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Wanda’s hot flashes were barely a disturbance during menopause. In fact, she jokingly referred to the impromptu waves of warmth as “power surges,” but one of her friends wasn’t so lucky.

“We’d be sitting there chatting, and all of a sudden, Susan’s face would turn red, she’d start sweating, and we’d have to stop the conversation for a few minutes while she fanned herself,” Wanda said.

While the frequency and severity of hot flashes varies greatly in women going through menopause, 80% will experience some form of this symptom of changing hormone levels, said Angela Deneris, Ph.D., CNM, FACNM, a women’s health expert and midwife at University of Utah Health who is known for helping women navigate the difficulties of menopause.

“Some people only get one or two hot flashes a day and maybe one or two at night, and others can have excessive hot flashes that really disrupt their lives and sleep,” Deneris said. “It’s a pretty intense feeling — you feel your whole body heating up, and many women say they sweat through their clothing and feel like they need a change of clothes. With night sweats, they can particularly suffer because their pajamas and bedding get wet.”

How are hot flashes treated?

Hot flashes can often be treated effectively with hormone therapy, which got a bad wrap in 2002 when a Women’s Health Initiative study found that hormone treatment increased the chances of getting breast cancer. We now know that the higher risk affects just 0.1% of women and that the treatment can actually reduce heart disease because decreased estrogen can negatively impact the cardiovascular system.

“During that period of time when women were taken off any hormone therapy, [researchers] really delved into the data and were able to say: Hormone replacement therapy isn’t as scary as we thought it was,” Deneris said. “Unfortunately, an additional 50,000 women died of cardiovascular disease because they went off their hormones. Most women who are really suffering with hot flashes are willing to take that 1 in 1,000 risk of breast cancer.”

It’s worth noting that hormone therapy for menopause is given in a much smaller dose than, say, the average birth control pill, Deneris said, which women take for years without blinking an eye.

Certain types of hormone treatments — such as topical hormone treatments for vaginal dryness — are even safe for women at risk for breast cancer, according to the American Congress of Obstetrics and Gynecology in 2016, because the hormones remain localized, only re-estrogenizing the vagina and perineum. Such topical treatments, which come in the form of crèmes, pills or rings inserted into the vagina, are undetectable in the blood stream.

Still, hormone therapy — particularly the kind that affects the entire body — isn’t right for everyone. For example, it’s not for individuals who already have heart disease or are at risk for breast cancer or stroke, Deneris said. It can also raise the likelihood of deep vein thrombosis (6 in 1,000 women are affected).

What if you can’t take hormones?

Interestingly, medications for depression and anxiety can help reduce hot flashes. While Wanda, who’s now 55, wasn’t affected severely by hot flashes, she didn’t get off so easy when it comes to the mental and emotional symptoms of menopause. For a few years, she surprised herself with how readily she’d burst into tears. SSRIs given for mental health challenges often pull double duty for women in menopause.

“It’s not as significant as hormone therapy but SSRIs will definitely decrease the number and severity of hot flashes,” Deneris said.

And, while we’re on the topic: No, menopause-related depression doesn’t stem from being an “empty-nester.”

There’s something going on in the brain biochemically, and we don’t know what it is, Deneris said. Of course, lack of sleep from hot flashes can worsen symptoms.

“In the past, women have been told they have depression and anxiety symptoms because they’re grieving the loss of their reproduction, and I just don’t think that’s the issue at all,” Deneris said. “I’ve been dealing with this long enough to know that women who don’t have children or who had kids late in life will tell you they still have these symptoms at menopause.”

Other advice and remedies for hot flashes?

Diet can play a role in improving symptoms, Deneris said.

“Women in Asia don’t suffer as much as we do here,” she explained. “Their diets are much higher in soy, which can decrease hot flashes. Acupuncture and some Chinese herbs have been shown to help as well.”

Keep in mind that red wine, caffeine and hot drinks can cause hot flashes, Deneris advised. Smoking exacerbates problems as well.

As far as clothing goes, try dressing in layers. When it comes to trying to get a good night’s sleep, keep a fan nearby, she said. And stay away from synthetic fabrics that trap heat — go with cotton instead.

If you’re wondering what menopause may be like for you, talk with your mom about her own experience. The conversation is likely to offer some clues about when it’ll start for you and what to expect. Generally, once your periods are 42 days apart, expect menopause to happen in one year. In the U.S., the average age is 51.

“When you’re going through any major life change, sometimes it seems like it’s never going to end, but the majority of women have significant symptoms for a 2-5-year period,” Deneris said. “For the most part, the symptoms are time-limited, and helping people understand where they’re at in the whole stage helps give them an idea of what they’re facing.”

Wanda has made it to the other side. She’ll be turning 60 this year, and her moods are back to normal. She hopes Linda will soon be joining her in a world free of hot flashes and tampons.

Be sure to talk with your health care provider about which course of action is right for you.

Did you know that midwives are trained to care for women throughout their lives, and not just for obstetrics? Interested in scheduling an appointment with a midwife? Call 801-581-4014.