Hot Flashes and Menopause Facts
Hot flashes sometimes can be can be the result of certain medications.
- A hot flash is a feeling of warmth spreading throughout the body that is often most pronounced in the head and neck areas. Hot flashes are typically brief (lasting from about 30 seconds to a few minutes) and are sometimes associated with redness of the skin (flushing) and/or perspiration.
- Hot flashes are a common symptom of the menopausal transition in women.
- Hot flashes can also occur as a result of certain uncommon medical conditions.
- The majority of women in the menopausal transition experience hot flashes, but not all women approaching menopause will have hot flashes.
- Hot flashes may be accompanied by other symptoms including night sweats, palpitations, flushing (redness) of the skin, and excessive sweating.
- Hormone therapy (HT) has been used to manage hot flashes in women experiencing these symptoms related to menopause.
- Other types of prescription medications, including SSRIs, have also been used with some success in controlling hot flashes.
- Hot flashes related to menopause are not preventable but can be controlled and relieved by medications and lifestyle measures.
What Are Hot Flashes?
- A hot flash is a feeling of warmth spreading throughout the body that is often most pronounced in the head and neck areas.
- Hot flashes are typically brief (lasting from about 30 seconds to a few minutes) and are sometimes associated with redness of the skin (flushing) and/or perspiration.
- Hot flashes are a common symptom of the menopausal transition in women, but not all women approaching menopause will have hot flashes.
- A majority of women in the menopausal transition experience hot flashes.
- Hot flashes can also occur as a result of certain uncommon medical conditions.
The exact cause of the hot flashes is not fully understood, but the declining estrogen levels that occur as a woman approaches menopause are thought to play a role. A disorder in thermoregulation (methods the body uses to control and regulate body temperature) is responsible for the sensation of heat, but the exact way in which hormone levels affect heat regulation is not well understood.
While hot flashes are typically associated with the menopause in women, certain uncommon medical conditions can also lead to hot flashes and disorders of the body's ability to regulate temperature. One example is the carcinoid syndrome, which occurs due to a type of endocrine tumor that secretes large amounts of the hormone serotonin. Hot flashes can also develop as a side effect of some medications and can sometimes occur in association with severe infections or cancers.
What Are the Symptoms and Signs of Hot Flashes?
Hot flashes often begin before any menstrual changes suggestive of menopause develop, so hot flashes may appear even years prior to the actual menopause. Hot flashes always involve the sensation of heat, but other symptoms may also be associated as follows:
- An uncomfortable, diffuse feeling of warmth throughout the body, that is often most severe in the head and neck areas, is characteristic of hot flashes.
- Flushing (redness) of the skin may occur.
- Excessive sweating, including night sweats, can accompany hot flashes.
- Palpitations (unpleasant sensations of irregular and/or forceful beating of the heart) may sometime accompany hot flashes.
- Chills and shivering can occur following a hot flash.
The symptoms of a hot flash typically develop suddenly, without warning, and last from less than one minute to several minutes.
When Should You Call a Doctor for Hot Flashes?
It is appropriate to contact a health-care professional if a woman is experiencing disturbing or uncomfortable hot flashes.
What Procedures and Tests Diagnose the Cause of Hot Flashes?
As with any medical condition or complaint, a health-care professional will begin by taking a complete medical history. He or she will ask the woman to describe the hot flashes, including how often and when they occur, and if there are other associated symptoms. A physical examination will be used to help direct further testing if necessary.
Blood tests may be performed if the diagnosis is unclear, either to measure hormone levels or to look for signs of other conditions (such as infection) that could be responsible for the hot flashes.
What Are the Treatments for Hot Flashes?
There are a variety of treatments for hot flashes.
- Hormone therapy
- Prescription medications
- Herbal supplements
- Bioidentical hormone therapy
- Complementary and alternative treatments
Some of these have not been tested by clinical studies, nor are they approved by the US Food and Drug Administration (FDA).
Hormone or Estrogen Therapy
Estrogens or a combination of estrogens and progesterone (progestin) have been shown to significantly decrease the frequency and intensity of hot flashes.
However, long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women receiving combined hormone therapy with estrogen and progesterone showed an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. Studies with estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus).
More recent medical research has suggested that in younger postmenopausal women, hormone therapy may not have these same risks as in the older postmenopausal women who participated in the WHI studies, and research is ongoing to determine the risks and benefits of hormone therapy in younger postmenopausal women and women around the age of menopause.
The decision regarding hormone therapy, therefore, should be individualized for each woman, recognizing her medical history, the severity of the symptoms, and the potential risks and benefits of hormone administration.
A number of non-hormonal prescription medications and alternative treatments have also been used for the treatment of hot flashes (See next section).
Both oral and transdermal (applied via a cream or patch to the skin) estrogen are available either as estrogen alone or estrogen combined with progesterone. All available prescription estrogen replacement medications, whether oral or transdermal, are effective in reducing the frequency of hot flashes and typically reduce the frequency of hot flashes by about 80% to 90%. However, as described above, hormone therapy may carry some health risks.
