What you really need to know about menopause hot flashes

Menopause and hot flashes are virtually synonymous for a good reason: They’re bothersome symptoms during this phase of life, with up to 80% of women experiencing them in some way during the menopausal transition — whether that’s feeling a little warm during a work meeting or having to change into a fresh blouse in the middle of the day.

That might sound discouraging, but the good news: There are treatment options a healthcare provider may be able to prescribe to help manage them.

Hot flashes are sudden bursts of heat, typically from the chest up, caused by hormonal shifts that disrupt the body’s temperature regulation. They can vary wildly — some may feel mild warmth, while others may break into a sweat.

One survey found that among women who experienced hot flashes, about one-third had them just a few days per month, while nearly a quarter experienced them daily. Duration varies but often lasts one to two minutes.

For women considered to be in menopause, hot flashes don’t just feel hot — they may come with facial flushing, sweating, chills, and even anxiety.

“Some people feel like they’re having a panic attack — so, heart racing is also one that I hear about,” says Dr. Camille Moreno, D.O., medical director of the Midlife Women’s Health and Menopausal Medicine program at the University of Utah.

When hot flashes happen at night, they’re called night sweats: “[They’re] the physical symptom of waking up drenched in sweat,” says Moreno. As a result, you may need to change clothes or sheets in the middle of the night.

Hot flashes may begin when a woman is considered to be in perimenopause, the transitional phase before menopause. This may start in a woman’s late 40s, but there’s no fixed age.

“There’s no way of knowing you’re having a true menopause hot flash unless your provider can pair it with other symptoms, like an irregular period or brain fog,” says Dr. Sally MacPhedran, M.D., director of the Midlife Women’s Center at University Hospitals Cleveland Medical Center.

The precise mechanism is still debated, but most experts agree it involves the hypothalamus, the brain’s thermostat. During perimenopause, oestrogen levels drop, narrowing your thermoregulatory zone.

“Once a woman starts losing oestrogen, this thermoregulatory zone narrows, so our threshold basically decreases,” says Moreno. That means even a small rise in body temperature can trigger a hot flash or night sweat.

Some triggers may be temperature-related; others may be internal. These can include:

• Alcohol
  
  

• Caffeine
  
  

• Hot drinks
  
  

• Spicy food
  
  

• Stress
  
  

• Sleep deprivation
  
  

• Smoking

“When there's inflammation going on, you can really experience a cluster of symptoms, which can throw off the homeostasis in the body,” says Moreno.

There’s no one-size-fits-all solution, but treatments, with advice from a doctor, may include a few common categories:

Commonly known as hormone replacement therapy (HRT), this is considered a common option a doctor can prescribe for the treatment menopause, says Moreno. “It’s a common treatment option for hot flashes and night sweats.” It can work by helping restore oestrogen and helping stabilise body temperature.

MHT can also help with other bothersome menopause symptoms, like sleep issues and low libido, notes MacPhedran.

Moreno calls these “foundational interventions,” a.k.a. those that we have control over regardless of prescription medications., A healthy diet can help — namely, the Mediterranean diet, says MacPhedran, which may be linked with less hot flashes and night sweats. The reason isn't entirely clear, but it might be the diet’s impact on inflammation and blood sugar, she says. A series of studies have also found cognitive behavioural therapy to be beneficial, too — particularly for people whose hot flashes are triggered by stress.

OTC supplements or medications that promise to nix your hot flashes for good — such as black cohosh — generally don’t provide much relief. “Most of my patients have waited to come to see me, and they've told me that they've tried all of these over-the-counter supplements and they're still pretty miserable,” says Moreno.

If a woman of menopausal age is experiencing bothersome symptoms such as hot flashes, they should seek the advice of theirdoctor — even if they seem “mild.”

“It doesn't matter if it's mild or severe — that’s a perception,” says MacPhedran. Research show that hot flashes may last an average of 7.5 years for some menopausal women and may be linked to increased health risks (such as cardiovascular disease) early advice from a healthcare provider matters.

Learn more about menopause treatments