Dr. Nicole Sundene, NMD
"I have been taking Evening Primrose oil for night sweats and it was working well and then suddenly stopped working, what else can I try to naturally help my night sweats?"
~Pam J Scottsdale, AZ
Night sweats or nighttime “hot flashes” can be a very frustrating problem for women in menopause or perimenopause. If the Primrose oil is not working, it may be a sign of transitioning from perimenopause to official menopause.
Typically a hot flash is an experience of intense heat with sweating and increased heartbeat. The hot flash can last for a few minutes or up to 30 minutes.
Usually, the hallmark sign it is a hormonally triggered night sweat or hot flash is when the sensation of heat begins on the face or chest, or back of the neck and then spreads throughout the entire body. The skin will feel hot to the touch as all of the capillaries are in vasodilation to help cool the body down. Because of this women often end up feeling too cold, and bounce back and forth between hot flashes and cold flashes until we correct hormone imbalance.
Much more can be done for night sweats in addition to a good source of oils in the diet, such as evening primrose oil. If EPO is no longer working, I would try adding or switching to flaxseeds as they are a good source of phytoestrogens and lignans which are shown to be helpful in menopause, and contain beneficial omega-3 oils.
Freshly grind whole flaxseeds with a coffee grinder and consume about 1-3 tablespoons once to twice daily especially before bed. You can mix them in with yogurt, applesauce, or juice and consume one hour before expected bedtime.
Many of my patients have found immediate relief and “sleep like babies” just from this tip, which is simple, healthy and inexpensive "Food as Medicine." However, not everyone has the same biochemistry so let's talk about why these night sweats are happening first to understand them, and what other natural treatments for night sweats are shown to be clinically beneficial.
First of all, as women age, the ovaries are making less and less estrogen, testosterone, and progesterone. Estrogen naturally keeps us “cool” in both the temperature and attitude aspects as it not only affects our thermostat, but our neurotransmitter production, and thus mood swings occur along with other symptoms of menopause such as night sweats. Anxiety, agitation, depression, and ADHD symptoms can become worse at this time for women that already struggle with them or present themselves as completely new symptoms that women have never experienced before.
When women suddenly develop anxiety or depression in their 40's or 50's we should look at their hormones as the most likely underlying root cause of the mental health issue. If you are also struggling with your mental health, I recommend reading my article about hormones and mental health here: "Naturopathic Psychiatry: Hormones, Nutrition, and Neurotransmitters."
If you are having hot flashes all day and all night then the hormone imbalance is generally from deficient estrogen. If you are primarily too hot only at night and cannot sleep this is a hallmark sign of progesterone deficiency as is seen in perimenopause.
Men have less estrogen in their system, but don’t get hot flashes typically because they have some hormones in their system, are not usually at zero with their hormone tank, and are not having hormonal fluctuations from their menstrual cycle.
For men even with low testosterone, a steady state of testosterone is still burning off into a constant steady state of estrogen or at least 30-40 points for most men I have tested, which is why they don't get night sweats or hot flashes. They still have a small amount of estrogen in their tank, unlike most menopausal women I test are at zero. Therefore, the main treatment goal is to keep estrogen levels consistent so that estrogen levels don’t suddenly drop to zero and cause hot flashes and night sweats.
When the ovaries stop making hormones, the adrenals and body fat become the sole source of estrogen production which is why I see women that are very thin and very obese struggling with perimenopause and menopause the most. Having a little bit of body fat is a good thing for menopausal hormone balance. Working on weight loss is important for women in perimenopause and menopause yet often difficult to achieve without a Holistic Hormone Doctor such as myself helping them to be successful.
Natural Treatments for Night Sweats & Hot Flashes in Menopause:
First, please see your Naturopathic Hormone Doctor to ensure you are entering menopause and are not suffering from a different problem before implementing any self-help or natural protocols. There is always the rare possibility that hot flashes are being caused by diabetes, infection, or cancer. A skilled Women's Health Doctor will be able to confirm your diagnosis.
Labs for FSH, estrogen, testosterone and progesterone levels should be drawn, as well as testing of your thyroid, A1c, Basic Metabolic Panel, and CBC- Complete Blood Count (to rule out cancer and other causes of night sweats.) I commonly see women becoming diabetic and pre-diabetic with menopause so it is imperative your doctor checks your A1c.
Also, this transition period can be EXTREMELY stressful for some women so having the support of your physician, friends, and maybe even an online support group should ease the transition.
BHRT: Bioidentical Hormone Replacement Therapy is the most common treatment for menopause I provide, however not all women can take hormones due to family history of breast cancer. When needed, I recommend bioidentical hormones or estradiol, testosterone, and progesterone that have been made from yams by a compounding pharmacy and are the same natural molecule your body would make.
Premarin=Poison Whatever you do, please make sure you are not given premarin or prempro as premarin is made from “Pregnant Mare Urine” and is thus collected in a manor abusive to animals….and dangerous! Horsey Hormones are dangerous for women as they were shown in 2002 to increase breast cancer and stroke and therefore should never be prescribed anymore.
