Hot Flashes
During peri-menopause (the phase leading up to menopause), you may feel a sudden and very intense heat. This uncomfortable feeling is known as a hot flash (also known as “hot flush” and “vasomotor symptom”) and it can be accompanied by skin flushing, sweating and a rapid heartbeat. Hot flashes pass within a few minutes and are experienced by approximately 80% of women during their peri-menopause transition. Recent research has found that most women that have vasomotor symptoms, will experience it over the course of roughly 7.5 years. The onset is usually in a woman’s mid forties during peri-menopause and, up to 30% of women may still be experiencing it well into their sixties.
Approximately 80% of women experience hotflashes
If a hot flash occurs at night, it is referred to as a night sweat. You may wake from a deep sleep suddenly, sweating profusely, stuck in a tangled mess of sweaty sheets and feeling disoriented. Not surprisingly night sweats can cause significant sleep disruption.
Together, hot flashes and night sweats are referred to, in medical terms, as vasomotor symptoms. Vasomotor symptoms eventually cease on their own and strictly speaking don’t require any specific treatment. However, given the severe impact on the quality of life it has, most women seek treatment that can help make the symptoms more manageable and improve quality of life. Hormonal treatment is very effective with studies showing 75% of women no longer having any VMS symptoms, and the remainder seeing a significant improvement in severity and frequency of episodes.
Why is this happening?
Hot flashes and night sweats occur due to body temperature dysfunction caused by changes in gonadal hormones. It is not fully understood how the gonadal hormone changes take place during the phases of menopause but essentially what it means is that your fluctuating hormones cause your “hypothalamus” (the part in your brain that is responsible for regulating temperature), to randomly think your core body temperature has spiked and needs to be cooled down. So it starts the normal processes of signaling your blood vessels to dilate in order to release heat: what will follow is a quick increase in blood flow, most notably to your chest, neck and face, your heart will start pumping faster and of course your sweat glands will open. Final result is that you feel and look like you just finished a (very intense!) work-out.
Key data points
- According to a recent study, 75% of women report experiencing vasomotor symptoms during the peri- and menopause
- A recent analysis of the Study of Women’s Health Across the Nation (SWAN) found that hot flash symptoms typically last between 5 and 13 years and were rated moderate-to-severe by most women.
- A Swedish study discovered that 11% of 38-year-old women were already experiencing hot flashes, while the same study and other studies found that 30 - 42% of women aged between 60- 65 were still getting them.
Other impacted areas
Sudden feelings of excessive heat, day or night, may cause a significant impact on a woman’s ability to continue with her daily activities. Depending on the severity of her condition and a woman’s occupation, symptoms can cause debilitating scenarios. If night sweats are frequent, poor sleep and feelings of excessive daytime fatigue are likely.
A study from 2020 found a strong relationship between vasomotor and mood symptoms in Chinese women progressing from perimenopause through natural menopause.
Diagnosis
Diagnosis of vasomotor symptoms is performed through patient self-reporting. As it is a common symptom for many women during menopause, it is easily diagnosed without the need for an in-person doctor’s visit.
Possible triggers or risk factors
There is a direct correlation between stress levels and the occurrence of vasomotor symptoms, so efforts to treat underlying stress triggers may provide relief. Additionally, factors like smoking, and being overweight are thought to put a woman at greater risk. For some women VMS can be triggered by a long list of external factors, among them caffeine, alcohol, spicy foods, and hot weather.
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Treatments & remedies
The most effective treatment for vasomotor symptoms is Hormone Replacement Therapy (HRT) in the form of Estradiol. For women who are not able to tolerate hormone-based medicine, there are a few other effective alternatives like Paroxetine (SSRI antidepressant). In addition, there are over-the-counter products and holistic measures that may help to reduce the impact and frequency of vasomotor symptoms.
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Nutrition
Although there is no clear agreement regarding the efficacy of diet changes for mitigation of vasomotor symptoms, there is widespread anecdotal and cultural evidence of the following recommended practices:
- Soy (plant estrogen or “phytoestrogen”)
- “Mediterranean diet” (fruits and vegetables, whole grains, seafood, nuts and legumes, olive oil focus)
- Black cohosh
Exercise
Physical activity is not directly related to treatment of hot flashes, however maintaining a healthy weight and cardiovascular system during menopause is vital for a woman.
Mindset
Stress is a known trigger for hot flashes, and finding ways to reduce stress in your life could have a meaningful impact in reducing the impact your VMS have on the quality of your life. A study from 2011 found that Mindfulness-based stress reduction (MBSR) may be clinically significant in reducing the degree of bother that women experience from VMS, and may also significantly improve quality of sleep, anxiety and overall perceived stress.
