Why Hot Flashes Occur and How to Treat Them
Aug 08, 2023 Jaimie Seaton
There’s no mistaking a hot flash. A rush of heat suddenly rolls over you, often leaving you dizzy and drenched with sweat, or even chilled. Hot flashes can last a few minutes, or up to an hour, but they feel like forever.
“With a hot flash, a person experiences a kind of whole body flushing or heating up, where they can sometimes start sweating profusely,” explains Jessica Chan, MD, a reproductive endocrinologist at Cedars-Sinai. “Hot flashes can be very uncomfortable and disruptive for folks to carry on with their day, which can really impact their quality of life.”
Approximately 75% of menopausal women in the U.S. get hot flashes, but their underlying cause and triggers are still not completely understood, and there is no treatment that works for everyone. Although the Food and Drug Administration (FDA) recently approved a new treatment, it brings the number of non-hormonal treatments available to just two—and many people can’t take hormone therapy. The lack of available treatments highlights an unmet need, considering the large percentage of menopausal people who get hot flashes.
Here, Dr. Chan helps us understand hot flashes, their underlying cause, triggers and treatment options.
“Don't suffer in silence. This is something that can be addressed by your doctor and should definitely not be ignored or endured silently.”
The Basics of Hot Flashes
Hot flashes, also known as vasomotor symptoms, are a medical condition and the symptom most menopausal women seek treatment for. They usually come on suddenly and cause intense heat and sweat in the face, neck and chest, and the skin may turn red, as if blushing.
A hot flash may also cause chills and rapid heartbeat. Hot flashes can be mild (hot but not sweating), moderate (hot and sweating but not overwhelming) or severe (so hot and sweaty that you stop what you’re doing).
When hot flashes occur overnight, they’re called night sweats. Because people often wake up soaking wet and have to get up to change their pajamas, night sweats can lead to long-term sleep problems. Lack of sleep can in turn impact energy levels and productivity, focus, personal relationships and sexual activity.
Hot flashes generally can occur over seven to 10 years, and two to four years longer for Black and Latino individuals.
Who Gets Hot Flashes?
“Typically, we think of women who are either menopausal or perimenopausal (the years leading into menopause) who experience that big drop in estrogen,” Chan says.
This means hot flashes can start as early as age 40.
“But it can also happen to women who undergo early menopause or premature menopause, or women who lose their ovaries via surgery or chemotherapy or who are undergoing treatment for endometriosis,” Chan says.
She adds that any change in hormones can cause hot flashes, and this means transgender men (men who were assigned female at birth) who’ve had their ovaries removed or are getting hormone therapy can have them too.
What Causes Hot Flashes?
Hot flashes are related to fluctuating hormones that happen before, during and after menopause. Research suggests that dropping estrogen can change how the brain perceives temperature. In other words, our internal thermostat (hypothalamus) doesn’t work properly, so when it starts to think your body is too hot, it opens up all the blood vessels on the skin and the sweat glands to cool it off.
What Are the Risks and Triggers for Hot Flashes?
Risk factors include obesity, smoking and race. Triggers for hot flashes include anxiety or mood changes, eating spicy foods and drinking alcohol or caffeinated drinks. In one study, Black women were 50% more likely than white women to experience hot flashes.
Are There Lifestyle Changes That Can Mitigate Hot Flashes?
Because obesity is a risk factor for hot flashes, maintaining a healthy weight through diet and exercise can play a powerful role in decreasing them. Because anxiety and mood changes may also trigger hot flashes, practicing mindfulness meditation can also be good ways to manage them.
Dressing in light layers that can be quickly removed and carrying a portable fan are good ways to be prepared for the sudden onset of a hot flash.
Those who experience night sweats can lower their bedroom temperature and put a fan next to the bed. A cool drink of water before sleep may also help.
What Are the Treatments for Hot Flashes?
Chan says the most effective treatment for the relief of hot flashes is hormone replacement therapy, but that’s not an option for everyone. People who have had a history of certain types of cancer, blood clotting disorders or severe cardiovascular disease aren’t good candidates for estrogen—but they can often use non-hormonal treatments.
Until recently, Brisdelle (paroxetine) was the only FDA-approved non-hormonal medication to treat hot flashes, but the agency approved a second, Veozah (fezolinetant) in May. Both are taken orally. Veozah is the first neurokinin 3 (NK3) receptor antagonist approved by the FDA to treat hot flashes from menopause. It blocks the NK3 receptor, which plays a role in how your brain regulates body temperature and may offer relief to the women who don’t respond to current treatments.
“Certainly some of the non-hormonal options don't work in every single person, so sometimes we want to individualize our approach to patients with hot flashes,” Chan says, adding that Veozah provides a new alternative treatment available to patients.
Antidepressants, such as Paxil (paroxetine), Celexa (citalopram), Lexapro (escitalopram) and Effexor (venlafaxine), can be good non-hormonal treatment alternatives. Other medications, such as gabapentin (sold under various brand names) and Catapres (clonidine), have also been known to work.
Are Hot Flashes Dangerous?
While hot flashes themselves don’t pose any health risks, Chan says they can be a sign of low estrogen in the body, which is tied to many negative health impacts of menopause. These include lower bone density, which can lead to osteoporosis or fractures, and less cardiovascular protection—which means you’re at higher risk of cardiovascular events.
People who have hot flashes should reach out to their healthcare provider.
“Don't suffer in silence. This is something that can be addressed by your doctor and should definitely not be ignored or endured silently,” Chan says.