Hot flashes: Potential Causes and Treatments

Introduction

Hot flashes are a common symptom in many people, particularly in women during menopause. Hot flashes are a sudden sensation of intense heat, flushing, and sweating.

Hot flashes affect up to 80% of women during menopause [6, 7]. While the exact causes of hot flashes are not fully understood, they are thought to be caused by hormonal changes, particularly the decline in estrogen levels that happens during the menopausal transition [6, 8]. However, other factors, such as stress, certain medications, and lifestyle habits, can also contribute to hot flashes and their severity [9-12].

Hot flashes look different from person to person, with some reporting mild and infrequent episodes, while others may suffer from severe and frequent hot flashes that disrupt daily activities and sleep [13, 14].

In this article, we will delve into the various aspects of hot flashes, providing a full understanding of this common symptom. We will explore the potential causes, the range of symptoms and characteristics, and the available treatments and management strategies. Additionally, we will discuss the factors that may influence the severity and frequency of hot flashes.

What Are Hot Flashes?

Hot flashes are a sudden feeling of intense body heat, often with flushing of the face and neck, and sometimes sweating [24]. They are caused by the body's response to fluctuating hormone levels [24].

Hot flashes may involve the hypothalamus, a region of the brain responsible for regulating body temperature [6]. During a hot flash, the hypothalamus mistakenly senses that the body is overheating, triggering physiological responses designed to cool the body down [6]. These responses include dilation of blood vessels near the skin's surface, leading to flushing and the sensation of heat. It also causes increased heart rate and sweating [6].

Hot flashes vary in intensity and duration, lasting from a few seconds to several minutes, and can happen multiple times a day [24]. Some women may experience them infrequently, while others may have several episodes per hour [24]. The experience of hot flashes is personal, with some women getting mild discomfort and others describing them as debilitating and disruptive to daily life [13, 14].

In addition to the physical sensations, hot flashes can also go hand in hand with emotional and psychological symptoms, such as anxiety, irritability, and difficulty concentrating [9, 11].

Potential Causes of Hot Flashes

Multiple factors can cause hot flashes, with hormonal changes being the main cause. Other contributing factors include stress, certain medications, lifestyle factors, underlying medical conditions, and changed neurokinin-3 receptor signaling.

Hormonal Changes

The main cause of hot flashes is the fluctuation and decline in estrogen levels that happen during the menopausal transition [6, 7]. As women approach menopause, their ovaries produce less estrogen, leading to an imbalance in the body's temperature regulation system [6]. This can cause the blood vessels to dilate, leading to a sudden increase in blood flow and the sensation of intense body heat [6].

Stress and Anxiety

Stress and anxiety can also cause hot flashes [9, 11]. When the body is under stress, it can trigger the release of hormones like adrenaline and cortisol, which can affect the body's temperature regulation [9, 11].

Certain Medications

Some medications, such as certain antidepressants, blood pressure medications, and cancer treatments, can also cause hot flashes as a side effect [12, 13]. It is believed that these medications can interfere with the body's temperature regulation [12, 13].

Lifestyle Factors

Certain lifestyle factors, such as diet, alcohol consumption, and smoking, can lead to an increased risk of hot flashes [15, 16]. For example, consuming spicy foods, alcohol, or caffeine can potentially trigger hot flashes [15, 16].

Underlying Medical Conditions

In some cases, hot flashes may be a symptom of an underlying medical condition, such as thyroid disorders, diabetes, or certain types of cancer [17, 18]. These conditions can affect the body's hormone levels and temperature regulation [17, 18].

Symptoms and Characteristics of Hot Flashes

Hot flashes cause a sudden, intense sensation of body heat, often with flushing, sweating, and rapid heartbeat. They can vary in intensity and frequency, impacting quality of life during the menopausal transition.

Key Symptoms

• Sudden, intense feeling of body heat
• Flushing and reddening of skin, especially face and neck
• Sweating as the body attempts to cool down
• Rapid heartbeat or palpitations [24, 25, 26]

Duration and Frequency

Hot flashes can last from seconds to minutes and occur multiple times daily for some people [24]. The frequency and duration of hot flashes can vary among women, with some experiencing them now and then, and others having several episodes per hour [24, 30].

Triggers

Potential triggers of hot flashes include stress, anxiety, certain foods/beverages (e.g., caffeine, alcohol), temperature changes, and hormonal ups and downs [9, 11, 15, 16]. Identifying and avoiding your triggers can help manage hot flashes.

Personal Experiences

Hot flashes can vary significantly in how severe they are and how much they disrupt your daily life [13, 14, 35]. Some women may report mild discomfort, while others describe hot flashes as debilitating and disruptive to their quality of life [13, 14, 35].

Weight Gain Association

Having more frequent hot flashes over time has been associated with an increase in weight, body mass index, and waist circumference. However, it is not clear whether the hot flashes cause these symptoms. [29, 34].

Treatments and Management Strategies for Hot Flashes

Managing hot flashes can be difficult, but there are many treatments and management strategies to get relief. These include hormone therapy, non-hormonal medications, lifestyle changes, and certain therapies.

