On this page
What are hot flashes?
Hot flashes are one of the most common symptoms of the transition into menopause. They can be quite bothersome and, in some cases, may persist for several years. When they occur at night, they are often referred to as night sweats.
A hot flash is characterized by a sudden sensation of heat that seems to come from nowhere and can spread throughout the entire body. It may be accompanied by:
- sweating,
- heart palpitations,
- flushing or redness of the face.
Not all women experience hot flashes, and among those who do, the severity can vary enormously:
- some women experience only occasional hot flashes, with minimal impact on their overall quality of life,
- while others may go through 20 or more episodes per day, perceiving them as a major obstacle in their daily lives.
Generally speaking, the earlier hot flashes begin during the menopausal transition, the longer they tend to last over time.
If symptoms are relatively mild, it may not be necessary to make significant lifestyle changes or explore treatment options right away. However, if hot flashes are particularly bothersome, several countermeasures can be considered. It’s helpful to keep track of what seems to trigger your hot flashes and how disruptive they are, since these observations can be extremely useful when deciding how best to manage your symptoms with your doctor.
Causes
Hot flashes are a symptom experienced by the majority of women going through the delicate transition of menopause, most likely as a direct result of the intense hormonal changes that occur during this period.
Other possible causes of hot flashes include:
-
Breast cancer treatment: hot flashes experienced during cancer treatment are often more severe than those typically seen during natural menopause. Approximately seven out of ten women undergoing treatment for breast cancer experience hot flashes of varying frequency, caused by the drop in estrogen levels triggered by chemotherapy.
-
Prostate cancer treatment: men undergoing treatment for prostate cancer can also experience hot flashes, caused by the reduction in circulating testosterone levels associated with certain therapies.
Risk Factors
Not every woman going through menopause experiences hot flashes, and researchers still do not fully understand the reasons behind these individual differences. However, several risk factors have been identified that increase the likelihood of experiencing them:
-
Smoking: women who smoke are significantly more likely to experience hot flashes compared to non-smokers.
-
Obesity: a higher body mass index (BMI) is associated with a greater frequency and intensity of hot flashes.
-
Ethnicity: African American women appear to experience hot flashes more frequently than women of European descent, while hot flashes tend to be less common among women of East Asian descent (Japanese and Chinese women, for example).
Lifestyle Changes
Before considering medication, it’s generally advisable to try modifying certain lifestyle habits first. Doctors typically recommend persisting with these changes for at least 3 months before starting any pharmacological treatment.
If night sweats are interfering with your sleep, it can help to keep your bedroom cooler and to drink small amounts of cold water before going to bed. Setting up your bed with layered bedding that can be easily adjusted according to your needs is also a helpful strategy.
Here are some other lifestyle changes that can help manage this phenomenon:
-
Dress in layers, so you can easily remove clothing as soon as a hot flash begins.
-
Carry a portable fan with you, which you can use as soon as a hot flash starts to develop.
-
Avoid alcohol, spicy foods, and caffeine. All of these are known to worsen menopausal symptoms, including hot flashes.
-
If you smoke, try to quit, not only for the sake of your menopausal symptoms but also for your overall long-term health.
-
Try to maintain a healthy body weight. Women who are overweight or obese tend to experience more frequent and more severe hot flashes.
-
Try practices such as yoga, meditation, or other relaxation techniques.
-
Early-stage research has suggested that meditation, yoga, and tai chi may be genuinely helpful in improving overall menopausal symptoms.
Relaxation Techniques
Improving your breathing patterns, for example through the regular practice of relaxation techniques, is an effective way to reduce stress. This essentially involves taking a deep inhalation followed by a slow, steady exhalation.
This technique should be practiced for several minutes while sitting or lying in a comfortable position.
It’s based on slowly inhaling through the nose. With your hand placed just below your ribs, over your stomach, you should feel your stomach push your hand outward before your chest begins to expand.
Then, exhale slowly through your mouth, first allowing your lungs to fully empty, and then letting your stomach naturally fall back inward.
This type of breathing can be practiced almost anywhere and can be repeated several times throughout the day, whenever you feel under stress. You can also use this technique the moment you feel a hot flash beginning, or simply to help yourself relax before falling asleep at night.
Non-Hormonal Medications
If lifestyle changes alone are not enough to improve your symptoms, several non-hormonal treatment options may prove effective. These can represent valid alternatives for women who are unable to take hormones, or who are concerned about the potential risks associated with hormone therapy.
Although it is not officially approved for this specific indication in many countries, paroxetine has been shown to be an effective remedy for treating hot flashes. Researchers are also currently studying the effectiveness of other antidepressants belonging to the same drug class.
Women who take antidepressants specifically to manage hot flashes generally take lower doses than those typically prescribed for treating depression. Side effects vary depending on the specific type of antidepressant used and can include:
- dizziness,
- headache,
- nausea,
- agitation,
- or drowsiness.
As with any medication, always check with your doctor to determine whether a particular drug is appropriate for your specific situation, and discuss how any potential side effects can be managed.
Hormone Therapy for Hot Flashes and Night Sweats
Some women, together with their gynecologist, may choose to pursue hormone therapy to manage their hot flashes. A hormone is a chemical substance produced by a glandular organ, such as the thyroid or the ovaries. During the menopausal transition, the ovaries gradually become less active, and the production of estrogen and progesterone hormones declines over time. These hormonal changes are believed to be the primary driver behind hot flashes and many other menopausal symptoms.
