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Ask 10 people what a hot flash feels like to them, and you’ll likely hear 10 different answers. For some women who experience hot flashes and night sweats during perimenopause and menopause, it’s a subtle warming sensation. For others, it can feel like a five-alarm fire that's set their entire body ablaze. Like every other aspect of menopause, there is a wide variety of experiences, with some women needing medical help to manage their flashes and others breezing through like it's no big deal. Whether you’re feeling the heat or still keeping cool, here’s what you need to know:
How do if I know I'm having a hot flash and what does it feel like?
A hot flash is a sudden, intense sensation of heat, often in the head, neck or upper torso. Some women can experience flushing, sweating and an increased heart rate, as well.
Hot flashes tend to peak in late morning to late afternoon, though the severity, duration, and frequency are highly individualized to each woman. When they happen at night, waking you from your sleep, they're called night sweats, and they can leave you drenched with perspiration, shivering with cold — and exhausted the next day.
Hot flashes are one of a number of menopausal symptoms that occur because the body is producing less estrogen, which helps the brain regulate body temperature. It may sound counterintuitive, but a hot flash is actually the brain’s attempt at cooling down what it thinks is an overheated body. “We describe it as sort of a malfunctioning thermostat in the hypothalamus,” says Stephanie Faubion, M.D., director of Mayo Clinic Center for Women’s Health and medical director of The North American Menopause Society.
Hot flashes typically last for one to five minutes and can occur several times per hour. “It can be anywhere from a mild nuisance to something that stops you in your tracks so you can't think or do anything else except deal with it,” Dr. Faubion says.
A long-held myth was hot flashes were short-term, temporary inconveniences. But that’s not the case, experts say. Some women can start experiencing hot flashes as early as their 30s and as late as their 60s, says Rebecca Thurston, Ph.D., professor and Pittsburgh Foundation Chair of Women’s Health and Dementia at the University of Pittsburgh Medical Center and president emeritus of the North American Menopause Society. “The mean duration of [menopause] symptoms is seven to nine years, and about a third of women will hot-flash for a decade or longer,” Dr. Faubion adds.
What’s happening in the body when you have hot flashes?
Researchers still don't know precisely how or why hot flashes happen. “We don’t know the exact mechanism of hot flashes, but we are starting to figure out more and more about where it occurs in the brain,” says Dr. Faubion. A cluster of neurons in the hypothalamus may hold the secret to unlocking the hot-flash mystery. New research has found that these neurons — dubbed KNDy neurons (pronounced “candy”) — seem to begin firing when the ovaries stop producing estrogen.
“These neurons appear to facilitate the crosstalk between the thermoregulatory centers and the reproductive endocrine centers in the brain,” says Thurston.
A new class of drug called NK3 inhibitors may be able to block the pathway that’s hosting that “crosstalk” and — fingers crossed — shut down hot flashes. Dr. Faubion says it may even be approved by the FDA later this year.
Who gets hot flashes?
A majority of women will get hot flashes at some point, whether they’ve entered menopause naturally or surgically, following a hysterectomy (surgical removal of the uterus) or oophorectomy (surgical removal of one or both ovaries). Women undergoing treatment for breast cancer also often experience hot flashes. Even men being treated for prostate cancer can get them.
Though it's estimated that 70% of American women will have hot flashes, there are very pronounced racial-ethnic differences, Thurston says: 80% of Black women will have hot flashes and 50% of Asian-American will have them, while the incidence rate for white women and Latinas falls somewhere in the middle. Researchers haven’t yet pinpointed why those differences exist, Thurston says.
What causes hot flashes?
Even though researchers aren’t positive about why some women experience hot flashes more severely than other women, there are certain factors that seem to be predictive. Body weight is one, but that depends on what stage of the menopause transition you’re in, since fat produces estrogen. “In the earlier stages of menopause transition, if you're heavier, you're going to have more hot flashes,” Thurston says, However, by the time you get to the later stages of menopause, body fat becomes your only source of estrogen, so it you lose that fat, there is the possibility you could start having flashes again, Dr. Faubion explains.
What are the best treatments for hot flashes?
Even though hot flashes are a common symptom experienced by the majority of women who go through menopause, most of them do not seek out treatment for them — only about 27%, according to a 2021 survey of more than 1,000 menopausal women.
But there is no reason to suffer in silence, or to accept uncomfortable symptoms as
"part of being a woman." Hormone replacement therapy is safe and effective for most women, both experts say, except for those with a history of breast cancer or cardiovascular disease. Other FDA-approved pharmacological treatments include SSRIs and SNRIs — antidepressants prescribed “off-label” to treat hot flashes.
If you want to try a non-pharmacological route, Thurston says studies on cognitive behavior therapy, clinical hypnosis, yoga and mindfulness-based stress reduction have shown promise in helping women cope with hot flashes—although they won’t get rid of them altogether.
A slew of supplements and herbal remedies promise to quell hot flashes, but neither Dr. Faubion nor Thurston recommends them. “There is very, very inconsistent data around their efficacy, and there are questions of purity because these are not [FDA-]regulated,” Thurston says.
Should I be worried about my hot flashes?
A hot flash by itself isn’t cause for alarm, although it can certainly be disruptive to sleep, work, and other everyday tasks. But you shouldn’t ignore them, either, as they may be markers for other health problems later on. “We think certain patterns of hot flashes may be associated with increased risk for heart disease,” says Dr. Faubion. (Although the research is ongoing and not yet conclusive, women whose hot flashes begin well before their last menstrual period and last beyond menopause have been shown to be at higher risk for cardiovascular disease.)
The bottom line is: Hot flashes happen, but you don't have to suffer through them. "Women have to be advocates for themselves," says Dr. Faubion. "If somebody's saying 'tough it out,' you need to ask for help."
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