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The Basics of Hot Flashes


Published April 27, 2015

Of the many symptoms associated with menopause, none characterizes this stage in a woman’s life like hot flashes. A Hot flashes is a sudden, transient feeling of warmth. When I was a resident, early in my medical career, I remember an ER nurse joking about her hot flashes. She would frequently announce, “Oh boy, here it comes” and laugh as she would fan herself with a patient chart in an attempt to cool off. We all laughed about it with her, and it didn’t seem to be such a big deal. I would later learn that hot flashes are usually not a laughing matter. Looking back, it’s possible this nurse didn’t find her hot flashes funny at all but didn’t know how else to cope with them.

In my practice, I have met many women with severe hot flashes. Some reported having hot flashes every 30 minutes, day and night, and described the temperature rise as so intense, they would sweat through their clothing and experience chills as each hot flash subsided. Hot flashes can be so frequent and intense that it becomes near impossible to sleep, work, or enjoy life. They usually start as a woman enters menopause, however, some women start to experience hot flashes many years before this. Although not as common, men can also experience hot flashes as their testosterone levels decline with aging, otherwise known as andropause. There is no set pattern to hot flashes. It is commonly thought that once hot flashes begin, they will occur for a few years and then resolve as your body adjusts to hormonal changes. This is not necessarily true. Some women may experience hot flashes for many years after entering menopause and may possibly never have them subside. Others may be lucky enough to never experience any hot flashes, even as they face hormonal changes. Hot flashes can be mild and sporadic, or as described above, frequent and intense.

It is not exactly known what causes hot flashes, but it involves the hypothalamus. The hypothalamus is a structure in the brain with many functions, one of which is controlling body temperature. It is regulated by sex hormones, such as estrogen, progesterone, and testosterone. Neurotransmitters, which are biochemicals produced by the body to help control a number of functions, also have influence on the hypothalamus. You could think of the hypothalamus as the body’s thermostat. When the body needs to release heat, the hypothalamus signals blood vessels on the skin surface to dilate. Blood flow to the skin increases and heat is allowed to escape the body. When a woman approaches menopause or a man enters andropause, sex hormones decline. It is thought that this decline in hormones leads to hypothalamus dysfunction. It’s as if the body’s thermostat becomes broken. Because of this, the body can be triggered to inappropriately and abruptly release heat at inopportune times, resulting in what is known as a hot flash. This response can also be associated with anxiety, heart palpitations, and chills.

The most effective treatment for hot flashes is bioidentical hormone replacement therapy (BHRT), which helps treat hormone deficiencies. By restoring normal hormone levels, hot flashes and a number of other symptoms associated with menopause and andropause can be controlled. However, even with hormone replacement therapy, the threshold for hot flashes may remain lower than normal and can be activated by the following triggers:

Avoiding or managing these triggers can help reduce the frequency and intensity of hot flashes.

Although hot flashes are the dominant symptom of menopause, they are not the only symptom and do not define menopause. By definition, menopause designates the time in a woman’s life after her menstrual cycle has stopped. I often hear patients, and sometimes doctors, talk about using BHRT until menopause is over. To clarify, menopause does not end. One enters menopause when her menstrual period ceases and stays in menopause for life. The symptom of hot flashes may stop or become diminished as the hypothalamus adjusts to menopause, but that doesn’t mean menopause is over or that the health issues and other symptoms associated with it have gone away. Once hormone levels have declined, they will remain low, which can affect bone health, brain function, sexual wellness, energy, and quality of life. Maintaining hormone levels through BHRT and implementing a comprehensive health maintenance program can help you combat hot flashes as well as the many effects of aging.

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