What Are Hot Flashes, Why They Happen and What Can I Do About Them?
By Dr. Alyssa Dweck
If you have experienced a hot flash, you’ve probably realized it’s unmistakable and quite remarkable. The sudden burst of warmth experienced specifically in the upper neck, chest and face, the increased heart rate, the flushed skin: hot flashes can range in intensity and happen out of nowhere. Whether you’re approaching menopause or in your post-menopausal years, know that you’re not alone: 60-80% of women experience hot flashes at some point during their transition.1
This article will cover everything you need to know about hot flashes, including why they happen, and how to manage them.
- What are hot flashes?
- What causes hot flashes?
- Symptoms of hot flashes?
- What age do hot flashes begin?
- How long do hot flashes last?
- Causes of hot flashes besides menopause?
- Hot flash triggers
- Hot flashes at night
- Treating hot flashes
What are hot flashes anyway?
Simply put, hot flashes are the iconic symptom of the menopausal transition. Night sweats are hot flashes that occur during sleep. Collectively hot flashes and night sweats are referred to as vasomotor symptoms (VMS). The term “vasomotor" usually refers to blood vessel action i.e. constriction (narrowing) or dilation (widening) of blood vessels. Estrogen, among other hormones, does have an impact on blood vessels, which is why it has an impact on these symptoms. VMS are very common; in fact, it’s estimated that by 2025, 21 million women in the US and 1.1 billion women worldwide will experience them.2
Contrary to past generations, menopause and related symptoms are not thought of as a disease, but rather as just another life stage. The menopause taboos are lifting, slowly but surely.
Every woman’s experience with menopausal hot flashes can vary; in many cases, hot flashes are truly disruptive to day-to-day life, while in others, they are a mere inconvenience. And for a lucky few, they may be essentially nonexistent.
What causes hot flashes?
Truth be told, the underlying cause of hot flashes is still poorly understood. In very basic terms, hot flashes occur when the master thermostat in the brain, aka the thermoregulatory zone in the hypothalamus, goes awry. Women have a very small window of temperature tolerance during this time, and even a slight variation in environmental temperature can spark a hot flash. Diminishing estrogen levels are clearly involved in this intolerance to temperature changes. Specific neurons and receptors in the brain, neurotransmitters including serotonin, and vascular changes are also all influential on the thermoregulatory zone as well.
What are the symptoms of hot flashes?
Hot flashes are not fun! My patients often say they feel “like a furnace is erupting inside them.” In general, women mostly report a sudden and incredibly intense feeling of heat. This overwhelming sensation typically starts in the chest and neck and then moves quickly to the face. The face may become beet red. Excessive perspiration, followed by chills can occur. Timing, frequency and severity of hot flashes can vary, and they can be visibly noticeable to others.
Most hot flashes last from 1-5 minutes. They can occur once in a while or seem constant throughout the day and night. There really is no “normal” number of hot flashes day-to-day, but most women note individual patterns and triggers.
Symptoms may be:
- Mild: a sensation of heat without perspiration
- Moderate: a heat sensation combined with sweating but not interfering with activity
- Severe: flashes disrupt activity and can be truly debilitating and life altering
Often, hot flashes occur at night during resting hours. Otherwise known as night sweats, these flashes can result in significant sleep disruption and the need to change sleep clothes ( it’s not uncommon for pajamas to become drenched and uncomfortable).
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What age do hot flashes start?
Hot flashes usually start during the pre-menopausal/peri-menopausal time. This is the approximate 4-8 years prior to menopause when hormone fluctuations are notable.
Menopause is often acknowledged in hindsight, since it’s defined as 12 consecutive months without menses. The average age of menopause is 51 years in the US but can range from age 40 until the late 50s.
You may find a genetic association to when your hot flashes begin; many women experience a similar age of onset and experience as their mothers or sisters, barring any significant lifestyle differences.
How long do hot flashes last?
On average, 60-80% of women will experience hot flashes throughout menopause. Data suggests hot flashes last on average 7 years but have been reported for upwards of 15 years total. In addition, data suggests frequency and duration do vary by race, with Black and Hispanic women reporting increased symptom duration, followed by White and then Asian women.3
What can cause hot flashes, other than menopause?
Hot flashes and night sweats can be symptoms associated with certain medical conditions that are completely unrelated to menopause; therefore it’s vital to identify and exclude these potential causes. These could include things like:
- thyroid disorder
- certain medications
If you are a woman younger than age 40 and experiencing drenching sweats at night, random fever and chills, and rapid weight change, ensure you address this with your health care provider. A good medical history, physical exam, blood work and imaging might be in order before blaming your hormones.
Are there common hot flash triggers?