If a doctor is prescribing this, they are trapped in a 1990's model of medicine and should be put out to pasture with the pregnant horses that are kept locked in pens that collect their urine. Lets all just please be free of this Premarin nonsense. I hate to say that I actually have patients STILL on premarin come to me 20 years after the Women's Health Initiative in 2002 found Premarin dangerous garbage. I actually worked for multiple doctors at this time and we had to make hundreds of phone calls to stop all patients from taking this dangerous garbage.
That is when everything in my career became the Herbal Medicine and Bioidentical Hormones that I prescribe now. That is actually when MD's gave me FULL permission to put their hot flash patients on herbs out of desperation. I made them a self-help handout with many of these tips I still use today. Even the doctors that hated Naturopaths passed out my menopause tips! That was how dangerous Premarin was in their minds.
So I really don't know why any doctors still prescribe these, but if you check your hormone prescription and it says Premarin or Prempro you need to fire your doctor that is completely clueless about hormones and actually dangerous to your health. I would actually argue in this case they are seriously endangering your health. No hot flash is worth risking cancer or strokes!
For minor night sweats, start with natural treatments and work your way up to BHRT if need be. Some women need hormones temporarily as they transition to lower hormone levels and many of my patients opt to just use a light low dose hormone cocktail cream of estrogen, progesterone, and testosterone. For severe symptoms, that are disrupting your sleep, mood or quality of life....pop over to my SCHEDULE page to book a visit ASAP!
Herbs for Menopause, Nightsweats and Hot flashes
Nettles: Research shows stinging nettles at 450mg a night helped women with menopausal hot flashes. This is about 1-2 capsules of leaf not root depending on brand. Nettles are also excellent for Female Hair Loss!
Isoflavones: Molecules that weakly mimic estrogen found in nature such as soy, red clover, hops, and so forth can be helpful in establishing a more consistent estrogen level. Be sure to take these supplements regularly for optimal effect. As stability is key.
Flaxseed: 1-3 tablespoons freshly ground as mentioned above in your Bedtime Snack.
Ginseng: and other adrenal adaptogens are helpful as the liver and adrenal glands take over the sole production of hormones as the ovaries cease estrogen production. The ”Siberian” form of Ginseng is best for women. I also like Ashwaganda and Schisandra for women with stress accompanied by low sex drive.
Black Cohosh: Can be helpful for many women, if it doesn't work you need an appointment with me!
Diet and Nutritional Factors for Menopause, Hot Flashes and Night Sweats
Liver Support: The liver is metabolizing estrogen, so ensuring it’s proper functioning is prudent. Try increasing liver support foods such as kale, beets, artichokes, milk thistle, greens, apples, pears, carrots and lemons to balance hormones. Read: "Detox Diet"
Avoid the Hot Flash Trifecta: Caffeine, Spicy Foods, and Alcohol. This is one of the main problems women endure with natural treatments. If you aren’t willing to give these foods/beverages up….try having them earlier in the day. At the very least do an elimination period for a week so you can experience what life is like without them, then have them all at once and see if they induce a hot flash. Knowledge is powerful motivation.
Avoid sugar and heavy carbs before bedtime. A light dinner of veggies, brown rice or other complex carbs, and light protein is best for dinner. Skip the dessert before bed and follow my "Diabetes Diet" to balance your blood sugar and avoid hyperglycemia triggering your hot flashes.
Consider an herbal sedative in the evening as the main issue with night sweats is losing sleep and resulting sanity! If you aren’t sleeping well you likely aren’t coping well with the menopause transition. Proper sleep is imperative to good health. Read: "10 Best Herbal Sedatives."
Lifestyle Factors for Menopause, Hot Flashes & Night sweats
Keep a fan by your bed, workstation, etc. Keep your bedroom around 68F. A sleep study found women sleep the best at this temperature. A 77-78F bedroom in Arizona will not be compatible with sound sleep and you will end up spending more money on supplements to sleep soundly than you will if you just plan to turn the AC down every night.
I would tell a husband or partner that is not happy with the AC bill that the female hormone doctor has done a cost-benefit analysis after 23 years and concluded it will save him money. How do I know this? I have only worked in Women's Health and Hormones for 23 years and I see the same menopause challenges every day.
I know the consequences of insomnia for women and what supplements and hormones cost to get menopausal women comfortable in stuffy hot bedrooms vs a small bump in an AC bill. It will save you money in supplements for brain fog, chronic fatigue, and depression that occurs from hormonal insomnia. You can read my blog all about how I got randomly selected to become a Hormone Doctor or take my word for it.
Try a cooling mist spritz of water & essential oils Clary Sage and Lavender (add a few drops of each per ounce of H2O) and spritz on your face, neck, chest. Always test on your inner arm before first applying to your face, chest or neck. Start with 1-2 drops per ounce and increase as needed. I generally use about 5-10 drops in a mist but it will also depend on the patient's skin sensitivity. You can keep the bottle in the fridge by day, or on ice near your bed at night for added cooling benefit.