Hormone Therapy

One of the most effective treatments for hot flashes is hormone therapy, which uses estrogen, either alone or in combination with progesterone [24]. Estrogen therapy can be highly effective in lowering the frequency and severity of hot flashes in menopausal women [24].

Non-Hormonal Medications

For people who are unable or unwilling to use hormone therapy, there are non-hormonal medications that may be effective in managing hot flashes [1, 2]. These include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, and clonidine [1, 2].

A recent review found that fezolinetant, a neurokinin 3 receptor antagonist, was more effective than placebo and other non-hormonal therapies in lowering the frequency of moderate to severe vasomotor symptoms [31]. Fezolinetant works by targeting the neurokinin 3 receptor, which helps regulate body temperature and hot flashes [31].

Lifestyle Changes

Lifestyle changes can also be helpful in managing hot flashes [24, 25, 26]. These include avoiding triggers, stress management, dietary changes, and cooling techniques [24, 25, 26].

Complementary and Alternative Therapies

Many complementary and alternative therapies may be used to manage hot flashes, including acupuncture and herbal supplements [5, 32]. A recent review found that acupuncture may be effective in reducing the frequency and severity of hot flashes, with similar results to some non-hormonal medications [32].

Racial and Ethnic Differences

A large study found that women of certain racial and ethnic groups, such as Black, Hispanic, Indigenous, and those with multiple ethnicities, reported more severe menopausal symptoms compared to white women. These differences remained even after accounting for socioeconomic status [27]. Healthcare providers should be aware of these differences and personalize treatment.

Severity and Frequency of Hot Flashes

How severe and frequent hot flashes are depends on many factors, including hormonal changes, genetic predisposition, body mass index, lifestyle factors, underlying medical conditions, age, discrimination, stress, dietary factors, and the gut microbiome.

• Hormonal Changes: The main cause of hot flashes is the fluctuation and decline in estrogen levels during the menopausal transition [6, 7].

• Genetic Factors: Certain genetic variants are linked to an increased risk of more severe and frequent hot flashes [33].

• Body Mass Index (BMI): Women with a higher BMI are more likely to experience more severe and frequent hot flashes [34].

• Lifestyle Factors: Smoking, alcohol consumption, and stress have been linked to an increased risk of more severe and frequent hot flashes [9, 11, 15, 16].

• Underlying Medical Conditions: Conditions like thyroid disorders, diabetes, and cardiovascular disease have been associated with an increased risk of more severe and frequent hot flashes [17, 18, 36].
  
• Age and Menopause: Hot flashes are typically more common and severe during the perimenopause and early postmenopause stages [30, 37].

• Discrimination and Stress: Chronic exposure to discrimination and high levels of stress can make hot flash symptoms worse [27, 38].

• Dietary Factors: A diet high in advanced glycation end-products (AGEs) and low in certain nutrients (e.g., vitamin B6) may cause more severe hot flashes [39].

Conclusion

There are many possible causes of hot flashes, with hormonal changes being the main cause [6, 7]. Other contributing factors include stress, certain medications, lifestyle factors, underlying medical conditions, and changed neurokinin-3 receptor signaling [9-12, 21-23].

The symptoms and characteristics of hot flashes can look different in everyone, with some reporting mild and infrequent episodes, while others may suffer from severe and frequent hot flashes that disrupt daily activities and sleep [13, 14, 24-26]. Recent research has also shown ethnic differences, brain activity patterns, weight gain associations, and the role of discrimination in hot flashes [27-29, 38].

Hot flashes are best helped using a combination of treatments, including hormone therapy, non-hormonal medications, lifestyle changes, and complementary therapies [1, 2, 5, 24-26, 31, 32]. Treatment should be personal to the person’s preferences, medical history, and overall health status. Healthcare providers should be aware of potential racial and ethnic disparities in the severity of menopausal symptoms [27].

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Citations:

1. Iyer TK, Fiffick AN, Batur P. Nonhormone therapies for vasomotor symptom management.

2. Javernick JA. A Novel Nonhormonal Treatment for Vasomotor Symptoms of Menopause.

3. Kapoor E, Faubion SS, Kuhle CL, Kling JM, Miller VM, Fokken S, Mara KC, Moyer AM. The effect of genetic variation in estrogen transportation and metabolism on the severity of menopause symptoms: A study from the RIGHT 10K cohort.

4. Rojas K, Spring LM, O'Riordan L, Weiss A. Endocrine Therapy for Surgeons: Practical Pearls for Managing Menopausal, Bone Loss and Sexual Adverse Effects.

5. Ryoichi S, Lillian Nohara M, Bing-Syuan Z, Keng-Hsu C, Bing-Yan Z, Hung-Yu W, Che-Sheng C, Brendon S, Kuan-Pin S, Yu-Kang T, Yi-Cheng W, Pao-Yen L, Tien-Yu C, Yen-Wen C, Mein-Woei S, Malcolm H, Wei-Cheng Y, Cheuk-Kwan S, Yu-Shian C, Yow-Ling S, Chao-Ming H, Yutaka J M, Ping-Tao T. Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis.

