding of this relationship.  How it might have affected them in the past, or is affecting them now or may affect them in the future. This knowledge helps patients build confidence to manage their symptoms, to adjust to change and to move forward. When consulted my first thoughts are always to investigate symptom cause.

                  In this instance we know that hot flashes stem from a disruption of the endocrine (hormonal) system.  When a hormonal (in this case oestrogen ) supply is disrupted, in the body’s effort to cope other hormonal supplies may become unbalanced creating hypo (low) or hyper (high) levels of hormone secretions. The link  with decreased levels of oestrogen and the thyroid /adrenal connection can be confirmed via blood tests.   

               If we look for triggers to the hot flashes a good place to start is stress.  The “Fight or Flight” response is activated by the sympathetic nervous system through emotional /physical shock or trauma. It is reasonable to assume this response might be triggered by shock of diagnosis and experienced at stages throughout treatment and may now be imprinted and easily triggered. When stressed, anxious or fearful, the sympathetic nervous system (activator action) initiates the secretion of hormones from the adrenal glands. The inner part (medulla) secretes epinephrine (adrenalin) and norepinephrine (noradrenalin) in rapid response. Causing the heart to beat faster, blood vessels dilate, rise in blood pressure, vasoconstriction of vessels that supply digestive and urinary systems, breathing quickens,  spikes blood sugar levels by helping convert glycogen to glucose in the liver, increases waste removal and blood to active muscles and brain. All this action creates energy and energy creates heat.  The outer part (cortex) secretes the corticosteroid hormones. 1. Cortisol that helps regulate metabolism and helps the body respond to stress. 2.  Aldosterone that helps control blood pressure maintain a balance of salt and water.  3. Oestrogen and testosterone the sex hormones. (2 )The cycle of continual activation by the sympathetic nervous system to release adrenalin/noradrenalin can lead to adrenal fatigue. Often confused with hypo-thyroid, as the symptoms of poor sleep, loss of appetite, fatigue, depression and weight issues are similar.  This is a very simple explanation of a highly sophisticated and complex sequence of events.

              To ascertain to what extent stress might be triggering hot flashes. I encourage patients to keep a record of frequency, duration and severity of the hot flashes with a simple 1-5 scale.  (1 being tolerable and 5 being unbearable, and adversely affecting quality of life). This information with notes on any linked event enables identification of patterns of emotional /physical triggers. Once identified, therapeutic modalities can be explored.

               Managing stress with talking therapies such as counselling, offers patients the opportunity to explore and express their feelings or worries in a supportive, non-judgemental and safe environment. Patients are encouraged to develop techniques such as meditation, mindfulness, visualization, prayer with the aim of calming the mind and creating a sense of peace and tranquillity. Effective when trying to relax the nervous system and cope with hot flashes.  Managing stress with appropriate exercise such as gentle walking, Tai Chi, Yoga etc will not only release physical tension and increase mobility but provides the added bonus of social interaction, helpful in lifting mood and feeling of wellbeing. All forms of movement will assist in building strength, stamina and confidence.

               Reflexology, I have found to be the most remarkable therapy for balancing the hormonal and nervous systems in the body. Especially the effects of adrenal fatigue. The various nervous systems of the body are particularly responsive to this form of treatment as reflexology is thought to work through neural pathways. Connecting “mapped” areas on the feet, hand or ears to organs and systems of the body.  Re-balancing the autonomic nervous system by calming the sympathetic drive will help reduce physical effects of the fight or flight syndrome and produce a feeling of intense relaxation. Balancing the solar plexus (celiac plexus) will relax the major organs of the abdomen and diaphragm to ease breathing. (3)

              The side effects from chemotherapy, medication and stress are often poor appetite and digestion, bowel and bladder dysfunction and issues with weight. To aid recovery it is important to eat regularly a healthy balanced diet that contains all the necessary nutrients to repair and sustain the body. Marginal vitamin and mineral deficiencies may be responsible for minor symptoms, such as predisposition to headaches, difficulty sleeping or skin complaints. (4 ) Major deficiencies can identified via blood tests. The causes of deficiency may be through treatment and/or inadequate intake, digestion, absorption, assimilation and/or increased needs and losses.(4 ) Aiding the physical process of digestion is one function of the para-sympathetic nervous system and is worthy of note. In contrast, the stimulating effects of some substances such as Coffee, Tea, Chocolate, Sugar, Alcohol may irritate digestive processes and trigger hot flashes.  Evidence exists of the effects on the nervous system of Azo dye’s or E No’s these are chemical food colourings found in sweets and fizzy drinks. (Cola and branded energy drinks etc…. ) and Monosodium Glutimate  MSG E621 chemical flavour enhancer found in Chinese take-away foods, instant soups and ready meals. (5) It is not unreasonable to suggest a link between these stimulants and hot flashes.

                I have, in past articles discussed Herbal and Homoeopathic remedies that may offer some relief from naturally occurring menopausal symptoms. Salvia Officinalis (Sage), Agnus Castus (Chaste Berry), Red Clover (6) and many more. These are readily accessible over the counter in major pharmacies and health food shops. All seem to have a degree of success, bearing in mind that everybody is unique and will respond differently. In other words what works for one might not work for others. I am not medically qualified and as an experienced professional therapist I always recommend patients consult with a pharmacist before taking any “natural” remedies, and to be aware that contra-indications may exist.

