Hot Flush

hot flash, vasomotor symptoms, VMS

Hot flushes are sudden waves of intense heat that sweep through your body, often leaving you drenched in sweat and flushed. These uncomfortable episodes affect up to 80% of women during menopause and can disrupt daily life for years.

Table of contents

• What is a Hot Flush?
• How a Hot Flush Feels
• What Causes Hot Flushes
• Common Triggers
• How Long They Last
• Who is Most Affected
• Treatment Options
• Lifestyle Changes That Help

What is a Hot Flush?

A hot flush is a sudden feeling of intense warmth that spreads through your upper body, particularly affecting your face, neck, and chest^[1]. This is not just a mild sensation of being too warm—it is a rapid and exaggerated heat response that your body produces inappropriately^[5].

Hot flushes are the most common symptom of menopause (the time when menstrual periods stop) and perimenopause (the years leading up to menopause)^[1]. They are also called vasomotor symptoms, which means symptoms that affect how your blood vessels expand and contract to control body temperature^[2]. When hot flushes happen during sleep, they are called night sweats^[1].

Between 75% and 80% of women going through menopause experience hot flushes^[3]. For some women, these episodes are mild and infrequent, while for others they can be severe enough to disrupt work, relationships, and sleep^[2].

How a Hot Flush Feels

Hot flushes feel different for everyone, but they share some common features^[2]. Most people experience a sudden sensation of heat spreading through their body, often starting in the face or chest and then moving throughout the upper body^[8].

During a hot flush, you may notice several physical changes^[1]:

• Skin that becomes hot, red, and flushed, especially on your face and chest
• Profuse sweating, particularly on your upper body
• A fast or pounding heartbeat (typically 7 to 15 beats faster than normal)^[5]
• Feelings of anxiety or unease
• Chills or shivering after the hot flush ends, as your body loses heat too quickly^[1]

Some women describe feeling as if they are going to faint during a particularly intense episode^[8]. The skin becomes hot to the touch, which is why these episodes are sometimes called “hot flashes”^[8].

Hot flushes can range from mild (feeling warm without much sweating) to moderate (hot and sweating but manageable) to severe (so intense with heat and sweating that you must stop whatever you are doing)^[7].

What Causes Hot Flushes

The exact cause of hot flushes is not completely understood, but researchers know that changing hormone levels play a major role^[2]. The decline in estrogen (a hormone produced by the ovaries) during menopause disrupts your body’s ability to control its temperature^[2].

During a hot flush, several things happen in your body at once. Your blood vessels near the skin surface widen suddenly, causing increased blood flow to these areas^[5]. This makes your skin appear red and feel hot. Your body also activates its cooling mechanisms—you start sweating heavily to release heat through evaporation^[4].

Hot flushes occur because of changes in a small area of the brain called the hypothalamus, which acts as your body’s temperature control center^[4]. When estrogen levels drop, this temperature center becomes more sensitive. It triggers heat loss responses even when your body temperature has risen only slightly^[5]. Essentially, your thermostat gets “stuck” in a very narrow range, causing your body to overreact to small temperature changes^[5].

Specific nerve cells in the hypothalamus, called KNDy neurons, become larger after menopause due to the loss of estrogen^[4]. These neurons play an important role in triggering the inappropriate heat loss response that we experience as a hot flush^[4].

Common Triggers

While hormonal changes set the stage for hot flushes, certain situations or substances can trigger individual episodes^[2]. Identifying your personal triggers can help you manage how often hot flushes occur.

Common triggers include^[2]:

• Hot weather or being in warm rooms
• Drinking hot beverages like coffee, tea, or hot chocolate
• Eating spicy foods
• Drinking alcohol
• Drinking caffeinated beverages
• Smoking cigarettes
• Feeling stressed or anxious
• Wearing heavy clothing or being overdressed
• Taking hot showers or baths
• Exercising, especially in warm conditions

Taking note of when your hot flushes happen and what you were doing beforehand can help you identify patterns and avoid triggers when possible^[2].

How Long They Last

Each individual hot flush episode typically lasts between one and five minutes^[1]. However, some episodes can last as long as 30 minutes or even an hour, though this is less common^[8].

The frequency of hot flushes varies greatly from person to person. Some women have only a few episodes per week or month, while others experience multiple hot flushes every hour throughout the day^[1]. Up to one in three women report having more than 10 hot flushes per day^[2].

The length of time women continue to have hot flushes also varies considerably. On average, hot flushes last for about seven to nine years^[7]. Some women have them for only a few months, while others continue to experience them for more than 10 years^[1]. Studies show that Black and Hispanic women tend to have hot flushes for longer periods than women of other ethnic backgrounds—often lasting two to four years longer^[3].

