The curse is lifting, but the heat is on. Your own private heat. Summer in Washington, times 10. We're talking hot flashes -- power surges, flop sweats, melted mascara, nightly trips to the equator, tomato face, armpit swimming pool. Don't you want to jump right in?

Me neither. Especially not at this particular historic moment, when the pills of choice for menopausal symptoms are out of favor and we women are stranded like dogs in parked cars. (Can somebody please crack a window?)

Hormones work but are now recommended only for the shortest time and the hardest hit. Antidepressants show promise for treating hot flashes but only for the adventurous. (We brake for side effects.) So what about the rest of us, the everywomen who just want a little relief without a lot of risk? How can we handle the heat without prescriptions?

Denial's not a great strategy. Researchers say that about 75 to 85 percent of American women will experience hot flashes at some point during their muddle through menopause.

Waiting for medical science isn't a good bet, either. Doctors still don't know what causes hot flashes, nothing is known to cure them, and the few studies of nonprescription treatments are small and contradictory.

And yet there is one tiny ray of hope. A comprehensive research summary released this year by the North American Menopause Society buries this key sentence on page 5: "In well-controlled, randomized clinical trials, placebo treatment has reduced hot flashes by approximately 51 percent."

Sugar pills help half the time? Yes, said Nanette Santoro, lead editor of the report and an expert in women's health at the Albert Einstein College of Medicine in New York. "A placebo, when given in the context of a hot flash treatment trial, cuts hot flashes in half." In other words, for mild to moderate hot flashes, for eight to 12 weeks (until the placebo effect wears off), Santoro said, "just about anything may help."

Hmmm. In that case, I say let's try anything . . . and everything. Let's drop our doctors at the curb and treat ourselves to something cool, 'cause, hey, you just never know.

Here's my shopping list:

Things to Cool You Off

Wicking pajamas. In the heat of the night, wicking pajamas may do the trick. The special polyester fabric allegedly wicks the moisture away from your body, dries quickly and keeps you from sticking to the sheets.

The pair I tried from Wicking J. Sleepwear comes with a "water drop tester" and a note daring you to "place a drop of water on the Intera fabric and see how quickly the moisture evaporates." I put a dropper-full (does anyone sweat one drop?) of water on the pajamas, and 15 minutes later they were still damp. In spite of that, they're comfortable, wash well, and I like the style.

The same company is now marketing "the first 'Night Sweat Survival Kit' featuring a 'wicking' tank nightgown, a 'wicking' pillowcase and balance aromatherapy face, body & pillow mist." All for only $88.

The Chillow{reg}. Designed to keep your head cool all night long, the Chillow is a bit smaller than a pillow in length and width and only about an inch high. On one side, it's got a vinyl-like material; on the other, a soft blue fabric. In the middle lies some dense, highly absorbent white stuff.

To activate the Chillow, you pour 10 cups of water into the white stuff, then wait two hours and haul it up to your bed. Presto, minutes after you put your head down, it feels quite cool. The ad says, "It's like sleeping in the shade with a gentle breeze." Since I generally sleep in the dark with air conditioning, it didn't seem like a huge improvement. But others, including Christiane Northrup, the OB-GYN author of "The Wisdom of Menopause" (Bantam Books, 2001), swear by it. "I love that thing," she told me. "I couldn't live without it." (, $29.95)

(One safety tip from the manufacturer: "No Chillow fighting! Pillow fights while a Chillow is inside the pillowcase may cause serious injury to the person being struck.")

The layered look. From the sublime to the ridiculously obvious, women experiencing hot flashes learn to dress in layers. Pile them on in the morning; peel them off when the sweating starts. Northup said she's banished turtlenecks from her wardrobe forever. "It's 20 below here in Maine and I go into the car in a tank top," she said. (A sad irony: We've finally gotten the urge to take it all off just at the time when no one wants to see what's underneath?)

The freezer. And now to the subzero. My friend Janet Fingeret cools her hot flashes -- up to six a day for three years now -- by sticking her head in the freezer. Janet teaches reading at Marion Street Elementary School in Lynbrook, N.Y., in a classroom directly across from the faculty lounge. When the sweat starts popping, "all I do is just finish up what I'm doing and go open the freezer door. It really does work. It's the best thing for me."

The thermostat. When the freezer's not an option and moving to Alaska is impractical, take charge of the thermostat. Most experts agree that keeping the thermostat a few degrees cooler steadies a woman's core temperature, which may keep the heat away. According to the Menopause Society research summary, "Cooler air temperatures are associated with a lower incidence of hot flashes."

Pencil fans. When you've got no control over your environment, create a breeze any way you can. Use that folding fan your grandmother left you, make a fan out of that report on your desk or buy a little electric or battery-powered fan. I found some great options at The Preparedness Center's Web site (; motto: "Essentials for Your Survival"): the "pocket keychain fan," the "pen fan in fun colors," the "headwind visor fan with soft foam blades" and the "chilly bean clip-on cordless pocket fan." All are less than $15.

Things You Can Ingest

Tofu, tofu, tofu. If you've been bulking up on Tofutti and Tofu Pups and other soy-based foods to treat your hot flashes, you may want to cool it. The Menopause Society's analysis: "Randomized, controlled clinical trials have shown that, in general, hot flashes are only slightly reduced in women who consume soy-derived isoflavones [plant estrogens] when compared with controls." Then again, maybe you've learned to love soy lattes and edamame.

Black cohosh. A member of the buttercup family, this herb gets the hot-flashiest headlines. Alas, while early studies were promising, more recent ones haven't been. The verdict? "Conflicting data," according to the Web site of the National Center for Complementary and Alternative Medicine at the National Institutes of Health.

