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Hot Flashes: Causes and Treatments During Menopause & Perimenopause

Hot flashes are sudden, intense feelings of warmth in the body that are very common during perimenopause and menopause. Also called “hot flushes”, they are considered the hallmark symptom of the menopausal transition in women.

About 75% of menopausal women experience hot flashes, with over 30% rating them as severe or very severe. This article will provide a detailed overview of what hot flashes feel like, why and when they occur, what causes them, risk factors for more severe symptoms, how hot flashes are diagnosed, and both medical and natural treatment options for finding relief.

What are Hot Flashes?

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A hot-flash refers to a sudden sensation of intensified body heat, flushing, sweating, and skin redness that spreads over the face, neck, chest, and sometimes the whole body. Other terms for hot-flashes include:

  • Night sweats
  • Hot flushes
  • Vasomotor symptoms

The sensation of heat often starts in the chest area and rises into the neck and face. It can make the skin red and blotchy, resembling a blush. Profuse sweating often follows as the body tries to cool itself down. A rapid heart rate, anxiety, feeling flushed, and skin tingling may also occur.

Hot flash episodes usually last from 1 to 5 minutes, but the sensation can linger up to 30 minutes. In some cases, a chilly feeling and shivering follow the heat sensation as the body resets its thermostat. The frequency of hot flashes varies widely from a few per week to several per day.

Night sweats refer to hot flashes occurring at night during sleep. These nocturnal episodes can interrupt sleep and leave sweat-soaked bedsheets and nightclothes. All hot flashes result from the same mechanism, whether daytime or nighttime – a narrowing of blood vessels near the skin’s surface.

When do hot flashes happen in the menopausal transition?

Hot flashes most commonly begin occurring during perimenopause, as hormonal levels begin to fluctuate and decline. Perimenopause refers to the transition period leading up to menopause, often lasting about 4 years but sometimes longer.

  • The average age of perimenopause onset is 47-48 years old.

However, perimenopause can begin in some women as early as their late 30s or 40s.

  • Hot flashes frequently start in the 1-2 years before menstrual periods end.
  • Up to 80% of women experience hot flashes** by the end of perimenopause as menstrual cycling stops.

During the first year after the final menstrual period, in the early stage of menopause called postmenopause, hot flashes often peak in frequency and intensity. Over the next 5 years of postmenopause, the severity usually gradually decreases.

However, in some women, bothersome hot flashes persist for many years into the later stages of menopause for unclear reasons. There is also significant individual variation – some women have few or no hot flashes, while others suffer debilitating symptoms.

Related Post: Uterine Fibroids: Do all Women Show Symptoms? Discover Causes and Treatments!

What causes hot flashes and night sweats?

Causes of Hot Flashes

Hot flashes are primarily triggered by diminished and fluctuating levels of the hormone estrogen during the menopausal transition. This is because estrogen is involved in regulating body temperature and how blood vessels respond.

  • As the ovaries produce less estrogen, thermoregulatory dysfunction occurs in the hypothalamus, which governs body temperature.
  • Declining estrogen causes blood vessels near the skin surface to dilate rapidly. A sudden rush of blood flow heats the skin and core body temperature.
  • The hypothalamus senses the temperature change but overreacts, mistakenly perceiving this as body overheating.
  • It responds by initiating heat dissipation mechanisms – flushing, sweating, and increased heart rate to cool the perceived “overheating”.
  • But in reality, no actual overheating has occurred. The hypothalamus has become hypersensitive because of lower estrogen levels.
  • Once the hot flash episode concludes, the hypothalamus resets back to baseline, often now registering the body as too cold. Chills and shivering may follow.

So, the temperature and vascular dysfunction related to estrogen withdrawal underlie the genesis of hot-flashes. But other hormones also likely contribute to thermoregulation problems, like FSH, LH, and progesterone. Stress and obesity may also play a role in some women.

What are Risk Factors for More Frequent or Severe Hot Flashes?

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While hot flashes are very common during the menopausal transition, some factors put women at higher risk of more bothersome symptoms:

  • Surgical menopause – Hot flashes may be more severe if triggered by surgery like ovary removal instead of natural menopause. Because the estrogen drop is sudden rather than gradual.
  • Ethnicity – Studies show African American and Hispanic women report more frequent, severe symptoms than Caucasians and Asians. The reason is unclear.
  • Early menopause – Hot flashes tend to be worse in women who undergo menopause before age 45, with symptoms lasting longer as well.
  • Lower BMI – Having a lower body mass index correlates with more intense hot flashes. Excess fat may have a protective hormonal effect.
  • Stress – Anxiety, depression, and stressful life events can worsen hot flashes symptoms and discomfort.
  • History of PMS – Women with a history of severe PMS seem more susceptible to menopausal symptoms.
  • Smoking – Cigarette smoking is linked to more frequent and severe hot flashes.
  • Sedentary lifestyle – Lack of regular physical activity correlates with worse symptoms. Exercise helps reduce hot flashes.
  • Alcohol use – Consumption of alcohol, especially heavy use, is tied to worsened hot flashes experiences.

So, while hot flashes are expected during the menopausal transition, certain women suffer more based on risk factors like ethnicity, surgical menopause, stress level, and health habits. Awareness of these factors can help identify who may need more intensive treatment.

When Should I see a Doctor for Hot Flashes?