Supplements
If you look around your local pharmacy or health store, you will likely find many supplements that claim to offer relief from vasomotor symptoms. However, scientific studies testing the efficacy of several herbal and supplemental products indicated there were no notable positive results in terms of reducing or controlling symptoms.
OTC Products
There are a couple of over-the-counter products or do it yourself options available to help manage the VMS and can provide immediate relief:
- Selecting moisture-wicking clothes and dress in layers
- Use of a handheld fan for self-regulated cooling
- Room temperature controls - especially for sleep and work environments
For night sweats:
- use special cooling sheets and/ or sheets made of breathable fabric such as cotton and linen
- provide different bedding for individuals sharing the bed - much easier and quicker to change a single duvet cover than a double!
- Have a hand-held fan next to your bed to help you quickly cool down
- Moisture wicking nightwear can help - sleep in a sports shirt, who cares if it helps!
Prescription
- Paroxetine - an SSRI (selective serotonin reuptake inhibitors) a type of antidepressants can reduce the occurrence of hot flashes and their severity. This low dose SSRI helps by increasing the level of serotonin in your brain, by inhibiting the reuptake of serotonin into your neurons (which is caused by the decline in Estrogen). US Food and Drug Administration (FDA) and the Health Sciences Authority (HSA) in Singapore have both approved the use of paroxetine in treatment of hot flashes but caution regarding side effects and drug combinations.
- Venlafaxine - an SNRI (serotonin norepinephrine reuptake inhibitor) also inhibits the reuptake of serotonin into your neurons and thereby increases serotonin in your brain.
- Escitalopram (SSRI) may be effective in improving the quality of sleep, if night sweats are causing clinical sleep dysfunction.
- Gabapentinoids (antiseizure drugs) and clonidine (high-blood pressure medication) have early research indicating that they may be effective in reducing severity and frequency of VMS, and particularly night sweats
Hormone Treatment
- Estradiol- a type of Hormone Replacement Therapy (HRT) and the most effective treatment for VMS currently available. HRT does exactly as the name indicates; it replenishes (or replaces) the hormones (estrogen and progesterone) that your body is naturally starting to produce less of as you transition into menopause. Studies have shown that HRT eliminates VMS completely for 75% of women that take them, and drastically reduces both the severity and frequency for the remaining 25%. HRT is more frequently prescribed as a woman gets closer to the end of peri-menopause and the beginning of post-menopause.
- Contraceptives - Low dose contraceptives are also prescribed in order to reduce fluctuations in hormone levels due to menopause. While HRT provides a woman with additional hormones, low dose contraceptives suppress current hormone levels and keeps the level consistent.
Holistic Treatment
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FAQ
What are the symptoms of Menopause?
There are roughly 34 symptoms of Menopause with the most commonly experienced being:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Fatigue
- Sleep problems
- Mood changes and irritability
- Weight gain
- Thinning hair and dry skin
Medically reviewed and detailed symptom fact sheets can be found here, and a general overview of what (peri) menopause is and entails can be found here.
What are Vasomotor symptoms?
Medically speaking, vasomotor symptoms are symptoms that occur due to the constriction or dilation of blood vessels. About 80% of women will experiencing Vasomotor symptoms like hot flashes, night sweats and less commonly heart palpitations when going through the Menopause transition. The most likely reason why these symptoms occur during peri and sometimes the first few years of post menopause is that the fluctuations of hormones affect the mechanisms that control temperature control. Read more on that here.
What are hot flashes at night?
Hot flashes occurring at night are called "night sweats" as, you guessed, they have the tendency to leave you, your pajama's and bedding soaked in sweat.
Why are hot flashes worse at night?
Your hormone levels fluctuate throughout the day, but for many women the fluctuations are worse in the evening and at night increasing the severity and/or intensity of hot flashes. Another (contributing) factor is diet related - spicy food and alcohol are both known triggers for hot flashes and are more commonly consumer during and after dinner. Hot flashes at night are called "night sweats" and due to the increased severity and frequency can easily leave your pajamas and bedding soaked in sweat.
Why do hot flashes happen in menopause?
Hot flashes and night sweats occur due to body temperature dysfunction caused by changes in gonadal hormones. It is not fully understood how the gonadal hormone changes take place during the phases of menopause but essentially what it means is that your fluctuating hormones cause your “hypothalamus” (the part in your brain that is responsible for regulating temperature), to randomly think your core body temperature has spiked and needs to be cooled down. So it starts the normal processes of signaling your blood vessels to dilate in order to release heat: what will follow is a quick increase in blood flow, most notably to your chest, neck and face, your heart will start pumping faster and of course your sweat glands will open. Final result is that you feel and look like you just finished a (very intense!) work-out.