Osteoporosis and menopause go hand in hand, as estrogen drives calcium in to our bones. If you are reading this your hot flashes are a warning sign that it is time to get a DEXA to check your bones! Both of my Grandma's had terrible osteoporosis that caused them miserable pain at the end of their lives. They developed fractures that would never heal. I never want any patient under my care to suffer from this highly preventable disease!
Keep in mind that you should be taking 500mg of calcium with food twice daily, combined with 250mg of magnesium and 2000-5000 IU of vitamin D, along with weight bearing exercise to prevent your bones from becoming brittle and susceptible to fractures now that your body has less estrogen. Women should do 20 minutes of "Weight Bearing Exercise" with weights like a Body Pump class, walking with hand weights, wrist weights and ankle weights. Some patients fill up a gallon jug of water and hike or walk with it in their backpack. If you hike uphill you can dump the water out at the top of your hike to save your knees on the way down. WARNING: If you do walking, cycling, and swimming for your exercise you are at high risk of Osteoporosis and not driving calcium in to your bones!
Proper Colon Elimination: If you are not having 1-2 bowel movements daily, you should increase water and fiber in your diet. Along with the liver, the colon plays a role in estrogen elimination, and consistency is key since your body will become adjusted to whatever level of hormones you are at and it is fluctuation of the hormone levels that can trigger hot flashes.
Wicking Fabrics: Try sleeping in pajamas and bedding that are designed to wick sweat away. Work out clothes designed to “breathe” can make for great pajamas for those with night sweats. They have cooling pillows, and bedding designed for menopausal night sweats on Amazon.
Exercise in the morning. By exercising in the AM you should sleep better and exercise is also beneficial for menopause.
How do I know if my Herbs for Night Sweat Treatment is working?
I know this problem is frustrating, because most women want an IMMEDIATE and quick fix….for good reason. I am very impatient myself so I will not make any empty promises with herbs and diet for menopause and night sweats. You need to allow 2-6 weeks for herbs to work! They are not a quick fix.
Bioidentical Hormones are THE quick fix for women with severe symptoms, and we can wean women off of them later. The great thing about using natural or "bioidentical hormones" is that we can gradually taper the dose down as your body adjusts to its new normal rather than suddenly crash after a very high state of estrogen as is common in perimenopause to extreme estrogen deficiency.
Hormone imbalance in a woman's 40's is much different than in their 50's and estrogen levels are at complete opposite extremes. So for my patients that don't want to use bioidentical hormones long-term, we simply use them to restore sleep and mental health and then gradually taper their hormone cream down to a light dose they can eventually just stop.
Factors that Make Menopause and Night Sweats Worse:
Remember menopause is a normal and natural transition of life for women, and a healthy body should go through it relatively smoothly when expecting a few bumps in the road. I commonly see women that are poorly conditioned aka they do not exercise enough struggle the most with their hot flashes.
Inflammation and a poorly toned cardiovascular system are thought to also be a cause of hot flashes and night sweats. Exercise for 30-60 minutes daily in the cardio zone per your fitness level to help tonify your cardiovascular system and help it become less reactive to low estrogen.
Never suddenly stop your hormone cream or menopause herbs. Plan to taper them at a time that is convenient such as in the cooler winter months, and well after the holidays.
Be gentle with yourself and patient with your body. Ask people to be nice to you to avoid hormonal agitation.
To monitor treatment efficacy for your menopause doctor, please keep account of the duration and frequency of your night sweats and hot flashes. The goal is to head in a diminishing direction. If after 6-12 weeks you are finding no effect with your natural herbal treatments for night sweats, then you need an appointment with me.
If you are receiving some relief then keep the current treatment on board and add something new into the mix. A diet diary may also be helpful. Rate your hot flashes on a scale of 1-10 with 10 being the most severe each day along with what you ate and drank. Note the duration in minutes as well. This may help sort out dietary causes such as alcohol, caffeine, and spicy foods and encourage you to decrease consumption.
It is very important for women to check in with their doctor around perimenopause and menopause. New changes to hormones can impact the thyroid, cholesterol, and blood pressure. Therefore women should always see their doctor for a check-up and labs when experiencing signs of hormone imbalance in their 40's and 50's. The average age of menopause is 51, and perimenopausal changes for most women begin 10 years prior to official menopause. While some women will experience changes earlier such as around 35, some women will not feel the impact in their hormones until their late 40's.
There are many great bioidentical hormones and natural products specifically for hot flashes, be sure your brand is high quality and independently laboratory tested and/or prescription-grade or it will not work. If you are using poor-quality supplements or herbs, keep in mind that none of my treatment plans will work because in the USA you can put anything you want in a bottle and label it without regulation. All herbs should be certified organic or they may contain pesticides and heavy metals.
The aforementioned tips are some of my favorites, but there are also many options available to women including Bioidentical Hormones.
~Dr. Nicole Sundene
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!