Hot Flashes: What You Need to Know

If you’re entering the age of menopause and you’ve ever been overwhelmed by a sudden sensation of overheating, you’re in good company. Hot flashes are the most common menopause-related discomfort, affecting more than 75 percent women in midlife, according to The North American Menopause Society. Hot flashes involve an immediate feeling of heat, especially on the face, neck and chest. Your skin may become red and flushed, and some women perspire heavily and experience rapid heartbeat or chills.

Amy Brendel, M.D., an internist at the Palo Alto Medical Foundation says understanding the causes and treatment options can help women cope. Here she answers commonly asked questions:

How often do hot flashes usually occur?

The frequency and severity of hot flashes varies greatly from woman to woman. Each episode generally lasts a few minutes, and occurrences can continue for a year or longer. Some women may experience them several times per week, while others have them several times per day. When hot flashes occur at night, they may negatively impact sleep. In severe cases this can contribute to problems with memory, anxiety and depression.

What causes hot flashes?

The latest thinking is that hot flashes involve the hypothalamus, the area at the base of the brain that acts as the body’s thermostat. Menopause seems to affect the functioning of the hypothalamus, causing it to mistakenly sense that a woman is too warm. This creates a situation where the body increases blood flow to the surface of the skin in an attempt to dissipate body heat, and the woman perspires as a way to cool down the body.

Why do certain women experience hot flashes while others don't?

We’re not sure why this is. We do know that smoking, being overweight and being physically inactive increase your risk. Ethnicity also plays a role. More African-American women report menopausal hot flashes than women from other ethnic groups, and more Caucasian women experience them than Japanese and Chinese women.

What's the best treatment for hot flashes?

The most effective treatment for hot flashes is hormone therapy; however, that approach does carry some health risks, especially in the later years of menopause. These may include blood clots, stroke, heart disease and breast cancer. Other medical treatments for hot flashes include antidepressants and anti-seizure drugs but these also have potential side effects such as nausea, dizziness, weight gain or sexual dysfunction.

Women whose hot flashes or other menopausal symptoms interfere with daily life should definitely discuss the pros and cons of medical treatment with their doctors. Certain drug choices may be better for certain patients depending on the severity of symptoms and personal or family health histories, such as heart disease or breast cancer risk factors. Overall, the latest medical evidence shows it’s best to use the lowest effective dose for the shortest time as possible to address symptoms. And starting treatment earlier in menopause and soon after symptoms appear seems to limit risk and help women cope.

Are there any non-medical methods for managing hot flashes?

Many women effectively manage their hot-flash symptoms with lifestyle changes. These include:

• Losing weight and getting plenty of exercise.
• Dressing in layers and removing outer layers when a hot flash comes on.
• Keeping your environment cool, especially at night.
• Reducing stress.
• Eating a diet rich in fruits and vegetables and low on refined white flour and sugar.

Nevertheless, a panel convened by The North American Menopause Society reviewed evidence for and against numerous approaches for treating hot flashes and found that most non-medical therapies offered little if any relief. These included everything from sleeping with ice packs to acupuncture, soy consumption and herbal supplements.

Two approaches that did show promise in helping patients handle hot flashes without hormones were behavioral therapies (such as paced breathing) and clinical hypnosis. These approaches seemed effective at reducing hot flashes in number and/or severity; however, the study groups were small so further research is necessary. (Read the study.)