Menopause: Managing hot flashes

If you have experienced hot flashes, you're already well aware that they are sudden sensations of intense body heat, often with heavy sweating and reddening of the head, neck, and chest or the entire body. At night, they commonly cause drenching "night sweats," making them a cause of sleep problems for perimenopausal and postmenopausal women.

During a typical hot flash, your skin temperature rises. Although you may feel very warm during a hot flash, because of the heat lost by your body's cooling mechanism (perspiration), your body temperature may actually drop. Some women feel chilly after a hot flash, and some women feel the chill without the flash.

The biochemical cause of hot flashes is not well understood. However, they are linked to declining estrogen levels, and they do seem to be made worse by stress, heavy alcohol use, and cigarette smoking. Although menopausal hot flashes can be disruptive, frustrating, and at times embarrassing, they are medically harmless. They are not a sign of a medical problem, nor do they cause medical problems.

It is normal for hot flashes to:

• Happen in women of all ages when they are upset or embarrassed.
• Happen during the perimenopausal years before menopause, when estrogen levels fluctuate. They are most common, most frequent, and most intense during the 2 years following menopause (postmenopause), when estrogen declines.
• Be accompanied by mild to severe heart palpitations, anxiety, or irritability. In rare cases, panic attacks are triggered at the same time as hot flashes, usually in women who have a history of panic attacks.
• Be especially severe in women who become menopausal from chemotherapy, antiestrogen treatment for breast cancer, or surgical removal of the ovaries.
• Subside within a couple of years after menopause. But some women do continue to have hot flashes for years after menopause. There is no reliable method for predicting whether, when, or how long you will have hot flashes.

Hot flashes are uncommon in various places around the world. Further research is necessary before experts can identify specific factors about American women's environment and lifestyle that make hot flashes a common problem.

Test Your Knowledge

1. Hot flashes are a normal part of perimenopause and postmenopause and are caused by declining estrogen levels.

   1. True

      This answer is correct.

      Hot flashes are a normal part of perimenopause and postmenopause and are caused by declining estrogen levels. They usually subside within a couple of years after menopause.

   2. False

      This answer is incorrect.

      Hot flashes are a normal part of perimenopause and postmenopause and are caused by declining estrogen levels. They usually subside within a couple of years after menopause.

2. My doctor will be able to tell me how long I can expect to have hot flashes.

   1. True

      This answer is incorrect.

      Hot flashes usually stop on their own, but there is no reliable method to help your doctor predict when this will happen.

   2. False

      This answer is correct.

      Hot flashes usually stop on their own, but there is no reliable method to help your doctor predict when this will happen.

Hot flashes are a normal part of perimenopause for most women. If yours are mild or infrequent, there is no need to treat them. But it's common to look for relief of moderate to severe or frequent hot flashes that disrupt your daily life and sleep.

You may not have to "treat" hot flashes to prevent them or get them under control. Making healthy lifestyle choices is your best and first choice for hot flashes and can make a big difference in how your body handles the transition to menopause. But if hot flashes are frequent and powerful, additional treatment may be needed to help you get enough sleep or lead a predictable daily life.

Test Your Knowledge

1. Hot flashes require treatment.

   1. True

      This answer is incorrect.

      Hot flashes don't require treatment for medical reasons. It's up to you to decide whether to try a treatment if your symptoms are making your life difficult.

   2. False

      This answer is correct.

      Hot flashes don't require treatment for medical reasons. It's up to you to decide whether to try a treatment if your symptoms are making your life difficult.

You can manage hot flashes by making certain lifestyle choices. You can also take daily medicine. Some measures help prevent or reduce hot flashes, and others can make you more comfortable when you're having a hot flash. If you are looking for additional treatment measures, you have a few options to choose from.

Lifestyle choices for preventing or reducing hot flashes

Eat and drink well, and avoid smoking.

• Limit your intake of alcohol.
• Drink cold beverages rather than hot ones.
• Eat smaller, more frequent meals to avoid the heat generated by digesting large amounts of food.
• Eat plenty of low-fat, high-fiber foods.
• Do not smoke or use other forms of tobacco.

Stay cool.

• Keep your environment cool, or use a fan.
• Dress in layers, so you can remove clothes as needed.
• Wear natural fabrics, such as cotton and silk.
• Sleep with fewer blankets.

Reduce stress.

• Get regular physical exercise.
• Use relaxation techniques, such as breathing exercises, yoga, or biofeedback. Using a breathing-for-relaxation exercise called paced respiration may reduce hot flashes and emotional symptoms.

