Menopause Symptom Guide: Hot Flashes

Medically reviewed by:

Emily Hu, MD

Hot flashes are the most common symptom of the menopausal transition. The average age of menopause is 51 and hot flashes often start for women in their 40s.

What are hot flashes?

Hot flashes (also called “hot flushes” or “vasomotor symptoms”) are sudden feelings of extreme heat in the body that are most intense over the face, neck and chest. They can cause your skin to look like you’re blushing—and can make you want to take that ice bucket challenge ASAP.

Hot flashes can also make you sweat (“night sweats” are actually hot flashes that happen during sleep) and can lead to a rapid heartbeat and feelings of anxiety or dread. If you lose enough heat, you may feel chilled when they’re over.

Up to 75% of women experience hot flashes, making them the most common symptom of perimenopause and menopause. That’s right, you can have hot flashes and still be getting your period. Each episode can last anywhere from thirty seconds to ten minutes, and recent research has suggested that most women get them over the course of about 7.5 years, often starting in their 40s during perimenopause. Good times, right?

What causes them?

Hot flashes are caused by the fluctuation and decline of your hormones, mainly estrogen. Certain factors are thought to make them worse, including stress, smoking, and being overweight. Some people find that hot flash episodes can be triggered by a long list of factors, among them caffeine, alcohol, spicy foods, processed foods, food sensitivities, and warm weather.

What’s happening inside your body?

Normally, when your body gets too warm, the hypothalamus (the part of the brain that modulates body temperature) signals your blood vessels to dilate in order to release heat. This causes blood to flow more quickly to your face, neck and chest, your sweat glands to open, and your heart to pump faster.

During menopause, lower estrogen levels cause your hypothalamus to set off this reaction at random, making you feel like you just ran a four minute mile when really you did nothing of the sort.

What does the research say?

A recent analysis of the Study of Women’s Health Across the Nation (SWAN) found that hot flash symptoms typically last between 5 and 13 years and were rated moderate-to-severe by most women.
A 2006 analysis of SWAN looked at hot flashes symptoms by ethnicity and determined that African American women experience them more frequently than other groups, while Asian women experience them less frequently.
Research on 430,000 Swedish women discovered that 11% of 38-year-old women were already experiencing hot flashes, and 30% of 60-year-old women were still getting them.

How are hot flashes diagnosed?

A doctor can diagnose you based on your description of your symptoms.

What are effective treatments?

Estradiol: This is the most effective treatment available. Replenishing the exact form of estrogen that your ovaries are no longer producing, estradiol is scientifically proven to eliminate hot flashes completely in up to 75% of women and to reduce the frequency and severity in the remainder.
Gabapentin: A non-hormonal off-label prescription medication, Gabapentin is believed to act on a mechanism that helps control body temperature. It is particularly effective for night sweats.
Paroxetine (aka “Paxil” or “Brisdelle”): An FDA approved, low-dose SSRI (selective serotonin reuptake inhibitor) that may be prescribed for women who aren’t candidates for estrogen therapy due to breast cancer or who want non-hormonal treatment. It acts by inhibiting the reuptake of serotonin into your neurons, thus increasing the level of serotonin within your brain.
Venlafaxine (aka “Effexor”): An SNRI (serotonin norepinephrine reuptake inhibitor) that may be prescribed off-label to women who aren’t candidates for estrogen therapy due to breast cancer or who want a non-hormonal treatment. It acts by inhibiting the reuptake of serotonin and norepinephrine by your neurons, thus increasing their levels within your brain.
Clonidine: Clonidine is a high blood pressure medication prescribed off-label to treat hot flashes by lowering blood pressure.

What are some non-medical treatments?

While less effective than the medical treatments, some women find that these help:

Nutrition: Phytoestrogens (like those found in soy) can mimic estrogen within your body. While soy is one of the most well-known phytoestrogens, other sources include yams, flax, and lentils.
Supplements: Some women have found that using black cohosh, vitamin E, and dong quai can reduce their hot flashes. Studies suggest they work by regulating hormone levels, though exactly how is still being researched. Vitamins B6 and 12 have are also occasionally used to help with anxiety related to hot flashes.
Breathing exercises: Deep breathing exercises can help you manage the duration of hot flashes by calming your anxiety, thereby reducing heart rate and blood flow.
Physical exercise: Sustained physical exercise can help your body more effectively regulate temperature and release heat.
Layers: Wearing loose clothing and dressing in layers (think a t-shirt and light sweater versus a cable knit) allows you to control your temperature by removing items to cool off.
Cannabis: While cannabidiol (CBD) seems to be everywhere these days, at present, there is very little evidence to suggest that CBD can treat the symptoms of menopause.

What to do next:

Connect with an OBGYN who treats menopause: Many doctors will list their specialties/areas-of-interest on their website, or you can ask when making your appointment.
Determine your options: Collaborate with your doctor to identify and understand the treatment options available to you given your medical history.
Decide what works for you: You know your body best. Select your treatment and keep working with your doctor to make sure it’s working optimally for you.