Lifestyle habits might be to blame for the frequency and severity of hot flashes. Consider your diet carefully. Caffeine, artificial sweeteners, large meals and spicy foods are common culprits. Always have plenty of cool water on hand, since adequate hydration tends to mitigate symptoms. Alcohol, particularly red wine, can bring on hot flashes. Smoking also triggers hot flashes: in fact, regular smokers tend to experience menopause at an earlier age and have more severe symptoms.
Sedentary lifestyle and obesity are directly correlated with hot flash occurrence. Choice of clothing material and fit can make those with flashes more or less comfortable. My hot flashing patients often tell me that they have given away all their turtlenecks and avoid silk in fear of perspiration. Finally, stress is an incredibly common trigger.
Hot flashes at night
Night sweats can definitely disrupt sleep. Women report a myriad of symptoms including difficulty both falling asleep and staying asleep. Constant awakening interrupts normal sleep patterns, leaving many women feeling unrested, groggy and foggy during daytime hours. Furthermore, constant awakening allows the “busy mind” to take over in the middle of the night, which can make getting back to sleep torturous. Good sleep hygiene practices include a cool, ambient room temperature, moisture wicking sleep clothes, a comfy mattress and avoidance of screen time just before bed.
Management and treatment for hot flashes
Thankfully, there are numerous options available for management of menopausal hot flashes and night sweats.
- Prescription medications may help. Surprisingly, various antidepressants have been shown to reduce hot flash frequency.4 Potential side effects and individual circumstances must be taken into account, but this avenue has been particularly helpful for those who are dealing with underlying depression or anxiety.
- Gabapentin, a prescription medication used in neurology for seizure control and nerve pain, has been shown clinically to reduce hot flashes.5
- The most common treatment for hot flashes is hormonal replacement therapy (HRT). The efficacy of HRT is excellent. HRT comes some with baggage however, causing the appetite for HRT to wax and wane over the years. Risks might include a heightened risk of breast cancer, uterine cancer and blood clots. The decision to use HRT is a shared one between a woman and her health care provider and should be individualized.
Vitamins and supplements
- Black cohosh, evening primrose oil and other “phytoestrogens” are over the counter, plant-derived, “estrogen-like” supplements, which have been commonly used for years. Most clinical studies however, suggest no favorable effect or only minimal relief above placebo.
- Lifestyle matters. I typically recommend the Mediterranean diet, which is naturally low glycemic, heart healthy and helpful for weight management. Limiting carbs, processed food and sugar allows for steady glucose and insulin levels and diminished hot flashes as a result.
- Adequate exercise is advised not only for caloric burn and heat dissipation, but also for weight control and stress relief. While exercise in and of itself does not minimize hot flashes, secondary effects of exercise can. standard recommendation is 150 minutes a week of cardio, with the addition of strength and flexibility training.
- Meditation, mindfulness exercises, and yoga allow for stress relief.
Menopausal hot flashes and night sweats might be a non-issue for some but can be quite debilitating for others. They are incredibly common but won’t last forever. Be proactive with lifestyle changes and open up a candid dialogue with your health care provider. Your quality of life is what’s most important.
Alyssa Dweck, MS, MD, FACOG, Bonafide Medical Advisor, is a practicing gynecologist in Westchester County, New York. She provides care to women of all ages and has delivered thousands of babies. A graduate of Barnard College, she has a Master’s Degree in Human Nutrition from Columbia University and her Medical Degree from Hahnemann University School of Medicine in Philadelphia, now named Drexel University. Dr. Dweck currently practices in Mount Kisco, NY and admits to Northern Westchester Hospital in Mount Kisco, NY. She has been voted “Top Doctor” in New York Magazine and in Westchester County and has co-authored three books to date: “The Complete A to Z for your V,” “The Sexual Spark,” and “V is for Vagina.”
- Gold EB, Colvin A, Avis N, et al. Longitudinal analysis of the association between VMS and race/ethnicity across the menopausal transition: Study of Women’s Health Across the Nation. Am J Public Health. 2006;96(7):1226-1235.
- World Health Organization. Women, Ageing and Health : A Framework for Action. Focus on Gender. Geneva, Switzerland: World Health Organization; 2007. www.who.int/ageing/publications/Women-ageing- health-lowres.pdf. Accessed February 28, 2019.
- Freeman EW, Sammel MD, Lin H, Liu Z, Gracia CR. Duration of menopausal hot flushes and associated risk factors. Obstet Gynecol. 2011;117(5):1095-1104.
- Guthrie KA, LaCroix AZ, Ensrud KE, et al. Pooled analysis of six pharmacologic and nonpharmacologic interventions for VMS. Obstet Gynecol. 2015;126(2):413-422.
- Rahmanian M, Mohseni A, Ghorbani R. A crossover study comparing gabapentin and fluoxetine for the treatment of VMS among postmenopausal women. Int J Gynaecol Obstet. 2015;131(1):87-90.