What you really need to know about menopause hot flashes

Menopause hot flashes might be the best known symptom out there: To a lot of people, menopause looks like frantically fanning yourself, sticking your head in the refrigerator, or rolling down the car window to get some air.

But menopause and hot flashes are virtually synonymous for a good reason: They’re incredibly common 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 there are more ways than ever to manage hot flashes — and even dial down their frequency and intensity.

What are hot flashes in menopause?

Hot flashes are short bursts of heat in the body. They come and go quickly, but their intensity can vary from person to person; some people get drenched with sweat, while others just feel a little warm. They’re the result of the hormonal changes that happen during the menopausal transition, which can throw off your body’s ability to regulate its temperature.

How often they happen can vary: One survey found that among women who experienced hot flashes, one-third had them anywhere from one to three days over the course of a month — while almost a quarter had hot flashes every single day. (Everyone else fell somewhere in between.) For the majority of people, they last roughly one to two minutes, but the intensity is unpredictable; people can have mild, moderate, and severe hot flashes all in the same day.

What do menopause hot flashes feel like?

While hot flashes are definitely hot, that’s not the only sensation you might feel. First, the warmth can be experienced anywhere from the chest up — even on your face, according to Dr. Camille Moreno, D.O., the medical director of the Midlife Women’s Health and Menopausal Medicine program at the University of Utah. (That’s because there are differences in response and volume of the blood vessels in the face, neck, and chest versus those in other areas of the body.)

“You can actually see a woman's face turn red, and we call that facial flushing, " says Moreno. “Hot flashes can also be accompanied by other symptoms like chills and perspiration, and some people feel like they’re having a panic attack — so, heart racing is also one that I hear about.”

When can hot flashes start?

Hot flashes often begin during perimenopause. That’s the time leading up to menopause — which is, by definition, the moment you’ve gone 12 months without your period. During perimenopause, your period may be irregular, which means your cycle length either is outside of the typical 21- to 35-day range, or varies by more than seven days from month to month.

The exact age that hot flashes start can start is harder to pin down. The average timespan of menopause symptoms is four to eight years, and the average age of menopause is 51. So, doing the math, perimenopause could start in your late 40s. However, everyone goes through menopause on a different schedule, says Dr. Sally MacPhedran, M.D., the director of the Midlife Women's Center at University Hospitals Cleveland Medical Center and a professor of reproductive biology at Case Western Reserve University School of Medicine. So 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.

Causes of hot flashes during menopause

While experts are still debating the exact mechanism of hot flashes, they’ve found that the connection is centralized in the brain, according to Dr. Moreno — specifically, in the hypothalamus, the part of the brain that oversees your body temperature. That’s determined by your thermoregulatory zone.

“Once you start losing estrogen in perimenopause, this thermoregulatory zone narrows, so our threshold basically decreases,” she says. In other words, your threshold for feeling hot (and the usual bodily responses to heat, like sweating) gets lower — so your brain tees up a hot flash even if you don't actually feel that hot. Your body’s ability to regulate temperature becomes so sensitive that any tiny temperature increase can now set off hot flashes and night sweats (which are hot flashes that occur overnight).

What triggers hot flashes?

There are a ton of things that can inadvertently set off a hot flash, from the food you eat to the stress you feel. They include:

• Alcohol
• Caffeine
• Hot beverages
• Hot weather
• Sleep deprivation
• Smoking
• Spicy food
• Stress or anxiety

While many of these things raise your body temperature, some, like stress and smoking, can increase inflammation. “And when there's inflammation going on, you can really experience a cluster of symptoms, which can throw off the homeostasis in the body,” says Dr. Moreno. So even though there might not be a direct link just yet, “we can attribute it to the inflammation,” she says.

Symptoms of hot flashes

Hot flashes aren’t only a physical sensation of sudden warmth. They can also include symptoms like:

• Redness on your face, neck, and chest
• Increased heart rate or panicky feeling
• Chills
• Sweating

Treatment for menopause hot flashes

There are many different treatments for hot flashes, which include both medications and lifestyle tweaks—and MacPhedran recommends both, especially if your hot flashes are intense or frequent enough to interrupt your daily activities.

“Lifestyle interventions should be discussed and tried to be implemented no matter what,” she says. However, she notes, if someone needs hormone therapy, then she’ll offer that alongside lifestyle tweaks. With that in mind, here’s what doctors recommend.

Hormone replacement therapy (HRT)

Menopause hormone therapy (MHT), more commonly known as hormone replacement therapy (HRT), involves getting additional estrogen and sometimes other hormones, like progesterone, through a patch, pill, tablet, or topical cream. It is considered the gold standard for hot flashes.

“It’s the most effective treatment option for hot flashes and night sweats,” says Moreno, who says that it’s effective — meaning it lessens the intensity and frequency of hot flashes — up to 80% of the time. By restoring some estrogen to your system and maintaining a stable level, it can help you better maintain your internal body temperature.

Also a big deal? HRT is the only medication that helps with most of the symptoms of menopause, such as loss of libido and sleep issues, says MacPhedran. That’s not something you get with non-hormone prescriptions.