Northrup, however, insists that it works. "Black cohosh decreases hot flashes, elevates mood and can increase moisture in the vaginal area," she said.

Santoro, also an OB-GYN and the lead editor of the Menopause Society's report, is more skeptical. "Try black cohosh for eight weeks," she recommends. "After eight weeks, if it's not helping, stop wasting your money."

Supplement surprise. What about dong quai, chasteberry, wild yam, evening primrose, valerian root, ginseng, licorice, Chinese herb mixtures and vitamin E? Most medical researchers say they don't work.

But Northrup said many of the studies she puts stock in "don't tend to appear in Western, peer-reviewed literature." She said women "wouldn't risk anything" by taking a supplement containing her top five ingredients: black cohosh, mother wart, licorice, dong quai and chasteberry.

"My favorite thing to do if you possibly can is work with someone who is trained in acupuncture and Chinese medicine," said Northrup. "You'll get herbs that are prescribed specifically for your condition, and that would be ideal."

Remember, herbs aren't subject to the same sort of regulation you find in prescription drugs or even over-the-counter drugs. You don't know if the label accurately represents what's in the pills, the maker rarely tells you about possible side effects and dangerous interactions, and no one knows whether there are long-term negative effects.

Things You Can Wipe On Yourself

Progesterone cream. If your estrogen levels are surging, the theory goes, boost your progesterone to restore balance. You can theoretically do that with nonprescription or "natural" progesterone cream, which is made from plant-based sources like soybeans and wild yam and smeared on your skin. One randomized, double-blind, placebo-controlled study found it effective; two didn't. Full disclosure: I tried it for PMS symptoms (in both nonprescription and prescription varieties) and didn't notice any significant benefit. It's nice for your skin, though, and certainly some women find it helpful.

Baby wipes. If you're going to sweat, be prepared. In his book, "Amazing Kitchen Cures: 1,150 Ways To Prevent and Cure Common Ailments with Brand-Name Products" (Rodale, 2002), my college chum Joey Green suggests that women plagued by hot flashes "carry a handful of Huggies Baby Wipes in a gallon-size Ziploc Storage Bag. Wipe your forehead to ease the intensity of the hot flash." If that doesn't help, at least you're ready for picnic clean-up.

Things You Can Do

Give up things you love. If you cut out caffeine, refined carbohydrates and alcohol, Northrup said, "you will be able to get rid of more hot flashes with that lifestyle change than from just about anything else you can do, other than pop estrogen." Sugar and alcohol, she said, increase insulin levels in the blood, which "for whatever reason, contributes to hot flashes." And, she said, caffeine boosts stress hormones, which also leads to hot flashes.

Of course, there's no comprehensive research on this triumvirate -- where would they find 50-ish, female test subjects willing to give up coffee, chocolate and wine for any sustained period of time? What we do know is that smokers get more hot flashes than nonsmokers (you should give that up already) and that hot, spicy foods and drinks that raise the core body temperature may bring on hot flashes. Cold, bland foods at midlife. Yum.

Lose weight and exercise, blah, blah, blah. We know that sedentary women get more hot flashes than women who exercise regularly, and fat women get more hot flashes in pre- and peri-menopausal years than thinner ones. Will exercise and weight loss reduce hot flashes? It hasn't been studied. (Hey, there's also a correlation between low socioeconomic status and increased risk for hot flashes. Will marrying rich help?)

Relax. In looking at all nonprescription ways to handle hot flashes, Santoro said, "the best medical evidence" exists for "paced breathing." Which is what, exactly? "Meditation without the oms, breathing with counting, chanting a word to yourself or not, yoga breathing" -- all of the above. "It's the slowing, mind/body awareness that seems to make a difference," Santoro said.

According to the Menopause Society report, three clinical trials showed that paced breathing at the start of hot flashes "lowered hot flash frequency by approximately 50 percent more than the controls."

There's no research tying emotional stress to hot flashes, but much anecdotal evidence that nontraditional activities and treatments -- including acupuncture, massage, meditation, and yoga -- may help some women.

Laugh it off. Inspired by a hot flash and a bottle of wine, Jennie Linders wrote "Menopause: The Musical," now playing in Detroit, Chicago and Los Angeles. She tells people it's for women "between 'Sex in the City' and 'Golden Girls.' " The old songs have new lyrics, from "Staying Alive" ("Staying Awake") to "The Lion Sleeps Tonight." ("In the guest room or on the sofa, my husband sleeps tonight.") I haven't seen it, but for the right audience I'm sure it's hilarious.

Another option for yucksters: Throw a party with goofy door prizes. You'll find a great selection at Our Lady of Menopause (, including coffee mugs, candles, memorial plates and a prayer ("Moist and Lovely Queen of Steam, guide me to all available remedies . . . so that the world may be spared overheated eruptions of ill temper and unregulated torrents of sweat . . .").

And it seems that writing silly books helps heaps of female readers and writers. Search for "menopause" and "humor" and you get 4,043 books (most of which are not funny). My favorite titles: "Honey, They Shrunk My Hormones" (Howard Publishing, 2003), "MenOpop: A Menopause Pop-Up & Activity Book" (Fill 'er Up Productions, 2002) and "Living Somewhere Between Estrogen and Death" (W. Publishing Group, 1997).

A final warning: No one has yet studied the impact of laughing on body temperature.


A regular contributor to Health, Stefanie Weiss works at Experience Corps, a national service program for Americans over 55.

Freezer treatment: One offbeat way to keep a cool head during a hot flash.Gotta go: Ix-nay on the coffee and wine?Wicking pajamas: Night sweats come into styleHead-visor fan: So a breeze can follow you wherever you goThe Chillow: Add water, apply head.Supplements: Guess what's in the bottle