Hot Flashes

Brandi Jones, MSN-Ed, RN-BC
·7 min read
<p>monkeybusinessimages / Getty Images</p>

monkeybusinessimages / Getty Images

Medically reviewed by Kelly Wood, MD

A hot flash is a sudden feeling of warmth that can cause sweating and a rapid heartbeat. The most common cause is hormonal changes with menopause, which is defined as no period for 12 consecutive months.

About 74% of people in perimenopause (the time leading up to menopause) have hot flashes. However, they can also occur due to medications, warm environments, or certain medical conditions.

Hot Flash Symptoms

Hot flashes can vary in strength and frequency. Each episode typically lasts five minutes or less. Some people have a few hot flashes a week, while others might have up to 10 daily. With menopause, you might experience them for a few months or years. Symptoms include:

  • A sudden surge of heat (especially around the head, neck, or chest)

  • Flushing (red skin)

  • Sweating

  • A rapid heartbeat

  • Anxiety

  • Chills

  • Extreme tiredness or weakness

  • Headache

Related: 6 Side Effects of Menopause—Besides Hot Flashes

What Causes Hot Flashes?

Hot flashes are vasomotor symptoms, meaning they involve the blood vessels. They occur when the hypothalamus—your brain's thermostat—incorrectly senses your body is too hot. To cool you down, it tells blood vessels near your skin to widen, making you sweat and causing your heart to pump more blood.

Changes in hormone levels, like when estrogen drops during perimenopause or menopause, and certain medications and health conditions can cause the hypothalamus to malfunction. Example medications include:

  • Antidepressants: Including medications like Elavil (amitriptyline) or Zoloft (sertraline)

  • Blood pressure medications: Including medications like Cardizem (diltiazem)

  • Chemotherapy: A cancer treatment

  • Clomid (clomiphene): A fertility medication that makes it easier to get pregnant

  • Lupron Depot (leuprolide acetate): A medication that treats prostate cancer, endometriosis (when tissue like the womb lining grows outside the uterus), and uterine fibroids (non-cancerous tumors)

  • Nolvadex (tamoxifen): A type of medication that fights hormone-positive breast cancer

  • Selective estrogen receptor modulators (SERMs): An example is Evista (raloxifene) which helps reduce bone fractures after menopause

Examples of underlying health conditions include:

  • Adrenal insufficiency or tumors (the adrenal gland regulates stress hormones)

  • Allergic reactions

  • Diabetes

  • Pituitary abnormalities or tumors (the pituitary gland regulates hormones)

  • Polycystic ovary syndrome (PCOS), a condition that affects how the ovaries work

  • Pregnancy

  • Thyroid disease or tumors (the thyroid produces certain hormones and helps regulate metabolism)

  • Uterine tumors

  • Vitamin B12 deficiency

Risk Factors

Other risk factors for hot flashes include.

  • Age: The average age of menopause is 52

  • Excess body weight: Can cause hormonal imbalances

  • Race: Black females have a 50% higher chance of having hot flashes during menopause

  • Smoking: Affects blood circulation and hormone levels

Diagnosis

To diagnose perimenopause or menopause, healthcare providers consider your medical history, age, menstrual patterns, and symptoms. If you're in your late forties or early fifties and experiencing changes in your periods or have stopped having them—and you're not pregnant—your history might be enough for a diagnosis.

Your provider might also explore other potential factors, such as underlying health conditions like thyroid disorders, hormone imbalances, or tumors. This might involve a pelvic exam to check your reproductive organs, including the ovaries or uterus.

Diagnostic tests may include checking the following hormone levels in your blood:

Your healthcare provider may also order imaging tests to rule out underlying health conditions. These might include:

  • Ultrasound scan: Uses sound waves to create images of the thyroid or pelvis (area between the hips)

  • Magnetic resonance imaging (MRI) scan: Uses magnets and radio waves to create detailed images

  • Computed tomography (CT) scan: Combines X-ray images taken from different angles to create cross-sectional images

Treatments for Hot Flashes

The goal of treatment for hot flashes is to address underlying causes and reduce the discomfort and disruption hot flashes may cause.

Hormone replacement therapy (HRT) is the most effective perimenopause or menopause treatment. If hot flashes are due to other factors, the treatment approach may focus on addressing those.

