Hot Flash – a feeling of heat on the face, neck, and chest lasting 1 to 5 minutes. More common at night and may occur with headache, nausea, trouble sleeping, fatigue, sweating, and/or palpitations.  May cause misery and anxiety.  Some women feel very cold afterward.  Hot flashes often reduce quality of life and may have an effect on sexual, family, social, and work activities. They are the chief complaint in the menopause that leads women to seek medical treatment. Timing and severity of symptoms varies markedly from woman to woman.  To relieve hot flashes and improve quality of life consider the following.

CHANGE BEHAVIORS:
Weight Loss (if overweight) – really works.
Regular Exercise 30 minutes aerobics 4x/week
Relaxation techniques:
…Slow rhythmic breathing
…Yoga
Avoid Hot Flash Triggers: 
…smoking, caffeine, alcohol
…spicy, hot foods or beverages
…saunas, hot showers, red wines (in some women) 
…diet pills or anxiety.
…intense emotional stress

CHANGES LIFESTYLE: keep core body temperature low. 
Adjust Air Conditioning
Use a personal or ceiling fan
Dress in thin removable layers
Wear cotton, linen, or rayon
Wear cotton nightclothes
Avoid wool, synthetic clothes, and silk
Stick to open-necked shirts
Get a bigger bed if you and partner are on different “heat planets,” 
Take a cool shower before bed.
Keep ice water at hand to cool down from the inside.

ALTERNATIVE MEDICINE: Nonprescription/natural.
Soy foods
Isoflavone supplements (from soy or red clover)
Black cohosh
Vitamin E
Acupuncture

Thus far, soy and red clover extracts (all phytoestrogen products) are proven to be no different than placebo (sugar pills) for treating hot flashes. No data suggest these remedies are consistently effective. Safety should always be considered, so remember to discuss these with your healthcare provider first.

NONHORMONAL THERAPY:When women are unable or do not wish to take hormone therapy, non–hormonal prescription therapies government-approved for other medical conditions have shown some ability to help hot flashes. These drugs must be prescribed and adjusted carefully by your healthcare provider. 
Low-dose antidepressant medications 
Effexor(venlafaxine) or Paxil (paroxetine) – (Remember to taper, do not stop suddenly!)
Will both reduce hot flashing by about 60%
Estrogen therapy will reduce hot flashing by about 90%.

HORMONE THERAPY:
ESTROGEN – FDA approved  AND Bioidentical – The most effective,  safe option for the relief of hot flashes
Skin patch (Vivelle dot)
Topical gel (Estrogel)
Topical spray (Evamist)
Pill (Estradiol, Estrace).
Lower doses – good relief but takes longer 
If patient has a uterus a progesterone is required
PROGESTERONE
…Progesterone IUD
…Natural progesterone (Prometrium)
Low dose Birth Control Pills – higher than normal dose
Excellent option if  required contraception or control of irregular periods. 

Type and length of hormone treatment are determined by the risks and benefits for each individual, which should be reevaluated on a regular basis.