Hot flashes are sudden feelings of warmth, which are usually most intense over the face, neck and chest. Your skin may redden, as if you're blushing. Hot flashes can also cause profuse sweating and may leave you chilled.
Although other hormonal conditions can cause them, hot flashes most commonly are due to menopause — the time when a woman's menstrual periods stop. In fact, hot flashes are the most common symptom of the menopausal transition.
How often hot flashes occur varies from woman to woman, but usually the range is from one or two a day to one an hour. There are a variety of treatments for particularly bothersome hot flashes.
During a hot flash, you may experience:
- A sudden feeling of warmth spreading through your upper body and face
- A flushed appearance with red, blotchy skin
- Rapid heartbeat
- Perspiration, mostly on your upper body
- Feeling chilled as the hot flash subsides
Hot flashes vary in frequency — you may have few or many in a day — and each hot flash usually subsides in a few minutes. They're particularly common at night. Most women who experience hot flashes have them for more than a year, but they usually stop on their own within four to five years.
When to see a doctor
If hot flashes become particularly bothersome, consider making an appointment with your doctor to discuss treatment options.
The exact cause of hot flashes isn't known, but it's likely related to several factors. These include changes in reproductive hormones and in your body's thermostat (hypothalamus), which becomes more sensitive to slight changes in body temperature.
Not all women who go through menopause have hot flashes. It's not clear why only some women get hot flashes. The following factors increase your risk:
- Smoking. Women who smoke are more likely to get hot flashes.
- Obesity. A high body mass index (BMI) is associated with a higher frequency of hot flashes.
- Physical inactivity. If you don't exercise, you may be more likely to have hot flashes during menopause.
- Ethnicity. More African-American women report menopausal hot flashes than do women of European descent. Hot flashes are less common in women of Japanese and Chinese descent than in white European women.
Nighttime hot flashes (night sweats) can wake you from sleep and, over time, may cause chronic insomnia. These sleep disturbances can, in turn, eventually lead to memory problems, anxiety and depression in some women.
You'll likely start by seeking advice about your hot flashes from your family doctor or gynecologist.
What you can do
To prepare for your appointment:
- Keep track of your symptoms. For instance, make a list of how many hot flashes you experience in a day and note how severe they are.
- Make a list of any medications, herbs, vitamins and supplements you take. Include the doses and how often you take them.
- Have a family member or close friend accompany you, if possible. It can be difficult to retain all the information you get during your visit.
- Take a notebook or notepad with you. Use it to note important information during your visit.
- Write a list of questions to ask your doctor. List your most important questions first, in case time runs out.
Some basic questions to ask include:
- What tests might I need, if any?
- What treatments are available to minimize my symptoms?
- Is there anything else I can do to relieve my symptoms?
- Are there alternative therapies I might try?
- Do you have printed information I can have?
- What websites do you recommend?
Don't hesitate to ask other questions, as well.
What to expect from your doctor
Some questions your doctor might ask include:
- Are you still having periods?
- When was your last period?
- How often do your symptoms bother you?
- How uncomfortable do your symptoms make you?
- Does anything seem to help?
- Does anything make your symptoms worse?
Your doctor can usually diagnose hot flashes based on a description of your symptoms. To confirm the cause of your hot flashes, your doctor may suggest blood tests to check whether you're in menopausal transition.
The most effective treatment for hot flashes is estrogen, but taking this hormone can increase your risk of developing other health problems. Medications such as antidepressants and anti-seizure drugs also may help reduce hot flashes.
Discuss the pros and cons of various treatments with your doctor. If hot flashes don't interfere with your life, you may not need treatment. For most women, hot flashes fade gradually within a few years.
Estrogen and progesterone are the hormones used to reduce hot flashes. Women who have had a hysterectomy can take estrogen alone. But if you still have a uterus, you should take progesterone along with estrogen to protect against cancer of the lining of the uterus (endometrial cancer).
With either regimen, current recommendations from the American College of Obstetricians and Gynecologists are to use the lowest effective dose for the shortest amount of time needed to relieve symptoms.
A combination drug of bazedoxifene with conjugated estrogens (Duavee) has been approved for treatment of menopausal symptoms. This drug may avoid the increased risk of cancer, but more study is needed.
