Many women suffer from hot flushes when they start the menopause. Their upper bodies, arms and faces feel hot, their skin turns red and they sweat, usually for about four minutes.

Hot flushes are caused by a down-setting of the temperature-regulating part of the brain. When you have an infection and your temperature rises above 100 degrees, you sweat to cool off. At the time of the menopause, you still sweat when your temperature rises, but at lower than normal temperatures, such as when you go from 97 to 98 degrees.

Your body temperature rises and falls in a set pattern each day. Your body temperature is usually lowest at 3 in the morning, at around 96 degrees. It is highest in the early evening at at around 99 degrees. During the course of day and night, your body temperature rises and falls and with every rise, a post menopausal woman may suffer a hot flush. Sixty-five to 85 percent of women suffer from hot flushes which persists for five years in 60 percent and for more than 15 years for 10 percent.

A hormone called norepinephrine causes a woman's brain to think that her body is overheating, even if it isn't. She then flips open the blood vessels in her skin, giving her the feeling of a rush of heat, and she starts to sweat. Clonidine, a blood pressure medicine, lowers norepinephrine and blocks hot flushes in some susceptible women. We still do not have any good drugs to effectively lower norepinephrine levels in the brain, but here at least is a lead for future researchers.

What should a woman take for hot flushes after the start of the menopause now that large studies show that taking estrogen and progesterone increases risk for breast cancer, heart attacks and strokes? Several reports show that hot flushes possibly may be prevented by eating plenty of whole grains and soybeans or by taking a male-like estrogen called tibolone, which can be prescribed for women who cannot take estrogen. However, tibolone is not available in North America, even though it has been available in many other countries for the last five to ten years. Various remedies such as dong quai are advertised, but no large, long term studies have been conducted on any of these alternatives.

Gabe Mirkin, M.D.

Dr. Gabe Mirkin has been a radio talk show host for 25 years and practicing physician for more than 40 years; he is board certified in Sports Medicine and three other specialties.

Dr. Mirkin's daily features on fitness have been heard on CBS Radio News stations since the 1970's. He has written 16 books including The Sportsmedicine Book, the best-selling book on the subject that has been translated into many languages. His latest book is The Healthy Heart Miracle, published by HarperCollins.

Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. A Boston native, Dr. Mirkin did his residency at the Massachusetts General Hospital. He has served as a Teaching Fellow at Johns Hopkins Medical School, Assistant Professor at the University of Maryland, and Associate Clinical Professor in Pediatrics at the Georgetown University School of Medicine. He has run more than forty marathons and is now a serious tandem bicycle rider with his wife, nutritionist Diana Mirkin.