What Are Menopausal Hot Flashes? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Hot flashes are the most common of all the menopausal symptoms related to hormonal changes, but their exact cause is still somewhat unclear. Hot flashes, or hot flushes, are thought to be the result of changes in the hypothalamus, the area of the brain that serves as the body’s thermostat. If the hypothalamus gauges elevated body temperature, blood vessels near the skin’s surface begin to vasodilate (enlarge), which increases blood flow to help lower it. Hot flushes may produce a red color in the face, neck, and chest. They may also trigger sweating and an elevated heart rate.

Hot flashes are a vasomotor symptom of menopause (VMS). VMS are episodes of intense heat accompanied by sweating, predominantly around the head, neck, chest, and upper back. A flash can last for a few seconds or several minutes.

During a hot flash, you may experience:

• A sudden warm feeling that spreads across your chest, neck, and face
• A flushed appearance with red, blotchy skin
• A quicker heartbeat
• Perspiration, primarily in your upper body
• Chills as the hot flash passes
• Feelings of anxiety
• Sudden dizziness or feelings of nausea

Women over 40 years old who have reached the midlife and postmenopausal stages of life are most prone to hot flashes.

Certain risk factors are linked to menopausal hot flashes:

• Current and former cigarette smoking
• Symptoms of depression
• A history of abuse

Some research suggests that abuse or financial hardship early in life are linked to worse menopausal symptoms, including hot flashes.

What Causes Hot Flashes Besides Menopause?

There are several nonmenopausal potential causes of hot flashes. Hot flashes may occur in early pregnancy or as a response to cancer treatment or other medications. However, many women experience hot flashes related to menopause.

Experiencing hot flashes is a symptom, not a disease, so hot flashes cannot be diagnosed. They are a common symptom of the menopausal transition. There are no tests to show that you’re having hot flashes, but your doctor can usually identify that you are having them based on your menopausal status and a description of your symptoms.

Most women experience hot flashes for six months to two years, according to the North American Menopause Society (NAMS), but some research suggests that they can last up to a decade. For a small percentage of women, they may never go away. And it’s not uncommon for hot flashes to pop up again more than a decade after menopause, even in women in their seventies or older. There is no reliable way of predicting when hot flashes will first start or stop.

There are pharmaceutical and lifestyle remedies to help minimize and address hot flashes. Every medication comes with potential side effects and risks; talk to your doctor about the benefits and potential pitfalls of the options available to you.

Medication Options

• Hormone Therapy or Hormone Replacement Therapy Hormone therapy (HT), also known as hormone replacement therapy or menopausal hormone therapy, is medication to treat hot flashes and other bothersome menopausal symptoms such as night sweats and vaginal dryness. For hot flashes, hormones are taken via pills, patches, sprays, gels, or a vaginal ring. The NAMS considers this the first line of treatment for hot flashes, with estimates of a 75 percent reduction in vasomotor symptoms. Systemic hormones include estrogens — either the same or similar to the estrogens produced naturally in the body — and progestogens, which include progesterone or a similar compound. Systemic hormones have other benefits, like boosting bone health, but carry the risk of blood clots and breast cancer in some women. If you are having disruptive hot flashes, talk to your doctor or a menopause expert about HT and other options for treating VMS.
• Selective Serotonin-Reuptake Inhibitors (SSRIs) For women who choose not to or cannot take hormones, nonhormone drugs approved to treat depression, called selective serotonin-reuptake inhibitors (SSRIs), have been shown to be effective in treating hot flashes in women who don’t have depression. The only SSRI that the U.S. Food and Drug Administration (FDA) has approved to treat hot flashes is paroxetine (Paxil).
• Oxybutynin (Ditropan XL, Oxytrol) This nonhormonal drug is used for overactive bladder, but it has also been shown to successfully decrease hot flashes. In a Mayo Clinic study, researchers found that oxybutynin reduced hot flashes by roughly 77 percent.
• Gabapentin (Neurontin, Gralise) An anti-seizure medication, it is moderately effective in reducing hot flashes.
• Pregabalin (Lyrica) This is another anti-seizure medication that can be effective in reducing hot flashes.
• Clonidine (Catapres, Kapvay) Clonidine comes as a pill or patch and is typically used to treat high blood pressure, but it might provide some relief from hot flashes.
• Neurokinin 3 Receptor Antagonists In May 2023, the FDA approved fezolinetant (Veozah), a nonhormonal oral compound used to treat moderate to severe VMS. Studies have shown a rapid and substantial reduction in VMS frequency and severity, as well as improvements in health-related quality of life. Please note that on September 12, 2024, the FDA issued a warning that fezolinetant could cause a rare but serious liver injury. Women experiencing symptoms such as new-onset fatigue, jaundice, nausea and vomiting should stop taking the drug, the agency said.

