*Content reviewed by HotPause Health Medical Advisor & Board-Certified OB/GYN, Dr. Beverly Joyce

Hot Flashes In Menopause

Hot flashes, experienced by as many as 80% of women during the transition from perimenopause to menopause, signify the body's response to fluctuating estrogen and progesterone levels. [1] These vasomotor symptoms vary widely among individuals, characterized by sudden heat sensations, night sweats, blood pressure changes, and rapid heartbeats, marking a significant phase in the menopausal journey. [2]

Why Do Hot Flashes Happen in Menopause?

Hot flashes primarily stem from fluctuating hormone levels throughout throughout perimenopause and the menopause transition. The exact mechanism linking hormonal shifts to hot flashes isn't fully understood, yet it's believed that reduced estrogen levels make the hypothalamus, your body's temperature regulator, overly reactive to minor temperature variations. Consequently, if the hypothalamus perceives an increase in body temperature, it initiates a hot flash to counteract the supposed warmth, engaging processes to cool the body. This sensitivity in the hypothalamus to temperature changes is a central factor in why they occur.

How Long Do Hot Flashes Last?

Hot flashes generally last 1-5 minutes, although some episodes can last an hour. They may come on every few days or up to 20 times per day. Most women experience hot flashes for 6 months to 2 years, although some reports suggest that they last considerably longer—as long as 10 years, depending on when they began. For a small proportion of women, they may never go away. It is not uncommon for women to experience a recurrence of hot flashes more than 10 years after menopause, even into their 70s or beyond. There is no reliable way of predicting when they will start, or stop. [3]

What Can You Do About Hot Flashes in Menopause?

Lifestyle Adjustments:

• Refrain from smoking
• Engage in regular physical activity
• Aim for a healthy weight
• Steer clear of triggers like spicy foods, caffeine, and alcohol
• Stay cool by dressing in layers and utilize fans or air conditioning

Explore Natural Remedies: Research to date has been inconclusive as to whether these vitamins and supplements significantly impact hot flashes, but many women share their benefits anecdotally. We always recommend you research your options and discuss your options with your doctor.

• Black cohosh
• Ginseng
• Vitamin E
• Soy
• Red clover
• Flaxseed
• St. John’s Wort
• Curcumin/Turmeric

Non-Hormonal Medications:

• Certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like paroxetine, and serotonin-norepinephrine reuptake inhibitors (SNRI) like Effexor, have shown effectiveness in mitigating hot flashes.
• Gabapentin, an anti-seizure medication, has been beneficial for some patients in controlling hot flashes.
• Clonidine, a medication used to treat high blood pressure, can also be effective for managing hot flashes.
• Fezolinetant, a newer medication, works by targeting the brain processes that trigger hot flashes, providing a potential treatment for those experiencing moderate to severe symptoms.

Menopause Hormone Therapy:

• Menopause Hormone replacement therapy stands out as a highly effective treatment for alleviating symptoms of menopause, particularly beneficial for those experiencing a wide range of issues such as hot flashes, vaginal dryness, mood fluctuations, and memory problems. The primary hormone utilized in this therapy is estrogen. Women who have undergone a hysterectomy can use estrogen alone without additional hormones. However, for those with a uterus, estrogen is typically prescribed alongside progesterone (or its synthetic counterpart, progestin) to mitigate the risk of uterine cancer associated with estrogen-only therapy.
• An innovative treatment option includes a combination of estrogen and a SERM (selective estrogen receptor modulator) medication called named bazedoxifene, which not only addresses menopausal symptoms but also aids in osteoporosis prevention.
• Progesterone or progestin is available in oral form or through an intrauterine device (IUD) that releases progestin over several years. The choice between oral progesterone and an IUD depends on personal preference, considering factors like the possible discomfort of IUD insertion versus the side effects of oral progesterone, which may include weight gain and mood alterations.
• Talk to your doctor if these options might be ideal for you.