Natural or Herbal Remedies

Some people use herbs or supplements to help with hot flashes during perimenopause or menopause. While there's some evidence that herbal supplements like black cohosh might help, not all studies support this.

If you're considering trying these remedies, talking to your healthcare provider first is important. Even though they're natural, they could have risks, especially if you have breast cancer or take medications.

Examples of natural or herbal remedies for hot flashes include:

  • Anise

  • Black cohosh

  • Chaste tree

  • Evening primrose oil

  • Fennel

  • Fenugreek

  • Licorice root

  • Passionflower (can make you sleepy)

  • Red Clover

  • Sage

  • Soy or plant-derived estrogens in foods like soybeans and lentils

  • Valerian root (can make you sleepy)

  • Vitamin E

Complementary or Alternative Treatments

While the research on complementary treatments is ongoing, techniques like acupuncture, breathing exercises, hypnosis, reflexology, or yoga may be helpful.

Acupuncture involves the insertion of thin needles into specific points on the body to promote health. Hypnosis is when a therapist helps you deeply relax your mind. Reflexology involves applying pressure to specific points on the feet, hands, or ears corresponding to body systems to promote relaxation and well-being.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) involves taking estrogen, progesterone, or a combination of both at the lowest possible dose to manage symptoms. Hormones may come in pills, patches, or shots.

Estrogen is the most effective, reducing hot flash frequency by 75%. Progestin (progesterone) is a consideration for those who can’t take estrogen, but is less effective than estrogen.

Prescription Non-hormonal Therapies

Hormone therapy is typically the most effective treatment. For those who can't take hormones, there are non-hormonal medications like:

  • Antidepressants: Examples include paroxetine (Brisdelle) and venlafaxine (Effexor)

  • Catapress (clonidine): A medication that also treats high blood pressure

  • Ditropan (oxybutynin): A medication that also treats overactive bladder

  • Neurontin (gabapentin): A medication that also treats nerve pain and seizures

  • Veozah (fezolinetant): A fairly new medication that helps the brain with temperature regulation

Prevention

The following lifestyle and environmental changes may help prevent hot flashes:

  • Adjust the room temperature to keep it cooler

  • Avoid triggers like alcohol, spicy foods, hot drinks, and cigarettes

  • Drink cool drinks

  • Get regular exercise

  • Practice stress reduction techniques such as deep breathing or art therapy

  • Use a portable fan to keep you cool

  • Wear lightweight, breathable clothing in layers (remove top layers when you are hot)

Complications

Hot flashes are not dangerous, but they can indicate lower estrogen levels. Low estrogen can weaken bones, raising the risk of fractures. Estrogen also helps maintain healthy blood vessels and regulates cholesterol levels. Low levels reduce these protective effects, increasing the risk of heart conditions and stroke.

Your healthcare provider may suggest monitoring your heart and bone health with cholesterol blood tests and bone density scans. HRT might help reduce these risks, but discussing the pros and cons with your provider is essential.

A Quick Review

The primary causes of hot flashes are perimenopause and menopause, though other underlying health conditions or medications can also trigger them. These episodes happen when your brain mistakenly perceives your body as overheating and signals it to cool down.

Diagnosis involves a medical history and a physical exam, though other tests may be necessary. Treatment options include avoiding triggers, natural remedies, HRT, and non-hormonal medications.

Frequently Asked Questions

What stops hot flashes naturally?

To naturally reduce hot flashes, avoid triggers like spicy foods, and try using a cool compress on your neck when you feel a hot flash coming on. Wear breathable clothing, keep your environment cool, and practice relaxation techniques.

Consider a small portable fan to help keep you cool during a hot flash. Herbal supplements like black cohosh may also help with hormone imbalances, but you must consult a healthcare provider to ensure they're safe.

Can drinking water help with hot flashes?

Cool water may be helpful, though its direct impact on hot flashes isn't fully proven. Even if it doesn’t immediately stop hot flashes, drinking water helps prevent dehydration and keeps your body temperature in check.

How many hot flashes per day is normal?

Some people have hot flashes only a few times a week, but some, especially those in perimenopause or menopause, have them up to 10 times daily.

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