Estrogen therapy is not a good option if you've ever had a blood clot or breast cancer.
Low doses of certain antidepressants may decrease hot flashes. Examples include:
- Venlafaxine (Effexor XR, Pristiq)
- Paroxetine (Brisdelle, Paxil, Pexeva)
- Fluoxetine (Prozac, Sarafem)
Brisdelle is the only antidepressant medication approved by the Food and Drug Administration for treating hot flashes. But, it's expensive compared with generic formulations. The other drugs and formulations are prescribed off-label.
Antidepressants aren't as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can't or don't want to use hormones. Possible side effects include headache, fatigue, nausea, dizziness, weight gain, dry mouth, sexual dysfunction, suicidality and a withdrawal syndrome if the medicines are abruptly stopped. Some side effects may decrease over time or with an adjustment to the dose. If you have suicidal thoughts while taking one of these medications, seek medical help immediately.
Other prescription medications
Other medications that may offer relief for some women include:
- Gabapentin (Neurontin, Gralise). Gabapentin is an anti-seizure medication that's moderately effective in reducing hot flashes. Side effects can include drowsiness, dizziness and headaches.
- Clonidine (Catapres, Kapvay, others). Clonidine, a pill or patch typically used to treat high blood pressure, may provide some relief from hot flashes. Side effects include dizziness, drowsiness, dry mouth and constipation.
If your hot flashes are mild, you may be able to manage them with lifestyle changes. Follow these tips:
- Keep cool. Slight increases in your body's core temperature can trigger hot flashes. Dress in layers so that you can remove clothing when you feel warm. Open windows or use a fan or air conditioner. Lower the room temperature, if you can. If you feel a hot flash coming on, sip a cold drink.
- Watch what you eat and drink. Hot and spicy foods, caffeinated beverages, and alcohol can trigger hot flashes. Learn to recognize your triggers and avoid them.
- Relax. Some women find relief from mild hot flashes through meditation; slow, deep breathing; or other stress-reducing techniques. Even if these approaches don't quell your hot flashes, they may provide other benefits, such as easing sleep disturbances that tend to occur with menopause.
- Don't smoke. Smoking is linked to increased hot flashes. By not smoking, you may reduce hot flashes, as well as your risk of many serious health conditions, such as heart disease, stroke and cancer.
- Lose weight. If you're overweight or obese, losing weight might help ease your hot flashes.
Many women have turned to alternative medicine, including mind and body techniques and dietary supplements to help curb hot flashes. There is a shortage of well-designed studies on complementary health practices for hot flashes, but research is progressing.
Mind and body approaches
A growing body of evidence suggests that certain techniques can help ease hot flashes, including:
- Relaxation techniques. Practices such as yoga, tai chi and qi gong might help relieve hot flashes.
- Acupuncture. Some studies indicate that acupuncture may reduce the frequency and severity of hot flashes.
- Hypnosis. Preliminary research shows that hypnosis successfully relieved hot flashes in women with breast cancer by reducing the number of hot flashes experienced each day. Another study shows promise for hypnosis in relieving hot flashes in postmenopausal women. More research is needed.
People often assume that "natural" products cause no harm. However, all supplements have potentially harmful side effects, and supplements can also interact with medications you're taking for other medical conditions. Always review what you're taking with your doctor.
Dietary supplements commonly used for menopause symptoms include:
- Plant estrogens. Asian women, who consume soy regularly, are less likely to report hot flashes and other menopausal symptoms than are women in other parts of the world. One reason might be related to ingestion of estrogen-like compounds in soy, red clover and many other plants. However, studies giving soy to women with hot flashes have generally found no benefit.
- Black cohosh. Black cohosh has been popular among many women with menopausal symptoms. Studies of black cohosh's effectiveness have had mixed results, and the supplement can be harmful to the liver.
- Ginseng. While ginseng may help with mood symptoms and insomnia, it doesn't appear to reduce hot flashes.
- Dong quai. Study results indicate that dong quai isn't effective for hot flashes. The supplement can increase the effectiveness of blood-thinning medications, which can cause bleeding problems.
- Kava. Kava may ease anxiety, but not hot flashes. It can also damage the liver.