What are hot flashes?
Note: Outside of the United States, the term “flushes” is used rather than “flashes.”
Sometimes I’ll have a hot flash or night sweat that literally takes my breath away and the sensation in my brain is that of hot, roaring white noise. It takes several minutes to recover. I am left drained, disoriented, and feeling like many brain cells have been destroyed.
4 things to know about hot flashes
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60% to 80% of women experience VMS at some point on the path to menopause. There are different trajectories in terms of when they start and differences by racial/ethnic group.
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Some women report VMS before the onset of menstrual cycle changes.
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While estrogen is the first line treatment for bothersome hot flashes there are non-hormonal options with close to as good effectiveness.
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Women’s experience of hot flashes varies — for some, it is a feeling of increasing warmth and for others they sweat, turn red, and experience a profound sense of dread sometimes with with a rapid heartbeat.
I also find that I am short of breath during this time and my heart races.
WLB’s Nina shares her first experience with hot flashes — it was actually a nighttime occurrence — here.
These data are from the Women Living Better Survey. LRS stands for the late reproductive stage and MT for the Menopause Transition. These are two stages on the path to menopause (the final menstrual period).
Hot Flashes
Night Sweats
I have resorted to sleeping on bath towels. At least that way when I wake up drenched, I don’t have to change the sheets on the whole bed!
Vasomotor Symptoms and Race/Ethnicity in Women with Monthly Periods (45-56 years)
Four Paths Of VMS
Source: SWAN (1,455 participants). A study examined the onset and frequency of VMS and found four trajectories:
|
Group
(% of participants)
|
Probability of VMS
(11 years before FMP)
|
Probability of VMS
(at FMP)
|
Probability of VMS
(11 years after FMP)
|
Peak VMS
(relative to FMP)
|
|---|---|---|---|---|
| Low Group (27%) | 10% | 25% | 5% | +1 year |
| Early Onset Group (18%) | 55% | 65% | 15% | at FMP |
| Late Onset Group (30%) | 10% | 65% | 30% | +3 years |
| High Group (25%) | 65% | 90% | 90% | +2 years, +14 years |
You can find these data graphed in this paper.
Remedies for hot flashes
*** For an overview of remedies, listen to our interview with Dr. Nanette Santoro about treatments for hot flashes and night sweats.
- Estrogen Therapy (ET) for those without a uterus
- Estrogen and Progesterone Therapy (EPT) for those with a uterus
Find an overview of specific product options for hormone therapy here.
Understand the differences between FDA-approved products and compounded products here.
Fezolinetant (Vezoah®): a new non-hormonal, oral, once-a-day pill that acts on the pathway in the brain that causes hot flashes. For moderate to severe hot flashes. FDA-approval in 2023. For more information, listen to Dr. Santoro talking about how this new therapy works in this interview.
The Menopause Society’s 2023 Non-Hormonal Position statement supported these as effective for VMS:
- Cognitive Behavioral Therapy (CBT)
- Clinical hypnosis
- SSRIs/SNRIs – Escitalopram (Lexapro), Venlafaxine (Effexor)
- Gabapentin
- Fezolinetant (Veozah)
- Oxybutynin
- Weight loss
- Stellate ganglion bloc
- Paced respiration
- Supplements/herbal remedies
- Cooling techniques
- Avoiding triggers (e.g. caffeine, alcohol, spicy foods)
- Exercise
- Yoga
- MBI
- Relaxation
- Suvorexant
- Soy foods and soy extracts, soy metabolite equol
- Cannabinoids
- Acupuncture
- Calibration of neural oscillations
- Chiropractic interventions
- Clonidine
- Dietary modification and pregabalin
- Identify and avoid triggers
- Dress in layers
- Keep a small fan handy
- Run hands under cold water
- Keep an ice pack under your pillow
Something to note: In trials of nonhormone treatments of VMS, the placebo effect is 20% to 66%. In addition, those with more anxiety show higher placebo response.
