A Complicated Cause
The common thought is that hot flashes are due to a drop in estrogen levels. While this explanation might be a factor, it is tremendously more complicated. The endocrine system is like a big pinball machine. Estrogen is only one hormone out of hundreds that interact with one another. Apart from the endocrine system we have liver and kidney functions that metabolize and process these hormones -- affecting the length of time the hormones remain in circulation. Each woman's physiology and anatomy brings a unique combination of factors. Given the complexity, it is not a surprise that some women, even with professional medical advice, have profound difficulty finding a remedy for this irritating (and even debilitating) symptom.
The typical first medical go-to remedy involves estrogen replacement. There are natural plant-based estrogens all the way up to high dose pharmaceutical grade synthetic estrogens. Estrogen-sensitive cancers thrive on estrogen, so it is the wise woman who begins her experimentation with estrogen as gently and cautiously as possible. This means beginning with natural estrogen assistance and working your way up until something either works, or shows itself it isn't going to work. The typical profile, however, of a woman needing estrogen support in menopause is one who has not only hot flashes but also vaginal dryness and irritation as well. If a woman is having only hot flashes, she might skip estrogen therapies and begin with progesterone solutions instead.
Progesterone levels virtually vanish at menopause. Even though the ovaries quit producing estrogen, adrenal and fat tissues continue making estrogen. Progesterone, on the other hand, disappears altogether as soon as the ovaries quit ripening and releasing eggs. Progesterone acts in some ways as a counter-balance to estrogen. Progesterone can be thought of as an eraser on a dry erase board. It erases the estrogen effects of a woman's cycle and resets the hormonal board for another cycle. In my clinical experience, progesterone supplementation has far more frequently relieved the hot flash symptom, more so than estrogen. It should be real progesterone, not the synthetic progestins that most pharmaceutical "progesterone" drugs contain. Progestin is a synthetic form that carries a large number of potential side effects, which natural or whole progesterone does not have.
The Liver Connection
The liver is in charge of breaking down nearly every hormone produced in the body. A "congested" or toxic liver could create a significant hormonal complication simply by it's inability to clear circulating hormones. A good liver cleanse at least once a year is always a good part of one's health planning.
It's An Experiment
There is no question that there is a solution to every woman's hot flashes. The medical problem is finding what that solution is. Some cases are straight forward and are easily fixed. Most cases require some shuffling around of different combinations or doses of things. A few cases require a great deal of effort and patience to find the combination that works. Sadly, there is a perception that medicine is so advanced that it should have a simple test and an easy solution for every woman. It's just not the case. There are seven billion people on the planet, roughly half of them women. Each one has a unique fingerprint. Each one has a unique body chemistry, with particular nutritional, hormonal, and physiological needs. Be encouraged that there is a solution out there and stubbornly refuse to give up finding that combination for you.