Maybe you’ve seen cartoonish depictions of hot flashes in popular culture, where a middle-aged woman is suddenly overcome and starts stripping off clothing in the middle of an airport or a business meeting. She’s red-faced, sweating and discombobulated.
Though hot flashes may get comic treatment on TV, they’re typically no laughing matter for those who experience them — which 75% of people in the menopause transition do. Hot flashes aren’t just uncomfortable, they’re also indicative of potential vascular issues, says Rajita Patil, MD, director of UCLA Health’s new Comprehensive Menopause Care program, which provides personalized care for hot flashes and other concerns that arise during menopause.
Menopause is a natural part of aging that happens to everyone with ovaries, typically around middle age – the average age is 51, but it can occur as early as 40 or as late as 60. The experience is characterized by changing hormone levels, often over a period of several years, which can abruptly disrupt the functions of various organ systems throughout the body. This can cause symptoms that significantly affect a person’s quality of life and risk for chronic disease.
Hot flashes are the most common symptom of menopause, Dr. Patil says.
“It isn’t just very disturbing for patients, but it really does signify endothelial injury of some sort,” she says. “So the more hot flashes a person is having, the more severity they’re having them with, and the more they are affecting sleep, there’s a direct correlation with cardiovascular disease 10 years down the road.”
A study published in May of 2023 found that people who experience hot flashes have increased risk for cardiovascular events compared with those who don’t have hot flashes. There’s also a direct correlation between hot flashes and dementia and osteoporosis, Dr. Patil adds.
What are hot flashes?
Also known as vasomotor symptoms, hot flashes feel like a sudden rush of warmth in the body, with heat concentrated in the chest, neck and face. A person might feel flushed, like they’re blushing. They may sweat. Their heart may race or palpitate. They may feel anxiety or panic. The experience can last less than a minute or as long as five minutes, Dr. Patil says.
Some people may have as many as 15 to 20 hot flashes a day. They also happen at night, causing night sweats and disrupting sleep, adds Erica Oberman, MD, co-director of the Comprehensive Menopause Care program.
On average, people experience hot flashes for seven to 10 years after menopause, which is the point at which a person has gone 12 consecutive months without a menstrual period. Up to 10% of people continue to experience hot flashes, lifelong, after menopause.
What causes hot flashes?
Our bodies generally exist within a “thermoneutral zone,” where we’re not shivering nor sweating. Menopause narrows that zone, Dr. Oberman says, so slight alterations in body temperature can cause sweating. Decreasing estrogen has something to do with this change, but its exact role isn’t well understood, she says.
Contributing to this narrowing of the thermoneutral zone is estrogen’s effect on the hypothalamus, a region of the brain that links the endocrine system and the nervous system. The decline in estrogen characteristic of the menopause transition causes the neurons in the hypothalamus to fire differently, Dr. Patil says, which contributes to dysregulation of the thermoneutral zone.
Estrogen also supports vasodilation, the widening of blood vessels to allow for more blood to flow through them. Vasodilation naturally occurs in response to exercise and changes in body temperature. Lower estrogen levels during menopause affect this process, Dr. Patil says.
What treatments exist?
Fewer than half the people who experience hot flashes receive treatment for them, but the options are plentiful, says Brittany Davis, MD, co-director of the Comprehensive Menopause Care program.
Treatments include:
- Menopause hormone therapy: The U.S. Food and Drug Administration has approved menopause hormone therapy, which replaces declining estrogen, to treat hot flashes. This treatment can decrease hot flashes by as much as 80%, Dr. Patil says. However, menopause hormone therapy isn’t right for everyone. People with cardiovascular disease and other heart conditions may not be good candidates for menopause hormone therapy. “In the right patient population at the right age, it may actually have cardio-protective effects, although more studies are needed,” Dr. Davis says.
- Fezolinetant: In May of 2023, the FDA approved a non-hormonal drug, fezolinetant, to treat moderate to severe hot flashes. “It specifically targets that area in the hypothalamus to control hot flashes, without the side effects or safety issues that perhaps hormones have,” Dr. Davis says.
- Tissue Selective Estrogen Complex: Conjugated estrogen/bazedoxifene is an FDA-approved non-progesterone alternative to the traditional menopause hormone therapy to provide relief for moderate to severe hot flashes. It consists of estrogen to help with hot flashes and a selective estrogen receptor modulator that protects the uterine lining from abnormal thickening.
- Antidepressants: Some serotonin and norepineprhine reuptake inhibitors (SSRI and SNRI), can reduce the frequency and severity of hot flashes.
- Other prescription medications: Gabapentin and oxybutynin have been shown to help reduce hot flashes.
- Cognitive behavioral therapy: Studies show that four to six sessions of cognitive behavioral therapy can significantly reduce hot flashes, and improve sleep, mood and quality of life during the menopause transition.
- Integrative medicine: Mind-body approaches, lifestyle modification and techniques from Traditional Chinese and Ayurvedic medicine, including acupuncture, may be helpful for dealing with hot flashes.
Not everyone will experience hot flashes during menopause and not everyone who experiences them will need treatment. The Certified Menopause Practitioners at the Comprehensive Menopause Care program can provide personalized recommendations for dealing with hot flashes and other menopause issues.
“The whole purpose of this menopause program,” Dr. Patil says, “is to provide precision medicine to the person sitting in front of us based on their values and preferences as well as their individual health, genetic and lifestyle factors.”
