• Posted June 22, 2023

Hot Flashes & What to Do About Them

Hot flashes are a common -- and uncomfortable -- symptom of menopause.

More than 80% of menopausal women experience sudden, often debilitating bursts of heat that last several minutes, according to the U.S. Food and Drug Administration. They are the most common symptom of menopause that women note.

This article will examine what hot flashes are, why they happen, how they differ during and after menopause, and available treatment options.

What are hot flashes?

A hot flash is just what it sounds like -- a brief sensation of heat that flashes through your body. It can cause sweating, flushing and when it is over, leave you chilled. How intense, frequent and long-lasting hot flashes are varies from person to person.

Hot flashes during menopause:

Hot flashes can occur during perimenopause, the period before menopause when you start noticing changes, however, it is most common during menopause. Menopause can occur anytime in your 40s or 50s, but the average age in the United States is 51.

While it isn't clear how hormonal changes set off hot flashes, the Mayo Clinic notes that most research suggests that hot flashes occur when decreased estrogen levels cause your internal thermostat (hypothalamus) to become more sensitive to slight changes in body temperature. When the hypothalamus considers your body too hot, it instigates a chain of events -- a hot flash -- to cool you down.

Hot flashes after menopause:

For many women, hot flashes continue after menopause, in some cases lasting the rest of their lives. According to the Women's Health Research Center at Michigan State University, new research indicates that hot flashes continue, on average, for five years after menopause, and more than a third of women may experience hot flashes for up to 10 or more years after menopause.

Hot flash treatments

Only two medications are currently approved by the FDA specifically for hot flashes. They are paroxetine (Paxil), an antidepressant, and a new medication, fezolinetant (Veozah).

Dr. Juliana Kling, a women's health specialist at the Mayo Clinic in Phoenix and one of the authors of the new guidelines for fezolinetant, says in a clinic site it offers patients a choice.

"We have this area in the hypothalamus that's the thermoregulatory zone," she said. "It's like the thermostat in our brain. And after menopause, because of lack of estrogen feeding back to that area, you start to get hot flashes and night sweats. This medication will go and block part of that pathway to help prevent or treat those hot flashes and night sweats."

Hormone replacement therapy (HRT) is another medication category used to relieve hot flashes as well as other menopausal symptoms, according to the Cleveland Clinic. Estrogen is given to compensate for dropping levels of the hormone in the body. If you still have your uterus, you will need to take progesterone along with the estrogen to prevent cancer in your uterine lining. People who have had breast cancer, a heart attack, stroke, or a blood clot cannot take these hormones.

Other medications that are not specifically approved for hot flashes have been found to be helpful in some people, the Cleveland Clinic says. These include venlafaxine (Effexor), desvenlafaxine (Pristiq), fluoxetine (Prozac), paroxetine (Paxil, Brisdelle), escitalopram (Lexapro), and gabapentin (Neurontin). Discuss with your primary health care giver what the best option may be for you.

Beyond prescription medications, some women find over-the-counter therapies helpful. However, studies have not verified that they are effective, and many come with risks. Discuss these with your health care provider before trying them. They include:

• Evening primrose oil
• Soy (plant, or phyto, estrogen)
• Acupuncture
• Vitamin E

Before starting medications, the U.S. National Institutes of Health offers these suggestions for dealing with hot flashes:

• Lower the temperature in your bedroom and keep a fan at bedside.
• Drink some ice water before going to bed.
• Layer your sheets and blankets so you can adjust them as needed.
• Dress in layers so you can adjust your clothing during hot flashes.
• Carry a portable fan with you to use when a hot flash strikes.
• Avoid spicy foods, alcohol and caffeine, as these can make hot flashes worse.
• If you smoke, quit. Smoking makes hot flashes worse.
• Try to maintain a healthy weight. Women who are overweight may experience more frequent and severe hot flashes.
• Explore mind-body practices. Some early-stage research shows that hypnotherapy and mindfulness meditation might help.

While most women experience some disruption from hot flashes during, and even after menopause, with the proper knowledge and tools it is possible to avoid most of the intrusive effects hot flashes can have on your life.