What is the difference between hot flashes and hot flushes?
There is not difference between "Hot Flash" and "Hot Flush". Flash seems to be most commonly used in the USA, and Flush is more commonly used int British English.
What causes hot flashes?
Hot flashes and night sweats occur due to body temperature dysfunction caused by changes in gonadal hormones. It is not fully understood how the gonadal hormone changes take place during the phases of menopause but essentially what it means is that your fluctuating hormones cause your “hypothalamus” (the part in your brain that is responsible for regulating temperature), to randomly think your core body temperature has spiked and needs to be cooled down. So it starts the normal processes of signaling your blood vessels to dilate in order to release heat: what will follow is a quick increase in blood flow, most notably to your chest, neck and face, your heart will start pumping faster and of course your sweat glands will open. Final result is that you feel and look like you just finished a (very intense!) work-out.
What are hot flashes in menopause?
During peri-menopause (the phase leading up to menopause), you may feel a sudden and very intense heat. This uncomfortable feeling is known as a hot flash (also known as “hot flush” and “vasomotor symptom”) and it can be accompanied by skin flushing, sweating and a rapid heartbeat. Generally speaking a hot flash will pass within a few minutes. Hot flashes are very common during Menopause with approximately 80% of women experiencing them during their menopause transition.
What is the average age of Menopause?
The average age for menopause in Asian women (including women in Singapore) is 50 - 52. The onset of peri-menopause is usually in a women's mid 40s, with 3.7% of women experiencing it before the age of 30.
What are the symptoms of Menopause?
There are 34 different symptoms associated with the Menopause transition impacting women on a mental, emotional and physical level. Symptoms range from the well known Hot Flashes & Night sweats, to depression, anxiety and a dry itchy skin. For and overview of all symptoms and detailed symptoms fact sheets please click here.
Do men get Menopause?
The short answer is No. “Male Menopause” or “andropause” are terms that are being used by the media, but have no medical basis. Testosterone levels in men do decline as they age, but this is a very gradual process at less than 2% per year starting from their 30s/40s. There is no sudden drop in Testosterone around midlife causing severe symptoms as is the case with Menopause. In many cases the symptoms that are claimed to be part of “male menopause” have nothing to do with (a change in) hormones.
References
Avis, N. E., Coeytaux, R. R., Isom, S., Prevette, K., & Morgan, T. (2016). Acupuncture in Menopause (AIM) study. Menopause, 23(6), 626–637.
Avis NE, Crawford SL, Greendale G, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015;175(4):531–539. doi:10.1001/jamainternmed.2014.8063
Blümel JE, Chedraui P, Baron G, Belzares E, Bencosme A, Calle A, Danckers L, Espinoza MT, Flores D, Gomez G, Hernandez-Bueno JA, Izaguirre H, Leon-Leon P, Lima S, Mezones-Holguin E, Monterrosa A, Mostajo D, Navarro D, Ojeda E, Onatra W, Royer M, Soto E, Tserotas K, Vallejo S; Collaborative Group for Research of the Climacteric in Latin America (REDLINC). A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women. Menopause. 2011 Jul;18(7):778-85. doi: 10.1097/gme.0b013e318207851d. PMID: 21407137.
Deecher, D. C., & Dorries, K. (2007). Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Archives of Women’s Mental Health, 10(6), 247–257.
Ee C, French SD, Xue CC, Pirotta M, Teede H. Acupuncture for menopausal hot flashes: clinical evidence update and its relevance to decision making. Menopause. 2017 Aug;24(8):980-987. doi: 10.1097/GME.0000000000000850. PMID: 28350757.
El Khoudary, S. R., Greendale, G., Crawford, S. L., Avis, N. E., Brooks, M. M., Thurston, R. C., Karvonen-Gutierrez, C., Waetjen, L. E., & Matthews, K. (2019). The menopause transition and women’s health at midlife. Menopause, Publish Ahead of Print, 1213–1227.
Freeman, E. W., & Sammel, M. D. (2016). Anxiety as a risk factor for menopausal hot flashes. Menopause, 23(9), 942–949.
Ferrari, N. (2020, August 19). Menopause-related hot flashes and night sweats can last for years. Harvard Health Blog.
Herber-Gast GC, Mishra GD. Fruit, Mediterranean-style, and high-fat and –sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutrition. 2013 May; 97(5):1092-1099.
