Hot Flashes Demystified: Balancing Hormones for a Cooler, Calmer You in Perimenopause and Beyond
by Dr. Beth Meneley, DAOM, L.Ac.
Hot flashes. They're one of the most frustrating symptoms of hormone imbalance during perimenopause and menopause. You may wonder—why do they happen, and what can be done to stop them? As a functional medicine expert specializing in hormone health, I’m here to demystify this common concern for women navigating perimenopause and menopause.
At Evolved Menopause, we believe in empowering women with knowledge, so let's dive into the causes of hot flashesand explore the difference between estrogen dominance and estrogen deficiency.
Hot Flashes and Estrogen Dominance
Hot flashes aren’t just limited to women with low estrogen. In fact, estrogen dominance can also trigger hot flashes, especially during perimenopause, when hormone levels begin to fluctuate wildly.
Estrogen dominance occurs when your body is producing normal or high levels of estrogen but is lacking sufficient progesterone to balance it. This hormonal imbalance is common in women during the early stages of perimenopause, when ovulation becomes irregular and progesterone levels start to drop.
Symptoms of Estrogen Dominance may include:
Hot flashes
Breast tenderness
Heavy or irregular periods
Mood swings or irritability
Bloating and weight gain, especially around the hips
While estrogen is still present in the body during this stage, it’s the unpredictable surges and drops in estrogencombined with a lack of progesterone that cause the hypothalamus (the body’s thermostat) to misfire, resulting in those sudden heat waves we know as hot flashes.
Hot Flashes and Estrogen Deficiency
On the other side of the spectrum, estrogen deficiency is a hallmark of menopause or late perimenopause. During menopause, the ovaries produce less estrogen, and this lack of hormone disrupts the hypothalamus' ability to regulate body temperature.
Estrogen deficiency is the primary reason many women experience hot flashes in postmenopause. As estrogen levels drop significantly, the body’s internal temperature regulation becomes more sensitive, triggering vasomotor symptomslike:
Hot flashes
Night sweats
Vaginal dryness
Sleep disturbances
How to Address Hot Flashes in Perimenopause and Menopause
The good news? There are effective ways to manage hot flashes regardless of whether they stem from estrogen dominance or estrogen deficiency.
Bioidentical Hormone Replacement Therapy (BHRT): At Evolved Menopause, we prioritize natural, bioidentical hormone replacement therapy that works in harmony with your body. For women in perimenopause, supplementing with bioidentical progesterone can help balance estrogen dominance and reduce hot flashes. For those in postmenopause, bioidentical estrogen (combined with progesterone for safety) can ease the symptoms of low estrogen, including hot flashes.
Support Liver Detoxification and Estrogen Metabolism: One key component of hormone health is ensuring that your body metabolizes and detoxifies estrogen properly. Supporting your liver function with supplements such as DIM (Diindolylmethane), calcium d-glucarate, and methylation support (like B vitamins) can help estrogen break down through healthier pathways, reducing the risk of 4-OH pathways that may contribute to cancer risk.
Lifestyle and Nutrition: In addition to hormone therapy, your lifestyle plays a critical role in managing hormone imbalances. At Evolved Menopause, we recommend dietary and lifestyle changes that support hormone health:
Regular exercise to help manage weight and improve mood
Nutrient-dense diets rich in healthy fats, fiber, and phytoestrogens (from flaxseeds or soy)
Stress management techniques, including grounding, yoga, and mindfulness practices
Optimize Gut Health: Did you know that your gut plays a role in how well you metabolize and excrete estrogen? Supporting your GI health with probiotics, fiber, and digestive support is key to optimizing your hormone balance.
Liver and Mitochondrial Support: By optimizing your liver function and mitochondrial health, you not only enhance hormone metabolism but also promote energy production and anti-aging benefits. We recommend supplements such as CoQ10, NAC (N-acetylcysteine), and lipoic acid for boosting mitochondrial function.
Why We Don’t Recommend Non-Bioidentical Hormone Replacement Therapy
One of the reasons we are strong advocates for bioidentical hormones at Evolved Menopause is because they are chemically identical to the hormones your body naturally produces, making them safer and more effective.
Non-bioidentical estrogen, especially oral estrogen, has been linked to a higher risk of blood clots, stroke, and breast cancer. This is why we do not recommend synthetic or oral estrogen. Even non-bioidentical estrogen patches have potential risks for certain women, including an increased risk of cancer, particularly when not combined with progesterone.
Bioidentical progesterone is crucial when supplementing with estrogen because it protects against the risk of endometrial cancer. Together, bioidentical estrogen and progesterone create a safer, more balanced hormone therapy plan.
Conclusion: Take Control of Your Hormone Health
If you’ve been struggling with hot flashes, mood swings, or other hormone-related symptoms, know that you don’t have to suffer. Whether you're dealing with estrogen dominance or estrogen deficiency, the right hormone therapy and lifestyle changes can help you regain control of your body, mood, and overall well-being.
At Evolved Menopause, we’re here to support you through your journey. It’s time to say goodbye to hot flashes and embrace the next chapter of your life with renewed energy and vitality.
