Hot Flashes: Why You Have Them and How to Deal

October 29, 2021   Menstruation & Menopause


Is it hot in here or is it just me? One day, you may surprise yourself and sincerely utter these cliché words out loud. A hot flash — the common symptom most synonymous with menopause — can catch you off guard the first time you experience it.

A hot flash is a sudden feeling of heat that rushes to the upper body and face and may last from a few seconds to several minutes or longer (ACOG). But, why does this even happen? And more importantly, how can you deal with it?

Why do hot flashes happen?

If you’re a person who experiences hot flashes, you may wonder, what did I ever do to deserve this? Unfortunately, there’s no satisfying answer to that question. But rest assured, while they’re uncomfortable and inconvenient, they’re also completely normal. While hot flashes can be caused by other medical conditions or even medications, they’re most commonly due to menopause.

The exact cause is unknown, but it’s thought to be related to changes in the hypothalamus, the part of the brain that regulates the body’s heat production. During perimenopause and menopause, your hormone (progesterone and estrogen) levels vary wildly, and if the hypothalamus senses that your body is too warm, it may try to cool you down through increased blood flow to the surface of the skin and perspiration. As with a fever, the heat you feel may actually be your body trying to dispel heat. (Go figure!)


When can you expect to have them?

Hot flashes can start as early as perimenopause (or the pre-menopause years), and can last for ten years after menopause. Everyone’s experience is different, but on average, most women live with hot flashes for 10-15 years. Not everyone experiences hot flashes during menopause, but the vast majority (about 75%) does.

As far as frequency, it also varies a lot from person to person. Some people only experience hot flashes a few times a month. Others can have them several times a day. Hot flashes at night (also known as night sweats) are very common. Exactly when they hit can be unpredictable, which can be frustrating.



How do you know you're having one?

A hot flash can appear very suddenly in a burst or can be felt coming on a few minutes ahead of time. Symptoms can include:

  • A sudden feeling of warmth that spreads through your face, neck, and chest
  • Red, blotchy, flushed-looking skin
  • Increased heart rate
  • Sweating
  • Anxious feelings
  • A chill as the hot flash subsides

A single hot flash lasts anywhere from 30 seconds to five minutes and can vary in intensity. When they happen at night, they can wake you from your sleep, and some women experience hot flashes so intense that they disrupt their daily activities. If your sleep or daily life are being greatly affected by hot flashes, be sure to tell your medical provider so you can discuss treatment options.


What can be done?

Milder hot flashes can typically be managed at home through lifestyle changes. Here are some tips:

  • Stay cool — Dress in lighter, natural fabrics and multiple layers you can remove if needed. If you feel a hot flash coming on, try sipping some cold water or apply a cold towel to the back of your neck to help bring your body temperature down. At night, try using cotton bed sheets and keeping a fan on.
  • Eat mindfully — Limit hot and spicy foods, alcohol, sugar, and caffeine consumption, all of which can trigger hot flashes.
  • Limit stress — Use techniques to reduce stress, such as yoga, meditation, or slow breathing. Taking five deep, relaxing breaths when a hot flash starts can reduce its severity and duration.
  • Quit smoking — Smoking is linked to increased hot flashes, so now is as good a time as ever to say goodbye to the habit.
  • Keep a journal — Every person is different, and there may be particular things that trigger your hot flashes more than others. Try keeping a record of when they happen and what you were doing, eating, or any other relevant details so you can recognize patterns and see what to avoid in the future.

If these strategies don’t work or your hot flashes are more severe, a different avenue may be necessary. These can include:

  • Hormone therapy — A common approach that involves taking estrogen, and, if you’ve never had a hysterectomy and still have a uterus, a hormone called progestin. These hormones can be taken through pills, skin patches, gels, or sprays applied to the skin.
  • Prescription medication — There are several antidepressants that are used for treating hot flashes and easing associated sleep problems, as well as gabapentin, an antiseizure medication, and clonidine, a blood pressure medication.
  • Acupuncture — For some women, an acupuncture treatment regimen can be highly effective for treating hot flashes.
  • Surgery — In extreme cases, certain areas of the thyroid gland may be malfunctioning and making symptoms worse, and it may be necessary to remove them surgically.

Be sure to discuss all of your treatment options with your provider, who will help to find the best one for you.

Hot flashes are a part of life, but they don’t have to take over your life. With the right help and management, you can keep your cool.

Elizabeth Chase, MD

In most women, hot flashes are temporary and resolve gradually over several months. A small percentage of women have severe persistent hot flashes which do not abate. If this is you, it will be helpful to schedule an evaluation.

— Elizabeth Chase, MD, FPMRS

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