Striking without any warning in the day or night, one of the most noticeable and unpleasant symptoms of perimenopause and menopause is hot flashes. These sudden surges of internal heat can make it feel like your body has been thrust into an oven. They can cause your face and neck to flush, your heart to race, and leave you drenched in sweat or overwhelmed with anxiety.
Though 75% of women in this phase of life will have hot flashes, your experience will be unique. Hot flashes may be a mere blip on your radar, barely noticeable, or they might significantly impact your quality of life. The duration, intensity, and feeling can also vary. Your hot flashes may come and go within 30 seconds or linger for up to five minutes. You may feel an intense, full-body surge of heat or warmth that radiates from a specific part of your body. Your hot flashes may occur from six months to more than ten years, and the frequency might intensify in the two years following menopause.
While this might sound daunting, the good news is that several strategies and treatments are available to manage hot flashes effectively.
What causes hot flashes?
Researchers are unsure why we get hot flashes, but one idea points to the hypothalamus. This small yet essential part of the brain controls heat production and loss. During perimenopause and menopause, hormonal shifts can destabilize the hypothalamus, with fluctuating progesterone and estrogen levels steering your body's heat balance onto an unpredictable rollercoaster.
What can you do to manage hot flashes?
There are two ways to manage your hot flashes. The first is to try lifestyle changes to prevent them from happening. The second is to treat the source. As we’ve mentioned, every woman is different, but working with a healthcare provider knowledgeable about this life transition can infinitely improve your experience.
Preventing hot flashes with lifestyle adjustments
Whether or not you’ll experience hot flashes is mainly out of your control, but you may start to spot patterns or triggers by becoming more mindful of what you’re doing, wearing, or eating when they occur. This self-awareness can be a powerful tool, helping you possibly reduce the frequency and intensity of your hot flashes.
Triggers for hot flashes can vary significantly from person to person, but common ones include:
- Alcohol - especially red wine
- Bending over
- Eating spicy foods
- Feeling stressed or anxious
- Hot weather or being in a hot room
- Using hair dryers or curling irons
- Smoking or being exposed to cigarette smoke
- Tight clothing
- Poor sleep
To figure out what might be triggering your hot flashes, start keeping a journal about your symptoms. Write down everything you can think of related to each hot flash in your journal. What were you doing right before it happened? What had you just eaten or drunk? How were you feeling emotionally? What were you wearing?
Keep your notes as detailed as possible. After a few weeks, look over your entries to see if you can identify any patterns. Once you've identified potential triggers, work on avoiding them. This might mean making some changes, like cutting back on caffeine, wearing looser clothing, or learning new stress-management techniques. Remember, figuring out which changes work best for you might take some trial and error, so be patient with yourself.
Review your medications
You should also consider whether any medications you take contribute to your hot flashes. Certain medicines, including some high blood pressure and cholesterol medications, can trigger hot flashes in some women.
It's important to review all your medications, including over-the-counter drugs and supplements, with your healthcare provider. They can help determine whether any of your medications could be causing or exacerbating your hot flashes and discuss possible alternatives if needed. Never stop taking a prescribed medication without first consulting with your healthcare provider.
When lifestyle changes aren't enough, it's time to consider medical treatment. Society has taught us that menopause is something that women must endure as a “normal part of life” and that the symptoms are something we can cope with.
Addressing the root cause of the symptoms you’re experiencing during menopause can help you find relief and enjoy these years of your life rather than simply “getting through” them.
Hormonal hot flash treatments
Hormone Replacement Therapy (HRT) is the gold standard for managing hot flashes. HRT helps replace the estrogen lost during perimenopause and menopause, thereby alleviating symptoms.
Bio-identical hormones offer a more natural approach to hormone therapy. They are chemically identical to your body's hormones, which makes them different from the synthetic hormones used in traditional HRT. Bio-identical hormones can be found in both FDA-approved prescription products and pharmacy-compounded products. Compounded bio-identical hormone therapies are tailored to your individual hormone needs and are another method of effectively treating your menopause symptoms.
Before starting any form of hormonal treatment, it's crucial to have a thorough discussion with your healthcare provider. Together, you can weigh the potential benefits against the risks and side effects, which can vary depending on your personal health history and the specific hormone therapy used.
Hormone therapy is usually safest and most effective when initiated within the first ten years of menopause and is often recommended for a limited period. Regular follow-ups with your healthcare provider are essential to monitor your response and adjust your treatment as necessary.
Non-hormonal hot flash treatments
In addition to hormonal treatments for menopause, non-hormonal medications such as gabapentin, selective serotonin reuptake inhibitors (SSRIs), and clonidine have also been effective in reducing hot flashes.
In May 2023, the FDA approved a new non-hormonal medical treatment, Vezoah, or fezolinetant. Unlike HRT, fezolinetant blocks a specific neuron receptor in the brain that signals to increase body temperature. For women who can’t use or don’t wish to use hormonal treatments or SSRIs, Vezoah may provide the relief you’re looking for.
As with most medications, there can be side effects such as diarrhea, abdominal pain, insomnia, and potential liver effects. However, these are generally not common and are manageable with regular monitoring by your healthcare provider.
What’s most important if you’re suffering from hot flashes is understanding that you don't have to suffer in silence. Many options are available to transform your menopause journey from a phase of endurance to a period of well-being. Remember, each woman's experience is unique, and so is her path to relief. With the right support, guidance, and a proactive approach, the horizon is bright for managing your hot flashes.