For many women, hot flashes are menopause's most-dreaded symptom. And it's no wonder: These episodes come on suddenly, spreading an intense feeling of heat over the entire body, especially in the head and neck. What's more, they may be accompanied by rapid heartbeat, perspiration, or dizziness.

Although hot flashes don't last long—generally 30 seconds to a few minutes—they can occur up to 50 times a day during both menopause and perimenopause. These episodes are also remarkably common; approximately 75 percent of menopausal women experience them. For nearly 80 percent of those women, hot flashes will subside after five years, but 10 percent may experience symptoms for as many as 10 years. Doctors don't know why hot flashes occur, but they blame a combination of hormonal and biochemical fluctuations from declining levels of the female hormone estrogen.

Traditional Treatments

Historically, doctors have treated hot flashes with oral or patch forms of estrogen; or hormone therapy, consisting of either estrogen or an estrogen-progesterone combination. Both methods effectively reduce the frequency and severity of hot flashes by about 80 percent. However, many experts now view hormone therapy with caution after a federally-sponsored study was halted due to concerns about increase risk of heart attacks, strokes, and breast cancer.

Along these lines, experts urge women experiencing hot flashes to consider the potential risks and benefits—and their own medical history—before deciding to go the hormone therapy route. According to experts, women who decide to proceed with hormone therapy should get the smallest effective dose over the shortest amount of time.

Non-Estrogen Choices

Women who are concerned about hormone therapy complications can talk to their doctors about non-estrogen prescription medications, which have up to a 70 percent success rate in treating hot flashes. Keep in mind that most of the drugs have side effects, such as weight gain and drowsiness.

  • Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).
    The drugs, normally used to treat depression and anxiety, include Effexor, Paxil, Prozac, Zoloft and Celexa.
  • Clonidine
    Normally used to control blood pressure, this drug works in some women and fails in others.
  • Depo-Provera
    This birth-control method, administered by injection, also has yielded positive results in treating hot flashes.
  • Gabapentin
    Also known as Neurontin, is usually prescribed to treat seizures and migraine headaches. The drug reportedly is moderately effective in thwarting hot flashes.

Tips for Mild Hot Flashes

If your symptoms are milder, you may be able to combat hot flashes with these simple techniques:

  • Keep cool
  • Slight increases in your temperature can trigger hot flashes. Dress in layers so that you can remove clothing when you get too warm. Open a window or use a fan or air conditioner to keep air flowing. If you feel a hot flash coming on, sip a cold drink.

  • Get active
  • After getting the green light from your doctor, go on brisk walks or engage in another vigorous activity for at least 30 minutes or more on most days of the week.

  • Watch what you eat and drink
  • Hot and spicy foods, caffeinated beverages, and alcohol can trigger hot flashes.

  • Relax
  • Many women find relief from mild hot flashes through yoga, meditation, relaxation, or other stress-reducing techniques.

  • Practice paced respiration
  • Deep, slow abdominal breathing—known as paced respiration—can decrease hot flashes.

  • Quit smoking
  • Smoking is linked to increased hot flashes.

Alternative Treatments

Women in Europe and the United States have been using black cohosh for years to treat hot flashes, but health experts question its effectiveness. For instance, a study by the federal government's National Institutes of Health found that black cohosh was no better than fake pills for stymieing hot flashes.

As for soy products, some researchers believe their isoflavones (which are natural estrogen-like compounds) may also treat hot flashes. This is based on studies that show Asian women, who typically eat plenty of soy, report fewer symptoms. Other studies have found no such results. The best sources of soy are tofu, tempeh, soymilk, and soy nuts, which are more likely to work on mild hot flashes.

Another possibility is flaxseed because of its natural phytoestrogens. A small Mayo Clinic study in August 2007 found that post-menopausal women who were not on estrogen who used dietary flaxseed every day saw a 50 percent reduction in hot flashes over six weeks. Other observers warned the study was too preliminary to prove flaxseed's effectiveness at handling hot flashes.