Hot Flashes

Hot flashes and night sweats are the most common symptoms during the first stage of menopause (perimenopause) and often appear even before periods become irregular. While the exact cause is not known definitively, both hot flashes and night sweats are exacerbated by fluctuating hormone levels, especially estrogen.

Prior to menopause, most women’s bodies will easily adjust to slight changes in internal temperature. For example, if your normal internal temperature happens to be 98.6, your body might get as cold as 96.6 or as hot as 100.6 without you feeling a chill or a hot flash. Your hypothalamus (the region in your brain that regulates body temperature) sends a signal to your muscles to start shivering or to your sweat glands to start sweating, and normal internal temperature is restored.

During menopause, however, decreasing estrogen causes the body’s tolerance for temperature swings to drop, and the result is a narrower comfort zone. As the body adjusts to its new hormonal normal (which may take several years), any change in internal temperature may trigger an overreaction from the hypothalamus. Hence, the hot flashes and night sweats of menopause.
Behavior:
  • Get plenty of sleep. If hot flashes are keeping you up at night, reduce the temperature in your bedroom (but not too cold, as you will then have the shivers), eliminate excess bedding, use low thread count sheets, and try going to bed barefoot. Consider taking a cold shower right before bed to help lower your core temperature.
  • Reduce or eliminate stress. Some proven strategies include deep breathing, journaling, mindfulness meditation, tai chi and yoga. Even something as simple as listing five things to be grateful for every day has been shown to activate the parasympathetic nervous system, giving your body a chance to rest and recalibrate.

Diet:
  • Avoid eating hot, spicy foods; these can cause your internal temperature to spike.
  • Drink plenty of water, aiming for 60-80 ounces per day. A drink of cold water can even help cool your body’s core and shorten a hot flash.
  • Avoid alcohol.
  • Avoid sweet treats, simple carbohydrates and drinks loaded with sugar. Sugar in all its forms is a major trigger for hot flashes.
  • Avoid caffeine.
  • Try increasing your soy intake. Bean paste, edamame, soy milk, soy sauce, tempeh and tofu all contain isoflavones which the body converts into phytoestrogens during digestion.

Exercise:
  • Maintain a healthy weight. Fat adds insulation, making it harder for your body to adjust to temperature swings. Every woman’s body is different, but for some, losing even as little as 5 pounds can help reduce the frequency and duration of hot flashes.

Lifestyle Factors:
  • If you’re a smoker, please quit. This is one of the most positive steps you can take to improve your overall health. Smoking interferes with circulation and inhibits the body’s ability to warm and cool itself. Women who smoke are more likely to get hot flashes.

For around 80% of perimenopausal or menopausal women, hot flashes occur occasionally and don’t cause too much distress. For around 20%, however, hot flashes are severe enough to disrupt their sleep and day-to-day life.

There are many effective options for treating hot flashes, including hormone and non-hormone therapies.

Treatments for Hot Flashes

  • Hormone Therapy (HT): While hormone therapy is not for every woman, many patients are great candidates for HT use. Estrogen therapy comes in many forms, including patches, pills, gels and vaginal rings. Women taking estrogen therapy usually show a significant improvement within 10 days of starting therapy.
  • SSRIs and SNRIs: Another option is the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). These medications are FDA-approved for helping with depression and anxiety but have also been shown to relieve the symptoms of menopause. Certain SSRIs and SNRIs have been shown to reduce hot flashes nearly as well as estrogen.
  • Other Nonhormonal Medications:
    • Gabapentin is a medication approved by the FDA to treat epilepsy and nerve pain. This medication can also help with hot flashes and has a sedative effect.
    • Clonidine is a blood-pressure-lowering medication. Clonidine can modify how blood vessels respond to the body’s instruction to release heat quickly, thereby alleviating hot flashes.
  • Alternative Therapies: Many studies have shown that acupuncture and yoga can be effective in reducing hot flashes.

What is a hot flash?
A hot flash is the sudden sensation of heat in the face, neck and chest—and occasionally throughout the rest of the body—caused by a sudden dilation (enlargement) of blood vessels near the surface of the skin.

Hot flashes can be very mild (feeling a little warmth in the face) or very severe (becoming red in the face and sweating excessively). The most severe hot flashes may include symptoms similar to a panic attack, including dizziness, fear of loss of control, rapid heartbeat, sweating and trembling.

Some women will experience a cold chill after a hot flash, while a few women report feeling only the chill. Some women with severe hot flashes also report experiencing a headache after other hot flash symptoms subside.

What causes hot flashes?
Hot flashes are caused by fluctuating hormone levels, especially estrogen and, to a lesser extent, progesterone. These fluctuations impact the functioning of the hypothalamus, the part of the brain responsible for regulating body temperature, appetite, sex hormones and sleep.

How long does a hot flash typically last?
Most hot flashes last anywhere between 30 seconds and 5 minutes. Severe hot flashes can last up to 15 minutes and may recur as quickly as 10 minutes later.

Can hot flashes be damaging to my long-term health?
On their own, hot flashes are not damaging—they are just instances of the body’s natural response to an increase in internal temperature. However, depending on length and severity, recurring hot flashes can impact relationships, work, sleep and even cognition. Some research indicates that women with severe hot flashes may be at higher risk for heart disease and bone density loss than women without hot flashes.

How long will I have to deal with hot flashes?
This varies from woman to woman. Most women experience hot flashes for anywhere between two and seven years, on average. About 10% of women may have hot flashes lasting for 10, 12, or even 15 years. Typically, the earlier women start having hot flashes, the longer they last.

What are the risk factors for hot flashes?
Risk factors for hot flashes include smoking and being overweight. Some studies indicate that Black and Latina women tend to experience more severe hot flashes than white and Asian women.

Should I be worried if I don’t have hot flashes during menopause?
Not every woman experiences hot flashes. Up to 25% of women report having no hot flashes or such mild hot flashes that the symptoms are hardly noticeable.