Hot flashes - Symptoms and causes. (2020, April 24). Mayo Clinic.
Huizen, J. (2017b, May 20). Uses and side effects of black cohosh for menopause. Medical News Today.
Frequently Asked Questions About Menopause. (2002, October 7). WebMD.
Johnson ED, Carroll DG. Venlafaxine and desvenlafaxine in the management of menopausal hot flashes. Pharm Pract (Granada). 2011;9(3):117-121.
Leon-Ferre, R. A., Novotny, P. J., Wolfe, E. G., Faubion, S. S., Ruddy, K. J., Flora, D., Dakhil, C., Rowland, K. M., Graham, M. L., Le-Lindqwister, N., Smith, T. J., & Loprinzi, C. L. (2019). Oxybutynin vs Placebo for Hot Flashes in Women With or Without Breast Cancer: A Randomized, Double-Blind Clinical Trial (ACCRU SC-1603). JNCI cancer spectrum, 4(1), pkz088
Menopause.org, Burns, D. S., & Carpenter, J. S. (2012). Paced Respiration for Hot Flashes? The Female Patient.
Niazi, A. K., & Niazi, S. K. (2011). Mindfulness-based stress reduction: A non-pharmacological approach for chronic illnesses. North American Journal of Medical Sciences, 3(1), 20.
Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015 Nov;22(11):1155-72; quiz 1173-4. doi: 10.1097/GME.0000000000000546. PMID: 26382310.
Norton, S., Chilcot, J., & Hunter, M. S. (2014). Cognitive-behavior therapy for menopausal symptoms (hot flushes and night sweats). Menopause, 21(6), 574–578.
Pandya, Kishan J et al. “Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial.” Lancet (London, England) vol. 366,9488 (2005): 818-24. doi:10.1016/S0140-6736(05)67215-7
Pickar, J. H., Boucher, M., & Morgenstern, D. (2018). Tissue selective estrogen complex (TSEC): a review. Menopause, 25(9), 1033–1045.
Pragya Gartoulla, Roisin Worsley, Robin J. Bell, Susan R. Davis. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years. Menopause, 2015; 1 DOI: 10.1097/GME.0000000000000383
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Taku, K., Melby, M. K., Kronenberg, F., Kurzer, M. S., & Messina, M. (2012). Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity. Menopause: The Journal of The North American Menopause Society, 19(7), 776–790.
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Treatment & Relief For Menopause & Hot Flashes. (n.d.). Cleveland Clinic. Menopause. (n.d.). PCRM’s Nutrition Guide for Clinicians.
Hot Flashes
During peri-menopause (the phase leading up to menopause), you may feel a sudden and very intense heat. This uncomfortable feeling is known as a hot flash (also known as “hot flush” and “vasomotor symptom”) and it can be accompanied by skin flushing, sweating and a rapid heartbeat. Hot flashes pass within a few minutes and are experienced by approximately 80% of women during their peri-menopause transition. Recent research has found that most women that have vasomotor symptoms, will experience it over the course of roughly 7.5 years. The onset is usually in a woman’s mid forties during peri-menopause and, up to 30% of women may still be experiencing it well into their sixties.
Approximately 80% of women experience hotflashes
If a hot flash occurs at night, it is referred to as a night sweat. You may wake from a deep sleep suddenly, sweating profusely, stuck in a tangled mess of sweaty sheets and feeling disoriented. Not surprisingly night sweats can cause significant sleep disruption.
Together, hot flashes and night sweats are referred to, in medical terms, as vasomotor symptoms. Vasomotor symptoms eventually cease on their own and strictly speaking don’t require any specific treatment. However, given the severe impact on the quality of life it has, most women seek treatment that can help make the symptoms more manageable and improve quality of life. Hormonal treatment is very effective with studies showing 75% of women no longer having any VMS symptoms, and the remainder seeing a significant improvement in severity and frequency of episodes.
Dr. June Tan Sheren
Why this is happening
Hot flashes and night sweats occur due to body temperature dysfunction caused by changes in gonadal hormones. It is not fully understood how the gonadal hormone changes take place during the phases of menopause but essentially what it means is that your fluctuating hormones cause your “hypothalamus” (the part in your brain that is responsible for regulating temperature), to randomly think your core body temperature has spiked and needs to be cooled down. So it starts the normal processes of signaling your blood vessels to dilate in order to release heat: what will follow is a quick increase in blood flow, most notably to your chest, neck and face, your heart will start pumping faster and of course your sweat glands will open. Final result is that you feel and look like you just finished a (very intense!) work-out.
