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Published on June 11, 2014

Turn Down the Heat! How to not only survive, but thrive during midlife

SIOUX FALLS (June 1, 2014) – It’s 30 seconds to several minutes of dreaded discomfort: Heat rising in your neck and face, blotchy skin and beads of perspiration.

If you’re in a business meeting, you feel self-consciously anxious. If you were sound asleep, you’re robbed of minutes or even hours of rest. You might have just left the house feeling fresh, but now you want to head back to the shower. 

The unwelcome onslaughts might happen a few times a week or several times a day. To add insult to injury, the frequency and intensity of hot flashes can rise with the temperatures during the summer months.

Hot flashes can result from other conditions, such as thyroid trouble or an infection. Or, they can be a side effect of medications. Yet 75 percent of women during the years before or after menopause –  i.e., perimenopause – experience this symptom, said Janell Powell, MD, with Avera Medical Group Internal Medicine Women’s Sioux Falls.

The exact cause of hot flashes is still a mystery, but it’s thought that changing hormone levels impact the hypothalamus – the part of the brain that regulates body temperature.

Hot flashes might begin as early as the 30s and last into the 80s. Most women have them for an average of three to six years, yet more than one-third of women report moderate to severe hot flashes for 10 years. “Generally, the earlier they start, the longer they last. There’s no reliable way to know how long they will last,” Dr. Powell said.

For some women, hot flashes are a tolerable nuisance. For others, they are a major life interruption.

“Not every woman needs treatment for hot flashes. It comes down to how it is affecting your quality of life,” Dr. Powell said. There are many ways to ease hot flashes. Often, it’s a trial-and-error process of finding what solutions will work for you.

That might include avoiding those things that make hot flashes worse: Stress, lack of exercise, smoking, a high-carb diet, caffeine and excessive alcohol. “Try to identify and avoid what triggers your hot flashes,” Dr. Powell said.

Wear light, cool clothing. Keep your environment cool, especially at night. When you feel a hot flash coming on, take slow, deep breaths. Get plenty of exercise. Lose weight if you are overweight. Try meditation. Eat a healthy diet with more fruits, vegetables, protein and fiber.

Several over-the-counter remedies and supplements are on the market, including soy and black cohosh. It’s important to realize that these remedies are not FDA-approved, and potency varies. No supplements have been scientifically proven to be safe or effective. “You just want to be careful. If you wish to try supplements, start with a low dose, and see if you’re gaining any benefit,” Dr. Powell said.

Estrogen remains the most effective medical treatment. Yet health risks have been associated with estrogen therapy. “Women can minimize these risk by taking the lowest possible dose for the shortest period of time, to get you through the most difficult time when the symptoms are the most intense,” Dr. Powell said.

There are several non-hormonal medications that can reduce the frequency and intensity of hot flashes, including anti-depressants at low doses. The newest medication is Brisdelle, is the first non-hormonal drug approved by the FDA for treatment of perimenopausal symptoms. It is a low dose of the anti-depressant Paxil.

Another novel therapy is a nerve block to the neck – a common treatment for pain. This therapy is more expensive, and must be performed by an anesthesiologist. “For most women, it would come down to insurance coverage,” Dr. Powell said.

Dr. Powell advises that women address their health in its entirety in order to feel their best at midlife. This involves not only hormonal changes, but also bone health; chronic conditions such as high blood pressure, high cholesterol or diabetes; weight management; and lifestyle choices.

“This can make the difference between surviving and thriving at midlife,” Dr. Powell said. “Steps like more exercise, reducing stress, working to improve your sleep, and eating a better diet really do help.”

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