Hot flashes: what is behind them and what helps

What a hot flash feels like

A hot flash usually starts as a sudden sense of heat in the upper body and face. Your skin may redden, you may sweat, and your heart may race. As it fades, many people feel chilled. When the same thing happens during sleep, it is called a night sweat.

Episodes range from mild warmth to drenching heat that interrupts work or conversation. Some people have a few a week; others have many a day. According to The Menopause Society, hot flashes and night sweats affect up to 80% of women and last an average of 7 to 10 years, so they are often more persistent than people expect.

Why hormones cause hot flashes

During perimenopause, the ovaries produce estrogen less predictably. Those swings affect the brain's temperature-control center in the hypothalamus, which becomes more sensitive to small changes in core body temperature. The body responds as if it is overheating, widening blood vessels in the skin and triggering sweat.

That is why hot flashes can begin while you are still having periods, and why a single estrogen level does not predict them. Women who have both ovaries removed often have more sudden and intense hot flashes. Higher abdominal body fat and current or past smoking are linked with a greater likelihood of having them.

Other causes of flushing and heat

Not every hot flash is menopausal. Consider other explanations if your symptoms started well outside the usual age range, if you are a man, or if the pattern is unusual:

• Overactive thyroid, which often brings constant heat intolerance, weight loss, tremor and palpitations
• Medications, including some antidepressants, opioids, steroids, niacin and hormone-blocking treatments for breast or prostate cancer
• Alcohol, caffeine, spicy food, hot drinks, warm rooms and stress, which can trigger or worsen episodes
• Anxiety and panic attacks
• Infection or fever
• Rare flushing disorders, such as carcinoid syndrome or mast cell conditions, which tend to come with diarrhea, wheezing or hives

When to see a doctor urgently

Most hot flashes are uncomfortable rather than dangerous. Seek care quickly if flushing comes with any of these:

• Trouble breathing, throat tightness or facial swelling: call 911
• Chest pain, fainting or a racing, irregular heartbeat with light-headedness
• Wheezing, hives or ongoing diarrhea with the flushing
• Unintended weight loss or fevers
• Flushing that began right after starting a new medication or supplement

What testing can help

For women in the typical age range with a classic pattern, hot flashes are diagnosed from the history rather than a blood test. Estrogen and FSH change so much in perimenopause that one result neither confirms nor rules out the transition.

Testing is most useful for excluding other causes. A clinician may check thyroid function, a complete blood count, glucose or A1c and a basic metabolic panel. If symptoms suggest a rare flushing disorder, more specialized tests are arranged in person. Keeping a short log of when episodes happen, how long they last and what came before them is very useful.

Treatment options in general terms

Lifestyle steps can take the edge off: dressing in layers, keeping a fan nearby, lowering the bedroom temperature, and noticing personal triggers such as alcohol or hot drinks. Cognitive behavioral therapy and clinical hypnosis have evidence for reducing how much hot flashes bother you. Many herbal supplements have weak or inconsistent evidence.

Menopausal hormone therapy is the most effective treatment for bothersome hot flashes and is generally most favorable for healthy women who start it within about 10 years of menopause or before age 60. It carries risks, including blood clots, stroke, gallbladder disease and, with some regimens, breast cancer, and anyone with a uterus needs progesterone or a progestin alongside estrogen. Non-hormonal prescription options include low-dose paroxetine and fezolinetant, which are FDA-approved for hot flashes, and some medicines used off-label.

How HealifyMD can help

A HealifyMD clinician can review your symptoms, health history and risk factors online and, where appropriate, prescribe hormone therapy such as an estradiol patch or topical estradiol with progesterone. Labs to rule out thyroid and blood count problems can be ordered if needed. If your flushing has any red-flag features, we will direct you to in-person care first.

The women's hormone therapy plan is $349 for the first month, then $99/month, with estradiol and progesterone options included in the hormone therapy program. There is no membership fee and the eligibility check is free; the first month includes the evaluation and baseline labs, and your price is confirmed at the eligibility review. Some products in the plan are compounded, and compounded medications are not FDA-approved.