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A summary of research related to VMS from The Study of Women’s Health Across the Nation (SWAN), a multi-year, multi-ethnic study of midlife women.
AN EXPERT PERSPECTIVE: DEBATING MENOPAUSAL HORMONE THERAPY
When women are struggling with the decision about whether to try menopausal hormone therapy (MHT) for vasomotor symptoms that are making them feel lousy — and especially if they have multiple symptoms attributable to reductions in estrogen — I suggest they try them for 3 months. This way they have a precise idea of their unique benefit. If they don’t feel better, that’s easy. If taking MHT really makes a difference for them, then we have a discussion of their personal risks and we have a better sense of the benefits specific to them. It makes for a much better conversation.
Nanette Santoro, MD
Professor and E. Stewart Taylor Chair
Divisions of Reproductive Endocrinology and Infertility & Reproductive Sciences
Department of Obstetrics and Gynecology
Potential hormonal causes
While the exact understanding is not known, the leading theory is that changes in estrogen levels cause a narrowing of the “thermoneutral zone” (the zone in which we feel comfortable, not sweaty or cold) in women with hot flashes.
Take note: Night sweats can also be caused by many other serious medical conditions (the Mayo Clinic has a good list) so be sure to mention the onset of night sweats to your doctor to determine the root cause.
- Higher FSH
- Lower Estradiol
- Adiposity (obesity)
- Smoking
- Negative mood
- Anxiety
- Low socioeconomic factors
- Adverse childhood events (ACEs)
REFERENCES
- Gold EB, Colvin A, Avis N, Bromberger J, Greendale GA, Powell L, Sternfeld B, Matthews K. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women’s health across the nation. Am J Public Health. 2006 Jul; 96(7): 1226-35.
- Hale GE, Hitchcock CL, Williams LA, Vigna YM, Prior JC. Cyclicity of breast tenderness and night-time vasomotor symptoms in mid-life women: information collected using the Daily Perimenopause Diary. Climacteric. 2003 Jun; 6(2):128-39.
- Tepper PG, Brooks MM, Randolph JF, et al. Characterizing the Trajectories of Vasomotor Symptoms Across the Menopausal Transition.Menopause (New York, NY). 2016; 23(10):1067-1074. doi:10.1097/GME.0000000000000676.
- Rossmanith WG, Ruebberdt W. What causes hot flushes? The neuroendocrine origin of vasomotor symptoms in the menopause.Gynecol Endocrinol. 2009 May; 25(5): 303-14.
- Sood, R. et al. Paced breathing compared with usual breathing for hot flashes. Menopause. 2013 Feb; 20(2):179-84.
- Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms.Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007244. doi: 10.1002/14651858.CD007244.pub2.
- Maclennan AH, Broadbent JL, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD002978.
- Randolph JF, Jr., Sowers M, Bondarenko I, et al. The relationship of longitudinal change in reproductive hormones and vasomotor symptoms during the menopausal transition. J Clin Endocrinol Metab. 2005;90(11):6106–6112
- Freeman EW, Grisso JA, Berlin J, et al. Symptom reports from a cohort of African American and white women in the late reproductive years. Menopause. 2001;8(1):33–42.
- Freeman EW, Sammel MD, Lin H, et al. The role of anxiety and hormonal changes in menopausal hot flashes. Menopause. 2005;12(3):258–266.
- vanDie MD, Teede HJ, Bone KM, Reece JE, Burger HG. Predictors of placebo response in a randomized, controlled trial of phytotherapy in menopause. Menopause 2009;16:792-796. doi: 10.1097/GME.0b013e318199d5e6
- Reed SD, Lampe JW, Qu C, Copeland WK, Gundersen G, Fuller S, Newton KM. Premenopausal vasomotor symptoms in an ethnically diverse population. Menopause. 2014 Feb;21(2):153-8. doi: 10.1097/GME.0b013e3182952228. PMID: 23760434.