Non-hormonal medications

First, there’s the drug fezolinetant, which was released in 2023. It’s “actually the first medication in its class that's non-hormonal and also not an antidepressant to treat hot flashes and night sweats,” says Moreno, who says that it’s about 70% effective for those symptoms. The issue is that it’s not often covered under insurance plans since it’s so new, so it can be expensive.

Otherwise, “we rely on SSRI and SNRIs, which are used for depression and anxiety — but also used off-label for hot flashes and night sweats,” says Moreno. “So depending on the antidepressant that you're choosing, it can be effective anywhere between 40-70% of the time.” (At this time, only one SSRI, Brisdelle, is approved by the FDA for hot flashes.)

The thinking is that these medications, in affecting the serotonin receptors in the brains, “also help regulate the temperature control that’s found in the hypothalamus,” says Moreno. Your other symptoms might factor in, too: If you’re experiencing both depression and hot flashes during menopause, then this might be a treatment option worth considering.

Over-the-counter (OTC) therapies

OTC supplements or medications that promise to nix your hot flashes for good generally don’t work. “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.

The National Institutes of Health notes that the findings for black cohosh — an herb that's touted for helping with hot flashes — are "inconclusive." For vitamin E, the effect is pretty small, with one study finding that people had one fewer hot flash a day. (The study authors themselves wrote: “The clinical magnitude of this reduction was marginal.”) Plus, a lot of OTC supplements can interfere with other medications, so it’s best to talk to your doctor first.

Lifestyle changes

Moreno calls these “foundational interventions,” a.k.a. those that you have control over regardless of prescription medications. “Avoid the hot flash triggers, whether it's an environmental factor like being in a hot or warm environment or any of those dietary triggers like spicy food, caffeine, and alcohol,” she says. Seek out AC when you can, especially if you live in a warmer climate, and avoid exercises in heated spaces like hot yoga.

A healthy diet can also help. Research has found that people who followed a Mediterranean-style diet — which, like WeightWatchers for Menopause, prioritizes nutrients like protein, fiber, and hydration — were less likely to report hot flashes and night sweats, whereas those whose diets were high in fat and sugar increased their risk. The reason for this isn't entirely clear, but one mechanism might be the Mediterranean diet’s impact on inflammation and blood sugar — both of which have been linked to a higher risk of hot flashes. That, or people on the diet might have an overall healthier lifestyle, which can help reduce the risk of hot flashes.

A series of studies (called the MENOS studies) have also found cognitive behavioral therapy to be beneficial, too. That’s not a huge surprise, seeing as stressful situations can lead to hot flashes. “People will say someone cut them off while driving and they had a hot flash, or someone said something at work that was a little uncalled for, and that gave them a hot flash,” says MacPhedran.

Menopause hot flash prevention

Even with treatments, there's no way to completely avoid hot flashes. Your best bet is to identify your triggers and then avoid them, though some triggers (like alcohol, caffeine, smoking) are easier avoided than others (such as hot weather and stress).

What’s the difference between hot flashes and night sweats?

Night sweats are essentially hot flashes that occur at night. “Night sweats are the physical symptom of waking up drenched in sweat,” says Moreno. For some people, you might wake up with your clothes wet or notice your pillowcase and sheets are damp; these can start at your face, neck, and chest and spread across your body, possibly because you might be under a blanket (although the exact reason is unclear). But “there are severe manifestations where people are actually having to change their clothes or need to take a shower in the middle of the night,” she says.

When to see a doctor for menopausal hot flashes

If it’s disrupting your life, then it’s worth seeing a doctor. “It doesn't matter if it's mild or severe — that’s a perception,” says MacPhedran. “Some women might say something is mild and another one would say it's severe. Seeing as hot flashes can last for years (seven and a half on average), it’s worth getting them addressed sooner rather than later. Not only that, but there are many studies that have found a correlation between hot flashes and a higher risk of Alzheimer’s disease, cardiovascular disease, and even type 2 diabetes.

Once you’ve decided to treat your hot flashes, your first stop should be your primary care provider. If you then feel like your symptoms weren’t heard or addressed — since most primary care physicians are taking care of a multitude of concerns and might have limited time for your visits — then “it's time for patients and for women to seek out help from a menopause specialist,” says Moreno. You can find one at The Menopause Society’s directory or meet virtually with a clinician at WeightWatchers Clinic for Menopause. They will be able to go over your symptoms with you, create a treatment plan, and prescribe HRT if appropriate.

The bottom line

Hot flashes and menopause go hand-in-hand; they can be a fact of life for women in any stage of the menopause transition. They can be triggered by spicy food, alcohol, stress, or anything that raises your body temperature, be it intense exercise, hot weather, or a steaming cup of coffee. The best way to manage menopause hot flashes? Avoiding your triggers, as well as seeking out effective medications like hormone therapy or non-hormonal options. Together, these won’t fully prevent hot flashes, but they can be incredibly helpful in dialing down their intensity and frequency.