Key data points
- According to a recent study, 75% of women report experiencing vasomotor symptoms during the peri- and menopause
- A recent analysis of the Study of Women’s Health Across the Nation (SWAN) found that hot flash symptoms typically last between 5 and 13 years and were rated moderate-to-severe by most women.
- A Swedish study discovered that 11% of 38-year-old women were already experiencing hot flashes, while the same study and other studies found that 30 - 42% of women aged between 60- 65 were still getting them.
Other impacted areas
Sudden feelings of excessive heat, day or night, may cause a significant impact on a woman’s ability to continue with her daily activities. Depending on the severity of her condition and a woman’s occupation, symptoms can cause debilitating scenarios. If night sweats are frequent, poor sleep and feelings of excessive daytime fatigue are likely.
A study from 2020 found a strong relationship between vasomotor and mood symptoms in Chinese women progressing from perimenopause through natural menopause.
Diagnosis
Diagnosis of vasomotor symptoms is performed through patient self-reporting. As it is a common symptom for many women during menopause, it is easily diagnosed without the need for an in-person doctor’s visit.
Possible triggers or risk factors
There is a direct correlation between stress levels and the occurrence of vasomotor symptoms, so efforts to treat underlying stress triggers may provide relief. Additionally, factors like smoking, and being overweight are thought to put a woman at greater risk. For some women VMS can be triggered by a long list of external factors, among them caffeine, alcohol, spicy foods, and hot weather.
Treatments & Remedies
The most effective treatment for vasomotor symptoms is Hormone Replacement Therapy (HRT) in the form of Estradiol. For women who are not able to tolerate hormone-based medicine, there are a few other effective alternatives like Paroxetine (SSRI antidepressant). In addition, there are over-the-counter products and holistic measures that may help to reduce the impact and frequency of vasomotor symptoms.
Products
If you look around your local pharmacy or health store, you will likely find many supplements that claim to offer relief from vasomotor symptoms. However, scientific studies testing the efficacy of several herbal and supplemental products indicated there were no notable positive results in terms of reducing or controlling symptoms.
There are a couple of over-the-counter products or do it yourself options available to help manage the VMS and can provide immediate relief:
- Selecting moisture-wicking clothes and dress in layers
- Use of a handheld fan for self-regulated cooling
- Room temperature controls - especially for sleep and work environments
For night sweats:
- use special cooling sheets and/ or sheets made of breathable fabric such as cotton and linen
- provide different bedding for individuals sharing the bed - much easier and quicker to change a single duvet cover than a double!
- Have a hand-held fan next to your bed to help you quickly cool down
- Moisture wicking nightwear can help - sleep in a sports shirt, who cares if it helps!
- Paroxetine - an SSRI (selective serotonin reuptake inhibitors) a type of antidepressants can reduce the occurrence of hot flashes and their severity. This low dose SSRI helps by increasing the level of serotonin in your brain, by inhibiting the reuptake of serotonin into your neurons (which is caused by the decline in Estrogen). US Food and Drug Administration (FDA) and the Health Sciences Authority (HSA) in Singapore have both approved the use of paroxetine in treatment of hot flashes but caution regarding side effects and drug combinations.
- Venlafaxine - an SNRI (serotonin norepinephrine reuptake inhibitor) also inhibits the reuptake of serotonin into your neurons and thereby increases serotonin in your brain.
- Escitalopram (SSRI) may be effective in improving the quality of sleep, if night sweats are causing clinical sleep dysfunction.
- Gabapentinoids (antiseizure drugs) and clonidine (high-blood pressure medication) have early research indicating that they may be effective in reducing severity and frequency of VMS, and particularly night sweats
Lifestyle
Although there is no clear agreement regarding the efficacy of diet changes for mitigation of vasomotor symptoms, there is widespread anecdotal and cultural evidence of the following recommended practices:
- Soy (plant estrogen or “phytoestrogen”)
- “Mediterranean diet” (fruits and vegetables, whole grains, seafood, nuts and legumes, olive oil focus)
- Black cohosh
Physical activity is not directly related to treatment of hot flashes, however maintaining a healthy weight and cardiovascular system during menopause is vital for a woman.
Stress is a known trigger for hot flashes, and finding ways to reduce stress in your life could have a meaningful impact in reducing the impact your VMS have on the quality of your life. A study from 2011 found that Mindfulness-based stress reduction (MBSR) may be clinically significant in reducing the degree of bother that women experience from VMS, and may also significantly improve quality of sleep, anxiety and overall perceived stress.
Holistic
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