              From the earliest times, medicinal plants have been crucial in sustaining the health and wellbeing of mankind.(7) Confusion and doubts arise when trying to assess conflicting evidence concerning phytoestrogens. Phytoestrogen ( a natural substance that is structurally or functionally similar to estradiol ) is found in the seeds, stems, roots or flowers of a variety of plants.  Soybeans, alfalfa sprouts, clover and linseed being the most significant.(8) Evidence from a CEPO review found for breast cancer survivors, phytoestrogens, black cohosh and St John’s wort not be used to treat hot flashes.(9) Whereas, Professor Jane Plant explains, most vegetables naturally contain phytoestrogens or substances that are converted into phytoestrogens in the gut. Examples being berries, seeds, spices, wholegrain cereals, cabbage, hops, tea, peas and legumes )(10) Epidemiological and some supporting clinical data suggest a breast cancer protective role for phytoestrogens.(11) When oestrogen levels are too high, phytoestrogens, by using up available oestrogen receptors, block out powerful human oestrogens, causing an antioestrogenic effect (8). This confusion is compounded by evidence of the isoflavone, genistein found in soy can stimulate oestrogen receptor-positive (ER+) breast cancer growth and interfere with the anti-tumor activity of tamoxifen.(11 )Whereas, Prof Plant suggests experiments on soya-bean phytoestrogen isoflavones such as genistein continue to indicate that such chemicals help prevent the growth of breast and prostate tumors because they are antioxidants and inhibit cell growth and the ability of tumors to develop blood supply. (10 ) Furthermore, this inhibitory effect of ER breast cancer cell growth, was shown in studies, and it may be reasonable for women with ER tumors to safely consume soy and possibly other phytoestrogens.(11 ) It is virtually impossible to eliminate phytoestrogens from the diet due to it being a constituent in so many of our every-day foods. It is obvious from my investigations that there is a need for more research to clarify the role of phytoestrogens in breast cancer patients, as a preventative and in the management of  oestrogen-deficient symptoms.

               To try and answer the original question without confusing matters further and returning to my original thought that stress is a major factor in hot flashes. It might be useful to seek out remedies that may assist the endocrine and autonomic nervous systems to balance and calm the mind, body and emotions.

 Lemon Balm. Passion flower.  Siberian ginseng. Skullcap. Sweet basil. Chamomilla.(7)  Homoeopathic remedies indicated for stress Arsen Alb. Argent nit. Aurum met. Ignatia, Lycopodium, Sepia, Aconite. (12)

               Alongside clinical trials there have been a number of outcome studies, while not being double blind and controlled, ask patients about the outcome of their treatment. There is a public trend away from some aspects of conventional drug based medicine and sympathy with the idea of a more holistic way of treating the whole person. There is a growing interest from the medical establishment in exploring the possibility of integrating some complementary therapies into treatment approaches. (12)

So where does this leave the patient ?       My advice is “Do your own research” and ask questions to enable you to make informed choices. Copyright ©AW/2017

              My holistic top tips for managing hot flashes.

  1. Identify if stress is a contributory factor in your hot flashes.
  2. Search out and trial complementary therapies to establish what helps you.
  3. Consider your diet. Examine what and how you are eating and eliminate or restrict consumption of stimulants.
  4. Keep moving. Increase mobility to reduce the risk of lymph/fluid retention and to trigger the release endorphins to make you feel better.
  5. Keep cool. Mentally, avoid stressful situations. Physically, wear loose clothing of natural fibres.
  6. Environmental chemicals. Reduce your exposure in the home and to your body via personal hygiene products and cosmetics.
  7. Be happy. Engage in activities that are fun. Laughter releases “feel good”  hormones.
  8.  Always check with your pharmacist before taking any “natural” remedies or supplements.   ©AW/2017

1.   Bordeleau L, Pritchard K, Goodwin P, Loprinzi C.      Therapeutic options for the management of hot flashes in breast cancer survivors : an evidence based review     Clin Ther.    2007   (2)   230-41

2    Tucker L.      Anatomy  &  Physiology    2008    Ems publishing             London     88-98

3    Crane B.             Reflexology  :  The Definitive Practitioner’s Manual       1997     element    London     369-377

4    Sullivan K      Vitamins and Minerals   1998      element books     Dorset.  16-7

5    Hanssen M.     E for Additives.   10th edition   1988 Harper Collins   Glasgow     GB      85-8      277-280

6    Boericke  W.       Materia Medica with repertory.     9th edition     1927   Comprising the characteristic and guiding symptoms of all remedies. Boericke  union  Philadelphia  USA

7   Chevallier A.   The  Encyclopedia of Medicinal Plants   1996   Dorling  Kindersley      London   16-17

8    Dr M  Murray.   Dr J Pizzorno    The Encyclopedia of   Healing Foods   2006     Time Warner      Bath. 386-7

9    L’Esperance S,  Frenette S,  Dionne A , Dionne JY        Pharmacological and non-hormonal treatment of hot flashes in breast cancer survivors  : CEPO review and recommendations    2013   Support  Cancer  Care  (5)   1461-74.

10   Prof Plant J.     Your  Life  in  Your  Hands.   Understanding,  Preventing and Overcoming Breast Cancer.   2003   virgin publishing  GB 296-8

11  Duffy C, Cyr M     Phytoestrogens  :  potential benefits and implications for breast cancer survivors.   J   Womens Health   2003  (7)   617-31

  1. Lockie A     Encyclopedia  of    Homoeopathy    2000   Dorling  Kindersley    GB  London  211

For more information on symptom management take a peek into my “Holistic Health” book £9.00 including p&p available from Buena Vista. Gypsy Lane. Weymouth. Dorset DT4 0BZ. Tel  01305 784986. Abbigail is fully qualified, insured and DBS checked with 25years professional experience specializing in Clinical Reflexology, Counselling, Allergy Testing and Nutrition. ©AW/2017