Hot flushes often begin several years before menopause actually occurs and can continue for many years afterward^[8]. For most women, the symptoms gradually decrease over time, even without treatment^[10].

Who is Most Affected

While many women experience hot flushes during menopause, certain factors increase the likelihood of having them or make them more severe^[7].

Women who smoke cigarettes—either currently or in the past—have a higher risk of experiencing hot flushes^[7]. Being overweight or having a higher level of abdominal fat also increases the chance of having hot flushes, particularly in younger women and those earlier in the menopause transition^[7].

The way menopause occurs also matters. Women who undergo surgical menopause (having their ovaries removed before natural menopause) typically experience hot flushes that begin immediately after surgery^[7]. These women are more likely to have hot flushes than women who go through menopause naturally, and their symptoms tend to be more frequent and more severe^[7].

Hot flushes can also occur in younger women who experience premature menopause or early menopause^[3]. Additionally, women undergoing certain cancer treatments, particularly chemotherapy or treatments that affect hormone levels, may experience hot flushes^[3].

Some women notice hot flushes during pregnancy, with about 35% of pregnant women reporting them at some point^[6]. They may be more common during the first three months and the last three months of pregnancy^[6].

Treatment Options

If hot flushes are disrupting your daily life or sleep, several treatment options are available. The choice of treatment depends on how bothersome your symptoms are and your personal health situation^[10].

Hormone Therapy

Hormone replacement therapy (HRT) is the most effective treatment for hot flushes^[10]. It works by replacing the estrogen your body no longer produces. Women who have had their uterus removed can take estrogen alone. Women who still have a uterus typically need to take progesterone along with estrogen to protect against cancer of the uterine lining^[10].

Healthcare providers recommend using the smallest dose that controls symptoms^[10]. If you start hormone therapy within 10 years of your last menstrual period or before age 60, the benefits often outweigh the risks^[10]. However, hormone therapy is not right for everyone, and you should discuss the pros and cons with your healthcare provider^[10].

Non-Hormonal Medications

Several types of non-hormonal medications can help reduce hot flushes, though they generally do not work as well as hormone therapy^[10].

Some antidepressants, particularly a medication called paroxetine, are approved specifically for treating hot flushes^[13]. Other antidepressants such as venlafaxine, desvenlafaxine, fluoxetine, and citalopram have also been shown to be effective in reducing hot flushes^[13].

Medications normally used to treat seizures, such as gabapentin and pregabalin, can also help with hot flushes^[13]. A blood pressure medication called clonidine may provide some benefit as well^[5].

A newer non-hormonal medication called fezolinetant (brand name Veozah) was recently approved specifically for treating hot flushes. It works by helping restore the brain’s regulation of body temperature^[22].

Lifestyle Changes That Help

Before considering medication, many women find relief through simple lifestyle adjustments^[18]. Even if you choose to take medication, these strategies can help reduce the frequency and severity of hot flushes.

Keeping Cool

Small changes to your environment can make a big difference^[1]:

• Lower the temperature in your bedroom at night
• Use a fan, either at home or a small portable one you can carry with you
• Drink cold water, especially before bed
• Layer your bedding so you can adjust it as needed
• Keep a cool glass of water nearby day and night

Clothing Choices

What you wear can help you manage hot flushes more comfortably^[2]:

• Dress in layers that can be easily removed when a hot flush starts
• Choose loose-fitting clothes made from natural fabrics like cotton, linen, silk, or bamboo that allow air to circulate
• Avoid tight-fitting clothes and synthetic fabrics that trap heat
• Select lightweight pajamas for sleeping

Healthy Habits

Certain lifestyle changes can reduce your risk of hot flushes^[18]:

• If you smoke, try to quit—even reducing smoking helps
• Try to maintain a healthy weight, as being overweight increases hot flushes
• Avoid known triggers like spicy foods, caffeine, and alcohol
• Manage stress through relaxation techniques

Mind-Body Practices

Some research suggests that certain techniques may help with hot flushes^[1]:

• Mindfulness meditation can help you manage symptoms
• Paced respiration (slow, deep breathing) may reduce the frequency of hot flushes^[5]
• Some early studies show that hypnotherapy might help^[1]

Remember that hot flushes, while uncomfortable and sometimes embarrassing, are a natural part of the menopause transition for most women. You do not have to suffer in silence—talk to your healthcare provider about treatment options that might work for you^[3].