Dear Alice,

I was wondering just what "hot flashes" are. I've heard that women have them during menopause. I'm just curious.

— q

Dear q,

You've heard right! Experienced by three out of four women during menopause, hot flashes are quite common and don't represent any major health concern, though they can be uncomfortable. Hot flashes can also be caused by other hormonal (and non-hormonal) changes, but menopause is the most frequent cause.

It's not exactly clear why hot flashes occur during menopause. Body temperature is regulated by the hypothalamus and it appears that a decrease in estrogen can contribute to some hypothalamic deregulation. However, decreases in estrogen are not the sole cause of hot flashes, since people who have low estrogen levels (e.g., children) do not have hot flashes. So, it's something about the hormonal changes that seem to trigger them, though hormones may not be fully to blame.

Hot flashes can vary in their duration and frequency. They usually only last a couple of minutes but can last as long as 30 minutes. They can be as few as once or twice week, or they can happen many times a day. Though hot flashes feel different for different people, they are commonly described as a sensation of heat traveling through the upper half of the body or the face. Hot flashes may cause sweating, or a feeling of suffocation. A person may experience chills, either before or after a hot flash. Hot flashes at night are called "night sweats" and can be particularly insidious because they can interfere with sleep and cause chronic insomnia.

There are other causes of hot flashes. The most common, non-menopausal cause is stress. Some foods and drinks may also cause hot flashes. Depending on the individual, alcohol, food additives, or the size of the meal can trigger hot flashes. Also, many prescription drugs such as anti-hypertensive's and mood altering drugs such as anti-depressants or anti-anxiety medications can cause hot flashes. Smoking can trigger them, as well. Occasionally, hot flashes can be a symptom of more serious conditions. Hot flashes that occur in women under the age of 40 could be a sign of a more serious problem, such as primary ovarian insufficiency (POI), a condition usually accompanied by irregular periods and, sometimes, infertility.

Though hot flashes may be an undesirable experience, there are ways to mitigate the discomfort. For night sweats:

  • Turn down the thermostat before bed.
  • Sleep with light sheets and light clothes.
  • At least three hours before bed, avoid alcohol, caffeine, hot liquids, or any other foods you notice triggering the hot flashes.
  • Avoid exercise or cigarettes three hours before bedtime.

For daytime hot flashes:

  • Getting at least 30 minutes per day of physical activity (but not within three hours of sleep).
  • Dressing in layers that can be easily shed.
  • Carrying a small fan.
  • Staying well-hydrated.
  • Try to avoid situational or food triggers, which can vary person to person.

If someone experiencing hot flashes suspects anything other than stress, medication, or menopause as a culprit, it may be worth a trip to a health care provider to rule out a more serious cause. S/he may also be able to recommend some additional treatment options.

Here's to staying cool,


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