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  • If hot flashes interrupt sleep, work, or daily life
  • If symptoms do not respond to lifestyle modifications or over-the-counter remedies after 2-3 months
  • If hot flashes are accompanied by other concerning symptoms like palpitations, dizziness, nausea
  • If you are experiencing mood changes like depression or anxiety along with hot flashes
  • If you have surgical menopause before age 40 and need guidance for long-term management
  • If you want to discuss the pros and cons of hormone therapy or other prescription medications

Mild hot flashes can often be managed with home treatment. However, worsening or persistent symptoms should prompt medical evaluation to identify the best options for your health status. Most women benefit from at least some type of treatment plan.

How are Hot Flashes Diagnosed?

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There are no specific diagnostic tests for hot flashes. The diagnosis is based on the characteristic symptom history.

Your doctor will ask about:

  • Age and if periods have become irregular, signalling perimenopause
  • Frequency of hot flash episodes
  • Timing – do they interrupt sleep or occur mostly at night?
  • Triggers – do they happen in certain situations like stress or alcohol use?
  • Duration – how long does each hot flash last?
  • Associated symptoms – nausea, heart palpitations, dizziness
  • Impact on quality of life – sleep, concentration, social activities
  • Previous use of hormones – birth control pills, fertility treatments
  • Medical history – surgeries, chronic health conditions, medications
  • Family history – how was your mother’s menopausal symptoms?
  • Lifestyle factors like smoking, activity level

Blood tests of FSH, LH and estradiol levels may be done to confirm menopause if periods have been irregular. However, testing is not required to diagnose hot flashes themselves. There is no single test. Keeping a diary of your symptoms helps guide treatment.

Medical Treatment Options for Hot Flashes


If hot flashes become frequent or severe enough to disrupt quality of life, a variety of medical treatment options are available.

Hormone Therapy

  • Estrogen alone or combined estrogen-progestin therapy, available as pills, patches, gels, sprays or rings. Considered the most effective treatment for hot flashes and night sweats, it works by replacing deficient hormones.
  • Typically used at lower doses than in the past for menopause symptom relief.
  • Weigh benefits vs. potential risks like blood clots, stroke, and breast cancer with your provider. Short-term use under 5 years has lower risks.


  • Certain SSRI antidepressants like escitalopram (Lexapro) and citalopram (Celexa) have been found helpful for hot flashes.
  • May be preferred for women who cannot take hormones, with around 60% effectiveness.
  • Work by enhancing serotonin activity. Take daily.


  • An anti-seizure medication also used for nerve pain that may stabilize thermoregulatory neurons and reduce hot flashes.
  • Taken as a pill twice or three times daily. It may cause drowsiness.
  • Around 70% effective for reducing hot flash frequency and severity. Works within a few weeks.


  • A blood pressure medication that counteracts declining estrogen levels in the brain involved in hot flashes. May decrease their intensity.
  • Can cause side effects like dizziness, dry mouth, and constipation.
  • Mixed evidence on effectiveness. They are considered second-line treatment.

Discuss all medical options thoroughly with your healthcare provider based on your symptom severity and health history. Prescription therapies provide the strongest relief of hot flashes, but hormones especially must be used cautiously after weighing potential risks.

Lifestyle Changes and Natural Remedies for Hot Flashes

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Many women also seek to find relief from hot flashes through home remedies and lifestyle adjustments. These strategies may help ease milder symptoms:

  • Keep the core body cool – wear light layers, use fans, lower room thermostat, and avoid spicy foods.
  • Stay hydrated – drink adequate water and fluids like herbal tea. Dehydration worsens hot flashes.
  • Reduce alcohol intake– alcohol is a common hot flash trigger.
  • Learn calming techniques – paced breathing, yoga, and mindfulness meditation can reduce hot flash intensity. Managing stress is key.
  • Exercise regularly – 30 minutes per day, ideally in a cool environment. It helps regulate hormones and body temperature. Yoga and tai chi are especially beneficial.
  • Acupuncture – shown to reduce hot flash frequency and intensity in some women.
  • Keep a symptom diary – note timing, triggers, and severity to identify patterns.
  • Wear moisture wicking night clothes – prevents sweating discomfort at night
  • Natural supplements – soy, black cohosh, vitamin E and flaxseed have mixed evidence for relief of mild hot flashes. The effects could be more dramatic. Check with the doctor first about safety and potential interactions.

While not as fast-acting or robust as prescription treatments, home remedies and lifestyle changes may help control milder menopausal symptoms. But speak to your healthcare provider if symptoms are disrupting sleep and quality of life. More intensive treatment may be right for you. There are, thankfully, many options to explore for achieving hot flash relief.

Questions to Ask your Doctor about Hot Flashes:

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  • Is hormone therapy a safe option for me based on my health history?
  • What dose and formulation of hormones do you recommend – pill, patch, gel?
  • How long should I take hormone therapy – months, years?
  • Should hormone therapy be continuous or cyclic each month?
  • What are the risks and side effects I should watch for?
  • Would an antidepressant be better for me than hormones?
  • Do herbs like black cohosh actually help hot flashes? Are they safe?
  • Will my symptoms likely improve on their own with time?
  • What lifestyle changes do you recommend alongside treatment?
  • When should I follow up with you – days, weeks, months?

Do not hesitate to discuss all your hot flash concerns and questions with your healthcare provider. There are many individualized treatment options to provide symptom relief and help you feel like yourself again.



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