WTF Is A Hot Flash?
Isn’t it so rude when you’re sitting there minding your business and suddenly, out of nowhere, the surge of heat comes from your inner core!? Like…how? And why? You’re not alone. Studies estimate that over 70% of women going through the menopausal journey experience what’s called “vasomotor symptoms” or VMS. This is a fancy term for hot flashes and/or night sweats. In fact, some women experience these symptoms for YEARS - the average being 7.4 years depending on the woman.
In this article, I cover: what they are, why you get them, who is more prone to getting them and most importantly, what the heck can you do about them?!
What Are They?
As the names imply, a hot flash happens in the day and a night sweat happens at night. You may only get hot flashes, you may only get night sweats, or you may get both with regularity. You may notice in your journey that they start off more mild, such as feeling warmer than usual. This is especially true for women who typically report feeling “cold” most of their adult life. It can be a weird adjustment in temperature regulation!
As an example, of my best friends and I were sitting on my couch. She was further along in her menopausal journey than I was and happened to take off her sweatshirt. Then a few minutes later she put it back on. Then she took it off again. This went on about 10 times in the course of an hour. Finally I asked and she said she was having hot flashes but when they were done she felt cold!
Vasomotor symptoms can be described as mild to severe. Women often report feeling heat, sometimes intense, that radiates from deep inside their body to their head, neck, chest and back. Hot flashes can cause sweating similar to night sweats. In fact, some women report sweating through their clothes in the day or pajamas at night.
Once the vasomotor episode is done, you might feel chilly or clammy similar to my friend.
I am often asked, “When do they stop? Like, completely stop?” And the answer is, it depends. Assuming you do no intervention to stop them (discussed below), every woman’s experience is different. Some women’s hot flashes stop when their periods finally stop. And Some women still experience hot flashes well into their 60’s or 70’s.
Who Is More Prone to Hot Flashes?
According to this article, “ The Study of Women’s Health Across the Nation (SWAN) shows that US Black women will be most likely to get VMS and have the most persistent, frequent, and bothersome VMS of any racial/ethnic group; however, most women across the racial/ethnic groups studied (White, Black, Chinese, Japanese, Latina/Hispanic) experienced VMS during menopause.”
Why Do You Get Them?
It’s largely thought they are directly related to the decline in estrogens (estradiol, specifically) as you move through the menopausal transition. It affects a part of your brain that is called your thermoregulatory center. Think of it like your thermostat in your house. When estradiol drops, your thermostat adjusts thinking you need to get rid of “heat” in your body even if you aren’t hot!
That leads to annoying hot flashes and night sweats.
In fact, I’ve long said you can have hot flashes at any age. I’ve had patients who were younger but experienced big drops in estradiol leading to hot flashes.
As for other hormones, it appears for some women that taking progesterone helps combat vasomotor symptoms. However, I’m not seeing in research that dropping progesterone is a CAUSE of vasomotor symptoms.
I have seen some research to indicate that high histamine levels (such as with allergies) can worsen vasomotor symptoms too!
As I will explain below, the drop in estradiol seems to be the biggest cause however other compounding factors can make them worse.
Side note: flushing/sweating may be due to other reasons too such as fever, infection, hyperthyroidism, new medications/stopping medications, etc. Talk with your practitioner if you are unsure!
What Seems to Make Them Worse Beyond Low Estradiol?
This is not a comprehensive list, but what I see and hear most commonly includes:
Already being hot or overheated, hot weather or a hot room, after a hot shower
Caffeine
Spicy hot foods
Hot beverages - tea and coffee (for example)
Feeling stressed or anxious
High histamine
Blood sugar - low or high (or a big swing in either direction)
Obesity (but this is mixed as it may increase risk of hot flashes early in the menopausal journey but then not play a role or even help reduce the risk when older)
Depressive symptoms (according to studies)
What Makes Them Better?
There are a number of lifestyle, supplement, and pharmacological options that might help! Some of these are researched. Some are anecdotal or more common sense. Talk to your practitioner and see what works for you!
Lifestyle:
Dress in layers, try to keep a cooler room, use a fan, cooler showers, etc.
Reduce or eliminate caffeine intake
Switch to iced from hot drinks (or let the hot drink really cool down)
Stay hydrated - considering adding electrolytes (without sugar)
Minimize or avoid spicy foods for now
Avoid/minimize foods that tend to trigger a reaction
Focus on blood sugar - don’t skip meals, get 20-40 grams of protein at each meal
Smoking cessation!
Evaluate your alcohol intake - it can interrupt sleep and might induce night sweats as a result
Stress reduction methods: breath work techniques, vagus nerve exercises (hard gargling, singing, chanting or humming are favorites)
Regular exercise: weight lifting, walking, cardio, yoga, etc.
Cognitive behavioral therapy (CBT) or other forms of therapy to reduce stress and support this change
Acupuncture
Supplement/Nutritional
Ground flax seeds
Organic soy products
Eat 20-40g of protein at each meal
Swedish Flower pollen extract
Shatavari (Asparagus racemosus)
If stress is a factor, adaptogens such as ashwagandha might help
Pharmaceutical:
Hormone replacement therapy (specifically estradiol although as stated, some women report progesterone helped a great deal as well)
Anti-depressants (some are FDA approved for vasomotor, some are off-label)
NK3 inhibitors (Fezolinetant, for example)
Gabapentin (considered off-label)
Please understand, everyone’s journey through menopause is different. There are different levels of comfort with taking any of these products and some are not able to take some of these products. This is also not a comprehensive list. I tried to include the most common, most well researched with positive outcomes in humans (vs a rat or cell study) options.
Lastly, Why Is It Important To Address Vasomotor Symptoms?
Women experience different severity levels of hot flashes and night sweats. For many, they can interfere with life, disrupt work, affect mood, increase stress, and interrupt sleep. Research has also indicated that women who experience frequent vasomotor symptoms are at a higher risk for cardiovascular disease! This can mean worse cholesterol panels, higher risk for high blood pressure (hypertension), more insulin resistance, higher risk for atherosclerosis, and more.