Hot flashes — Just during menopause?

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! Though hot flashes feel different for different people, they’re commonly described as a sensation of heat traveling through the upper half of the body or the face. They most commonly occur during menopause and usually don't represent any major health concern, though they can be uncomfortable. They can also be caused by other health issues, but menopause is the most frequent culprit. Though it’s not clear why they occur, some theories suggest it’s due to changes in reproductive hormones and the hypothalamus, which is responsible for regulating body temperature. In most cases, the symptoms of hot flashes can be treated with some lifestyle changes and with medication in severe cases.

These waves of warmth vary in their duration and frequency — lasting a couple of minutes to as much as 30 minutes and as often as once or twice week or many times a day. Hot flashes may cause sweating or a feeling of suffocation. If enough body heat is lost, a person may experience chills afterwards. If hot flashes occur at night, they’re referred to as "night sweats," and can be particularly insidious because they sometimes interfere with sleep and cause chronic insomnia.

It appears that a decrease in estrogen can contribute to some hypothalamic deregulation, which may affect the regulation of body temperature. However, decreases in estrogen aren’t the sole cause of hot flashes, since people who have low estrogen levels (e.g., children) generally don’t experience hot flashes. It may be that something about the hormonal changes seem to trigger them, though hormones likely aren’t fully to blame. The most common non-menopausal cause of hot flashes is stress. Depending on the individual, certain foods and drinks, alcohol, smoking, food additives, or the size of the meal can trigger hot flashes. Occasionally, hot flashes can be a symptom of more serious conditions, especially among women under the age of 40. It 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. Some strategies include:

  • Turning down the thermostat to keep the environment cool
  • Sleeping with light sheets and light clothes
  • At least three hours before bed, avoiding alcohol, caffeine, hot liquids, or any other foods that may be associated with hot flashes
  • Avoiding physical activity or smoking three hours before bedtime
  • Dressing in layers that can be easily shed
  • Carrying a small fan to provide access to a nice breeze when having a hot flash
  • Staying well-hydrated
  • Trying to avoid situational or food triggers, which can vary person to person
  • Maintaining a healthy weight, as those who are overweight or obese tend to experience more hot flashes
  • Practicing stress management strategies such as yoga, meditation, tai chi, etc.

If the symptoms continue to impact daily life even after adopting lifestyle changes (typically for about three or so months), talking with a health care provider may be in order. They may suggest hormone therapy or use of antidepressants such as paroxetine to treat the hot flashes, among other treatment options. During this visit, it will be good to discuss the benefits and drawbacks of any medication to ensure the short term relief doesn’t lead to long-term health risks.

Here’s hoping your curiosity about the body doesn’t flame out anytime soon!

Last updated Aug 23, 2019
Originally published Oct 31, 1994

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