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By 'Today' show contributor
updated 4/5/2004 1:08:05 PM ET 2004-04-05T17:08:05

Q: I’m only 40, yet I’m getting hot flashes. Why is this happening and what can I do about it?

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A: Your question implies that you are worried that this is a “much too early” harbinger of menopause. If so, you are probably not there yet. Fewer than one percent of women become menopausal at or before age 40. The average age for menopause is 51.

Still, hot flashes can occur as early as 10 years before menopause. That’s because the hypothalamus – the center in your brain that tells the pituitary gland what to do – becomes more sensitive to hormone fluctuations as you get older.

Consequently, many women in your age group – you included – start to experience night sweats and hot flashes when their estrogen level plummets just before and during their period.

During the premenstrual low-estrogen phase, the hypothalamus becomes confused and thinks your core body temperature is too high. This part of the brain instructs your body to cool off by rushing blood to the small blood vessels in your skin (making you flush) and dispersing the heat outward with the help of evaporation (making you sweat).

If your hot flashes don’t seem connected with your period, you might have a thyroid disorder. Overactive thyroid, or hyperthyroidism, can cause sweating, intolerance to heat and hot flashes. It often emerges in women under 40.

As time goes on, our bodies also become more sensitive to what I call hot-flash instigators. The culprits include the usual suspects: caffeine, alcohol, spicy foods, hot drinks, sugar, nitrites and sulfites.

How you (and your doctor) deal with your hot flashes depends on whether you have them monthly, daily or after ingesting those hot-flash instigators. Here are the strategies I recommend for dealing with these various scenarios:

Premenstrual hot flashes
To cool down from premenstrual hot flashes, consider taking a birth-control pill continuously for up to three months so your body is not “exposed” to an estrogen low. You can use any birth-control pill to do this – just eliminate the week of placebo pills and take the active pills on an “extended-cycle” basis for three months.

We now know you need NOT have a period every month

Contrary to what you’ve heard, it’s also safe to take the pill if you’re over 35 – as long as you don’t smoke and don’t have severe hypertension, a history of blood clots or an estrogen-related cancer. Obviously, you will need to discuss your use of the pill with your doctor.

If you don’t wish to take the pill but your hot flashes are severe enough to keep you awake at night, soak your clothing or ruin your makeup, your doctor can prescribe an estrogen patch for the week when your estrogen is low. A dose of 0.05 mg of the estrogen Estradiol, in either the Climara patch (changed once a week) or the Vivelle patch (changed twice a week) should suffice.

Thyroid imbalance
If your doctor diagnoses hyperthyroidism through the appropriate blood test, it is necessary to calm the thyroid down, either with medications or by destroying the overactive cells with radioactive iodine. The latter will usually make the thyroid cease all its work and you will need to take thyroid supplements.

Flashes from food
If you find the flashes occur after eating certain foods (this may include wine containing sulfites and meat processed with nitrites), try to limit or avoid them.

A word about herbal remedies
In the health-food store, you will see rows of herbal supplements claiming to stop hot flashes. There is controversy as to which herbs work, and the studies that exist have been short-term. I do, however, have patients who swear by Black Cohosh. Some research shows this herb can be effective, at least in the short term.

Dr. Reichman’s Bottom Line: Despite the prevalent humor surrounding hot flashes, they are no joke. But a hot flash doesn’t mean you are on the verge of menopause, and there are plenty of ways to help yourself cool down.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You willl find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.

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