Medical treatment options for hot flashes

• Short-term, low-dose hormone replacement therapy (HRT) can reduce or stop hot flashes and other perimenopausal symptoms by raising your body's estrogen level. Use the lowest dose needed for the shortest possible time and have checkups every 6 months. This is because HRT causes breast cancer, ovarian cancer, blood clots, stroke, and dementia in a small number of women.^{1, 2} And HRT users who are 10 or more years past menopause are also at higher risk for heart disease.³ If you have a history of cardiovascular disease or breast cancer, avoid using estrogen for hot-flash relief-other options are available.
• Estrogen-progestin birth control pills (before menopause) can reduce or stop hot flashes and other perimenopausal symptoms by evening out fluctuating hormones. Don't use estrogen for hot-flash relief if you are older than 35 and smoke; have diabetes, cardiovascular disease, or breast cancer; or have a family history of these conditions. Other options are available.
• Antidepressant medicine can reduce the number and severity of hot flashes by improving the brain's use of serotonin, which helps regulate body temperature.⁴ Side effects are possible. This type of medicine is a good choice if hot flashes, irritability, or mood swings are your only perimenopausal symptom.
• Clonidine, a high blood pressure medicine, can reduce the number and severity of hot flashes by lowering blood pressure. Lowering blood pressure is safe for some women and not for others.⁵ This type of medicine is a good choice if hot flashes are your only perimenopausal symptom, especially if you have high blood pressure.
• Black cohosh may reduce or prevent hot flashes, depression, and anxiety. As with HRT, have a checkup every 6 months when taking black cohosh. Research on human cells and on animals suggests that black cohosh doesn't cause the same cancer changes that estrogen does. But it's best to be cautious until long-term studies are done.
• Some women eat and drink a lot of soy to even out hot flashes and other perimenopausal symptoms. But studies show mixed results about whether soy phytoestrogens are clearly effective, particularly when taken as a pill. This may be because the active ingredients in soy are not well understood.⁶

Test Your Knowledge

1. You may be able to control the frequency of your hot flashes by eating smaller, more frequent meals, which include low-fat, high-fiber foods.

   1. True

      This answer is correct.

      Dietary changes, such as eating smaller, more frequent meals that include low-fat, high-fiber foods, may help hot flashes happen less often.

   2. False

      This answer is incorrect.

      Dietary changes, such as eating smaller, more frequent meals that include low-fat, high-fiber foods, may help hot flashes happen less often.

2. You can help make yourself more comfortable during a hot flash if you dress in layers and keep a fan handy.

   1. True

      This answer is correct.

      Dressing in layers allows you to remove clothing during a hot flash. This may make your hot flash less severe and also less noticeable to others. Using a fan can also help cool the surrounding air and make you more comfortable.

   2. False

      This answer is incorrect.

      Dressing in layers allows you to remove clothing during a hot flash. This may make your hot flash less severe and also less noticeable to others. Using a fan can also help cool the surrounding air and make you more comfortable.

3. Regular exercise and the use of relaxation techniques, such as meditative breathing exercises, yoga, and biofeedback, may decrease the frequency and severity of your hot flashes. Using a breathing-for-relaxation exercise may reduce hot flashes and emotional symptoms.

   1. True

      This answer is correct.

      Regular exercise and the use of relaxation techniques, such as breathing exercises, yoga, and biofeedback, may make your hot flashes less intense and less often.

   2. False

      This answer is incorrect.

      Regular exercise and the use of relaxation techniques, such as breathing exercises, yoga, and biofeedback, may make your hot flashes less intense and less often.

4. Let your doctor know if you are taking any alternative medicine or herbal supplement for your hot flashes.

   1. True

      This answer is correct.

      If you are using an alternative medicine or herbal supplement, make sure your doctor knows. Alternative medicines and herbal supplements do not have to have the same testing or purity standards as prescription and other nonprescription medicines. Tell your doctor the type and amount you are taking, and how long you have been taking it. If you are taking black cohosh, have regular checkups to make sure it is not causing any medical problems.

   2. False

      This answer is correct.

      If you are using an alternative medicine or herbal supplement, make sure your doctor knows. Alternative medicines and herbal supplements do not have to have the same testing or purity standards as prescription and other nonprescription medicines. Tell your doctor the type and amount you are taking, and how long you have been taking it. If you are taking black cohosh, have regular checkups to make sure it is not causing any medical problems.

If you are having problems with hot flashes, discuss them with your doctor at your next regularly scheduled appointment. If your hot flashes are so severe that they are disrupting your sleep or affecting another area of your life, call your doctor to discuss your hot flashes.

If you would like more information about menopausal changes, see the topic Menopause and Perimenopause.

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