Hormone therapy works by stabilizing estrogen and progesterone levels in the body. It is a highly effective treatment for hot flashes in women who tolerate it well. However, taking hormones does carry certain risks, including an increased risk of:
- heart attack,
- stroke,
- blood clots (thrombosis),
- breast cancer,
- gallbladder disease,
- and dementia.
These risks vary depending on a woman’s age and whether she has previously undergone a hysterectomy, and should always be carefully discussed and evaluated together with your doctor.
Women who still have their uterus should take estrogen combined with progesterone, or another medication designed to protect the uterus. Progesterone is added to estrogen therapy specifically to protect the uterine lining from cancer, although it does appear to slightly increase the risk of blood clots and stroke. Hormone therapy should always be based on the lowest effective dose, taken for the shortest possible duration of time.
Hormone therapy for hot flashes is generally contraindicated in women with:
- a history of breast or uterine cancer,
- a previous stroke or heart attack, or a strong family history of these conditions,
- a previous history of blood clots,
- a history of unexplained vaginal bleeding or blood clotting disorders,
- liver disease,
- current pregnancy,
- previous allergic reactions to hormone-based medications.
When appropriate, hormones can be extremely effective at reducing both the frequency and severity of hot flashes, and they are also effective in treating vaginal dryness and preventing bone loss (osteoporosis) associated with menopause.
Hormone replacement therapy is typically available in several different forms, including:
- tablets,
- skin patches,
- subcutaneous implants,
- gels,
- creams,
- or vaginal rings and suppositories.
Skin patches are often considered the best option for women with cardiovascular risk factors, such as a family history of heart disease.
Several different types of hormones are available for treating hot flashes, including estradiol, conjugated estrogens, selective estrogen receptor modulators, and various synthetic hormone preparations.
Among the milder side effects associated with hormone therapy are breast tenderness, spotting or the return of menstrual-like bleeding, cramping, or abdominal bloating. By adjusting the type or dosage of hormones used, the method of administration, or the daily timing of doses, your doctor can often help bring these side effects under control. In many cases, these effects also tend to resolve on their own over time.
Risks
In 2002, a major study conducted by the Women’s Health Initiative (WHI), an American research group funded by the National Institutes of Health, was halted early after researchers found that participants treated with a specific type of estrogen combined with progesterone had significantly higher risks of:
- stroke,
- heart attack,
- breast cancer,
- dementia,
- urinary incontinence,
- and gallbladder disease.
This landmark study caused considerable concern at the time and led many women to become understandably wary of hormone therapy in general.
Since then, however, further scientific research has shown that younger women are generally associated with lower risks and greater benefits from hormone therapy compared to what was originally observed in the WHI study. In that particular study, the negative effects of hormone therapy occurred almost exclusively in women over the age of 60, well after menopause had already occurred. More recent treatment formulations, developed after 2002, may help reduce the risks associated with hormone use in symptomatic women during the menopausal transition itself, although their long-term safety still requires further study.
If hormone therapy is chosen, it should always be used at the lowest effective dose for the shortest possible duration, and always under close medical supervision. Be sure to share your complete personal and family medical history with your doctor, and don’t hesitate to discuss any concerns you may have about starting hormone therapy.
Other Remedies
Among the various remedies sometimes mentioned for treating hot flashes, you may come across black cohosh, DHEA (dehydroepiandrosterone), or soy isoflavones. The effectiveness of these products has not been clearly demonstrated, and some of them may even carry a risk of liver toxicity.
Phytoestrogens are naturally occurring, estrogen-like compounds found in certain grains, vegetables, legumes (such as soy), and herbs. They may act as mild, natural forms of estrogen, but the results of scientific studies on their effectiveness remain inconsistent, and their long-term safety is still not entirely clear.
At present, there are no definitive conclusions regarding the safety and effectiveness of these alternative remedies. Both their potential benefits and risks are still being actively studied. For this reason, it’s strongly recommended to always consult your gynecologist before taking any herbal supplement or natural remedy for hot flashes or other menopausal symptoms, since “natural” does not automatically mean “safe”.
Night Sweats and Sleep Disturbances
To improve sleep quality during and after the menopausal transition, consider the following recommendations:
-
Stick to a consistent sleep schedule. Try to go to bed and wake up at the same time every day.
-
Avoid late afternoon and evening naps whenever possible.
-
Establish a relaxing bedtime routine. Some people find it helpful to read, listen to calming music, or unwind with a warm bath before bed.
-
Try to avoid watching television or using computers and mobile devices in the bedroom. The light emitted by these devices can interfere with your ability to fall asleep.
-
Keep your bedroom at a comfortable temperature, neither too hot nor too cold, and as quiet as possible.
-
Exercise regularly, but avoid doing so right before bedtime.
-
Avoid large, heavy meals shortly before going to sleep.
-
Avoid caffeine (found in certain types of coffee, tea, or chocolate) later in the day.
-
Remember that alcohol does not actually help you sleep. Even small amounts of alcohol can significantly disrupt the quality of your sleep.
If simply changing your sleep routine doesn’t provide enough relief, consider exploring cognitive behavioral therapy (CBT). This therapeutic approach has recently been shown to be genuinely helpful for women experiencing sleep disturbances related to menopausal symptoms.
Cognitive behavioral therapy is available both as individual sessions and as group classes. Make sure that whichever therapist you choose has specific experience working with women going through the menopausal transition. Your doctor may be able to recommend a qualified therapist in your area.
Sources and Bibliography
- NHS – Menopause (licensed under the Open Government Licence)
- National Institute on Aging – Hot Flashes: What Can I Do?
- National Institute on Aging – Sleep Problems and Menopause: What Can I Do?