Complementary and Alternative Remedies for Treating Hot Flashes

While many natural products, herbs, and dietary supplements claim to help with hot flashes, the evidence for their effectiveness is mixed, and long-term safety is unknown. More research is needed to support their use for the treatment of hot flashes. There are fewer safety concerns with psychological treatment, dietary changes, and exercise approaches for menopausal symptoms.

A study published in the journal Menopause found that acupuncture, yoga, and health and wellness education classes demonstrated effectiveness in the reduction of hot flash frequency compared with controls.

Other potential nondrug options, according to the Mayo Clinic, include:

• Hypnosis
• Cognitive behavior therapy
• Exercise

Lifestyle changes such as these may help prevent hot flashes, and they may also aid with other unwelcome menopausal symptoms, such as difficulty sleeping or mood issues.

Eating certain foods and avoiding others may help reduce hot flashes, but diet alone cannot stop or prevent VMS. Some data suggests that a low-fat, vegan diet with at least ½ cup of soy beans a day helps reduce hot flashes, but more research is needed to show efficacy.

Managing a Hot Flash in the Moment

Is there anything you can do to help yourself when a hot flash happens? Experts stress that planning and preparation will arm you to cope with a flash as it happens. If you wear layers, you can remove some to cool down. Running cold water on your wrists may help relieve discomfort. If you carry a hand-held fan, you can use it to help cool off. See more tips and suggestions in the prevention section.

Menopausal hot flashes may be correlated with other health issues.

• Heart Disease Research has shown a link between vasomotor symptoms like hot flashes and an increased risk for cardiovascular disease. A study published in the Journal of the American Heart Association found that frequent and persistent vasomotor symptoms were associated with a higher risk for future cardiovascular disease and that vasomotor symptoms may be a novel female-specific heart disease risk factor. Plus, every time your heart rate increases, your blood pressure goes up; because of this, women who experience hot flashes are more likely to have damaged blood vessels.
• Lower Bone Density Research once held that hot flashes led to lower bone density in the hip, neck, and spine. But other findings suggest that among women with osteoporosis who are five or more years postmenopausal, the severity of persistent hot flashes isn’t associated with progressive bone loss or risk of fracture.
• Perimenopausal Depression The early and late stages of perimenopause — as well as the first few years after menstruation stops — are vulnerable times for the development of depressive symptoms and episodes, and midlife depression often occurs in combination with vasomotor symptoms like hot flashes. In 2018, the NAMS, along with the Women and Mood Disorders Task Force of the National Network of Depression Centers, released summary guidelines for the evaluation and treatment of perimenopausal depression.
• Migraine Research from the Mayo Clinic confirmed a link identified in a prior study between a history of migraine and hot flashes. The study of more than 3,000 women found that the correlation between hot flashes and migraine was significant, and the more severe your hot flashes are, the more likely you are to report severe migraines. It’s yet unclear whether migraine and hot flashes are separate issues that are both tied to heart disease risk or if they share a common pathophysiology.
• Cognitive Function and Mood Disorders The relationship between night sweats, sleep, and cognitive function has been challenging for researchers to deconstruct. Some research suggests that vasomotor symptoms can lead to fatigue, irritability, depression, and memory dysfunction.
• Insomnia and Other Sleep Problems Hot flashes and other vasomotor symptoms such as night sweats can disrupt sleep, and research shows that they contribute to insomnia and other serious sleep problems that many women develop in midlife.

As many as 75 percent of North American women have hot flashes during perimenopause, according to the NAMS, and nearly a quarter of them seek relief from a healthcare provider.

Hot flashes may be more severe in Black women. Findings from the Study of Women’s Health Across the Nation found that Black women have more severe and more frequent vasomotor symptoms, which include hot flashes and night sweats, when compared with white women.

A study published in the journal Menopause found that of people who have hot flashes, about 9 percent describe them as severe, 56 percent as moderate intensity, and 33 percent as mild.

While many menopause experts caution that lifestyle changes aren’t enough to prevent them, the National Institute on Aging offers these suggestions:

• Try to maintain a healthy weight. A study in the journal Menopause found that hot flashes are associated with a higher body mass index, and overweight and obese women may experience more frequent and severe hot flashes.
• Rethink your bedroom setup. Keep the thermostat lower in your bedroom if hot flashes keep you up at night. Use a fan, drink small amounts of ice water before turning in, and layer your bedding so you can shed or add blankets if needed.
• Avoid alcohol, spicy foods, hot beverages, and caffeine; they may trigger or worsen vasomotor symptoms.
• Quit smoking.

Explore mind-body practices. Some early-stage research has shown that hypnotherapy and mindfulness meditation could help manage hot flashes.