- The drugs known as selective serotonin reuptake inhibitors (SSRIs), commonly used in the treatment of depression and anxiety, have been shown in studies to be effective in reducing menopausal hot flashes. Paroxetine (Brisdelle) is an SSRI that has been approved for management of moderate to severe hot flashes associated with menopause. Another SSRI that has been tested and shown to be effective is venlafaxine (Effexor), although other SSRI drugs may be effective as well.
- Clonidine (Catapres) is a drug that decreases blood pressure. Clonidine, taken either by pill or skin patch, effectively relieves hot flashes in some women. It is associated with some side effects such as dry mouth, constipation, drowsiness, or difficulty sleeping.
- Gabapentin (Neurontin), a drug primarily used for the treatment of seizures, has also been effective in treating hot flashes.
- Progestin drugs have also been successfully used to treat hot flashes. Megestrol acetate (Megace) is sometimes prescribed over a short-term to help relieve hot flashes. Serious effects can occur if the medication is abruptly discontinued, and megestrol is not usually recommended as a first-line drug to treat hot flashes. An unpleasant side effect of Megestrol is that it may lead to weight gain. Another form of progesterone, medroxyprogesterone acetate (Depo-Provera) administered by injection, can also sometimes be useful in treating hot flashes, but may also lead to weight gain as well as bone loss.
Follow-up with a health-care professional is important if a woman has severe or troubling hot flashes that are not relieved by the recommended treatment.
Herbal Supplements for Hot Flashes
Many women turn to alternative therapies for the treatment of hot flashes. These have included herbal products, vitamins, and plant estrogens as well as other substances. Doctors can be reluctant to recommend alternative treatments because these nonprescription products are not controlled by the U.S. Food and Drug Administration (FDA). Because they are not regulated like prescription medications, their ingredients and strength can vary from manufacturer to manufacturer and testing and proof of safety is not required for marketing of these products as it is with prescription medications. Long-term, scientifically controlled studies for these products are either lacking or have not proved the safety and effectiveness of the product.
Some popular alternative treatments for menopausal hot flashes include:
- Plant estrogens, known as phytoestrogens. This broad category includes different types of compounds found in soy products, red clover, and flaxseed. Some studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. However, some phytoestrogens can actually have anti-estrogenic properties in certain situations, and the overall risks of these preparations have not yet been determined.
- Black cohosh has been widely used in Europe and is becoming increasingly popular in the U.S. The North American Menopause Society does support the short-term use of black cohosh for treating menopausal symptoms, for a period of up to six months. While some studies have shown that black cohosh can reduce hot flashes, most studies have not been considered to be stringent enough in their design to firmly prove any benefit. There have also not been adequate scientific studies that establish the long-term benefits and safety of using black cohosh.
- Vitamin E supplements have been used by some women to provide relief from hot flashes, but scientific studies are lacking to prove the effectiveness of vitamin E in relieving hot flashes.
- Other alternative remedies for hot flashes have included including
Scientific studies to prove the safety and effectiveness of these products have not been performed.
Bioidentical Hormone Therapy
There has been increasing interest in recent years in the use of so-called "bioidentical" hormone therapy for perimenpausal women. Bioidentical hormone preparations are medications that contain hormones that have the same chemical formula as those made naturally in the body. The hormones are created in a laboratory by altering compounds derived from naturally-occurring plant products. Some bioidentical hormone preparations are U.S. FDA-approved and manufactured by drug companies, while others are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. These individual preparations are not regulated by the FDA, because compounded products are not standardized.
Advocates of bioidentical hormone therapy argue that the products, applied as creams or gels, are absorbed into the body in their active form without the need for "first pass" metabolism in the liver and that their use may avoid potentially dangerous side effects of synthetic hormones used in conventional hormone therapy. However, studies to establish the long-term safety and effectiveness of these products have not been carried out.
What about lifestyle changes to reduce hot flashes?
Some women report that exercise programs or relaxation methods have helped to control hot flashes, but controlled studies have failed to show a benefit of these practices in relieving the symptoms of hot flashes. Maintaining a cool sleep environment and the use of cotton bedclothes can help ease some of the discomfort associated with hot flashes and associated night sweats.
Do Hot Flashes Go Away?
Hot flashes associated with the menopausal transition are not a life-long problem and can be effectively treated in most women if necessary. About 80% of women will stop having hot flashes five years after the onset of hot flashes. Less commonly, in about 10% of women, hot flashes can persist for up to a decade.
Can Hot Flashes Be Prevented?
It is impossible to predict which women will experience hot flashes in association with the perimenopause or the degree of severity of the hot flashes. Perimenopausal hot flashes may be controlled by some of the treatment measures described above, but are not preventable.
Stanten, R. J., et al. "Menopausal hot flashes." UpToDate. Jan 2020.