Is there new evidence that tells us about hot flashes in menopause? What is the cause? What can be done to reduce the frequency and intensity?
— Lisa from Ontario, Canada
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Short Take
The currently accepted theory is that hot flashes are caused by a disturbance in the thermoregulatory zone — sort of like your personal thermostat is malfunctioning. The most effective therapy for hot flashes is estrogen supplementation, but nonhormonal medications can be helpful, too.
Tell Me More
Hot flashes affect 75 percent of women during the transition to menopause, called perimenopause. They are a sensation of extreme heat, typically most intense in the head and upper chest, that lasts for approximately one to five minutes. Hot flashes can vary significantly from woman to woman — some are plagued for years with severe symptoms while some have mild symptoms that are barely perceptible. The average age of menopause is 51, and hot flashes typically start a few years before, during perimenopause. On average, a woman will experience hot flashes for seven years.
Hot flashes and night sweats are the two vasomotor symptoms of menopause. They occur as a result of a change in hormone levels that trigger changes in the thermoregulatory zone of the brain. The brain becomes acutely sensitive to minor increases in environmental temperature and responds in an exaggerated manner. Blood is shunted from the core of the body to the peripheral blood vessels, which dilate and produce the feeling of extreme heat along with sweating. A normally imperceptible increase in temperature can make the body respond as if you’ve just exercised in heavy clothes on a hot day.
Treatment of hot flashes is often neglected, but while hot flashes are benign, they can affect sleep and quality of life. Hot flashes and night sweats also have a significant economic impact; women with untreated vasomotor symptoms have higher health care expenses and more absenteeism from work.
The most effective treatment for hot flashes and other symptoms of menopause is estrogen replacement. Certain other prescription medications may be helpful for some women — including some anti-depressants as well as the medications gabapentin and pregabalin. Nonpharmaceutical options, such as herbal remedies, exercise and meditation, have not been shown to be effective in studies, although increasing dietary soy may have a beneficial impact for some women. Simple lifestyle changes — such as dressing in layers and avoiding warm rooms and hot drinks — may help some women with milder symptoms.
There is a lot of misinformation about hot flashes and night sweats online and in the doctor’s office, from medical professionals not believing the distress women experience or the importance of treating vasomotor symptoms, to people trying to exploit the gaps in medicine by selling ineffective and potentially harmful supplements. The North American Menopause Society is the best place for health care providers and patients to begin their search for quality information on hot flashes and night sweats.
Dr. Jen Gunter, Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy to healthy sex and clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called The Cycle, promises to handle your questions with respect, forthrightness and honesty.
