A “hot flash” is the term used to describe the sudden onset of warmth or heat that starts in the chest and spreads to the neck and face. These episodes often come with:

• Sweating
• Redness
• Palpitations
• Anxiety

Night sweats are part of this same symptom complex. Another term used to describe these events is vasomotor symptoms.

Hot flashes are problematic because they are recurrent—happening many times in a day. They are not life-threatening, but they can be distressing and disruptive. They can affect work, social interactions, and interfere with sleep.

Hot flashes are common—and not limited to “after menopause”

Hot flashes occur in 75 percent of postmenopausal women and are the most common complaint in women transitioning to menopause.

They reportedly occur 1 to 2 years before menopause and persist up to 5 years after menopause. Many women in their 40s report experiencing this phenomenon.

While these symptoms are typically associated with menopause, they can also occur in premenopausal women and women who are postpartum.

There are also situations where hot flashes can show up for reasons related to sudden hormonal changes or treatments:

• Women who have their ovaries surgically removed will experience vasomotor symptoms. In many cases, they are more severe than in women who go through a natural menopause.
• Immediately after delivery, there is a sudden drop in circulating estrogen levels. It is therefore not surprising that postpartum women experience hot flashes as well.
• Women taking tamoxifen for breast cancer also suffer with vasomotor symptoms due to the anti-estrogenic effect of this drug.
• Men who receive certain treatments for prostate cancer that affect androgen production also experience hot flashes.

Why hot flashes happen

A hot flash occurs when the core body temperature suddenly increases to a level that is above a certain set threshold. Above this threshold, sweating occurs—and below this threshold, shivering occurs.

There is a temperature range that is considered to be normal when no such symptoms occur. This “neutral zone” is postulated to be much smaller in women who experience hot flashes. That means small changes in core body temperature would precipitate sweating in a menopausal woman, but in a non-menopausal woman the same change would be within the neutral zone and a hot flash would not occur.

The narrowing of this neutral zone is triggered by a sudden decrease in circulating estrogen levels. Estrogen and testosterone affect natural endorphins, which in turn regulate core body temperature.

When treatment may be worth discussing

Vasomotor symptoms associated with menopause can be quite disturbing. Some women have mild symptoms or no symptoms and do not require treatment, but for others the occurrence of these flashes may be very disruptive.

Hot flashes are the major reason women going through the menopausal transition seek medical care. While hot flashes are not life-threatening and are not a sign of a medical disorder, they can interfere with daily functioning and quality of life, as well as cause sleep deprivation and produce anxiety.

If hot flashes and other menopausal symptoms become intolerable, treatment is recommended to allow normal functioning. It is important to discuss these symptoms with your doctor, who can then prescribe a treatment regimen that is right for you.

Treatment options for hot flashes

Options for treatment include hormonal and non-hormonal medication as well as behavioral therapies. There are many options for managing hot flashes. Hormonal treatment is one option, but many other alternatives exist. It is important to work with your health care provider to develop a plan that is right for you. 

Hormonal treatments

Traditional hormone replacement therapy (HRT)

Traditional hormone replacement therapy (HRT) is the gold standard for treating hot flashes. It reduces hot flashes by 80 to 90 percent.

Hormone replacement therapy entails:

• Estrogen-only therapy in women who have undergone a hysterectomy
• Combined estrogen and progestin in women whose uteri are still in place

Side effects include weight gain, tissue swelling, breast tenderness, and uterine bleeding.

Risks include blood clots in the deep veins, pulmonary embolus, heart attack, stroke, and breast cancer.

Progestin-only treatment

Progestin-only treatment is an option for women who can’t take estrogen or who desire an estrogen-free treatment. There are many progestins on the market that decrease the incidence of hot flashes, some by 75 to 80 percent.

Progestin-only therapy has its problems, including symptoms of depression and possible bone loss with long-term therapy in selected products.

Tibolone (available outside the U.S.)

Tibolone is a synthetic hormone that has estrogenic, progestational, and androgenic effects. It is available in many places outside of the U.S. and is effective in the management of vasomotor symptoms.

In addition to decreasing hot flashes, it also decreases vaginal dryness and some of the urinary symptoms that accompany menopause.

Non-hormonal options (medications and supplements)

Nutritional supplements

Nutritional supplements such as black cohosh, Vitamin E, and soy proteins have some reported benefits.

• Black cohosh is available over the counter in many pharmacies and grocery stores.
• Vitamin E, taken in the amount of 800 international units daily, is recommended for the management of mild hot flashes.
• Soy extracts or increasing the amount of daily soy intake is an option for hot flash management.

Non-hormonal blockers

Vasomotor symptoms are one of the most studied areas of menopause and new medications that are non-hormonal are being developed.

• VEOZAH (fezolinetant) is a newer, non-hormonal prescription option for moderate to severe vasomotor symptoms. It works by blocking neurokinin B signaling in the hypothalamus (the brain’s temperature-control center), which can reduce hot flashes and night sweats.
• Lynkuet is a newer, non-hormonal prescription option that works in the brain by blocking NK1 and NK3 receptors (neurokinin pathways involved in thermoregulation), which can reduce hot flashes and night sweats.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors have been shown to reduce flashes by 37 to 61 percent compared to a placebo.

These drugs are approved for the treatment of depression, so they are also helpful for the mood disturbances that some women experience when going through menopause.

Gabapentin

Gabapentin, a medication used for seizures and neuropathic pain, has been shown to decrease flashes by 46 to 49 percent. The recommended dose is 900 mg a day.

Behavioral therapies and lifestyle strategies

Behavioral therapies include lifestyle changes that make the flashes less severe. Strategies suggested include:

• Dressing in layers so garments can be easily removed
• Lowering the room temperature
• Drinking cool beverages

Paced respirations or slow, deep breathing can reduce flash frequency by approximately 50 percent. Stress relief and relaxation therapy are also helpful.

Bringing it together

Hot flashes are common during the menopausal transition and can persist for years. For some women, they are mild and manageable. For others, they disrupt sleep, work, and daily life.

The key is that there are multiple treatment options—hormonal and non-hormonal medication as well as behavioral therapies—and the right approach is individualized. It is important to discuss your symptoms with your doctor and work with your health care provider to develop a plan that is right for you.