6. Freedman, R. R. (2014). Menopausal hot flashes: Mechanisms, endocrinology, treatment. The Journal of Steroid Biochemistry and Molecular Biology, 142, 115-120.

7. Kronenberg, F. (1990). Hot flashes: epidemiology and physiology. Annals of the New York Academy of Sciences, 592(1), 52-86.

8. Sievert, L. L. (2013). Menopause: a biocultural perspective. Annual Review of Anthropology, 42, 451-471.

9. Thurston, R. C., Blumenthal, J. A., Babyak, M. A., & Sherwood, A. (2005). Emotional antecedents of hot flashes during daily life. Psychosomatic Medicine, 67(1), 137-146.

10. Otte, J. L., Rand, K. L., Landis, C. A., Paudel, M. L., & Newhouse, P. A. (2016). Confirmatory factor analysis of the Hot Flash-Related Daily Interference Scale. Menopause, 23(8), 901-906.

11. Burleson, M. H., Todd, M., & Trevathan, W. R. (2010). Daily vasomotor symptoms, sleep problems, and mood: using daily data to evaluate the domino hypothesis in middle-aged women. Menopause, 17(1), 87-95.

12. Joffe, H., Soares, C. N., Petrillo, L. F., Viguera, A. C., Somley, B. L., Koch, J. L., ... & Cohen, L. S. (2007). Treatment of depression and menopause-related symptoms with the serotonin-norepinephrine reuptake inhibitor duloxetine. The Journal of Clinical Psychiatry, 68(6), 943-950.

13. Shanafelt, T. D., Barton, D. L., Adjei, A. A., & Loprinzi, C. L. (2002). Pathophysiology and treatment of hot flashes. Mayo Clinic Proceedings, 77(11), 1207-1218.

14. Carpenter, J. S., Andrykowski, M. A., Cordova, M., Cunningham, L., Studts, J., McGrath, P., ... & Sloan, D. (1998). Hot flashes in postmenopausal women treated for breast carcinoma: prevalence, severity, correlates, management, and relation to quality of life. Cancer, 82(9), 1682-1691.

15. Whiteman, M. K., Staropoli, C. A., Langenberg, P. W., McCarter, R. J., Kjerulff, K. H., & Flaws, J. A. (2003). Smoking, body mass, and hot flashes in midlife women. Obstetrics & Gynecology, 101(2), 264-272.

16. Schilling, C., Gallicchio, L., Miller, S. R., Langenberg, P., Zacur, H., & Flaws, J. A. (2007). Relation of body mass and sex steroid hormone levels to hot flashes in a sample of mid-life women. Climacteric, 10(1), 27-37.

17. Deecher, D. C., & Dorries, K. (2007). Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) in menopausal women. Menopause, 14(2), 1-16.

18. Guttmann-Bauman, I. (2000). Metabolic control and quality-of-life changes in diabetes mellitus. Endocrine Practice, 6(2), 143-149.

19. Rosner, W., Auchus, R. J., Azziz, R., Sluss, P. M., & Raff, H. (2007). Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. The Journal of Clinical Endocrinology & Metabolism, 92(2), 405-413.

20. Baber, R. J., Panay, N., Fenton, A., & IMS Writing Group. (2016). 2016 IMS Recommendations on women's midlife health and menopause hormone therapy. Climacteric, 19(2), 109-150.

21. Rance, N. E., Dacks, P. A., Mittelman-Smith, M. A., Romanovsky, A. A., & Krajewski-Hall, S. J. (2013). Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: a novel hypothesis on the mechanism of hot flushes. Frontiers in Neuroendocrinology, 34(3), 211-227.

22. Jayasena, C. N., Comninos, A. N., Stefanopoulou, E., Buckley, A., Narayanaswamy, S., Izzi-Engbeaya, C., ... & Bloom, S. R. (2015). Neurokinin B administration induces hot flushes in women. Scientific Reports, 5(1), 1-8.

23. Prague, J. K., Roberts, R. E., Comninos, A. N., Clarke, S., Jayasena, C. N., Nash, Z., ... & Dhillo, W. S. (2017). Neurokinin 3 receptor antagonism as a novel treatment for menopausal hot flushes: a phase 2, randomised, double-blind, placebo-controlled trial. The Lancet, 389(10081), 1809-1820.

24. The North American Menopause Society. (2015). Menopause Practice: A Clinician's Guide (5th ed.). Mayfield Heights, OH: The North American Menopause Society.

25. National Institutes of Health. (2019). Hot Flashes: What Can I Do? Retrieved from https://www.nih.gov/health-information/hot-flashes-what-can-i-do

26. Mayo Clinic. (2020). Hot flashes. Retrieved from https://www.mayoclinic.org/diseases-conditions/hot-flashes/symptoms-causes/syc-20352790

27. Reeves, A. N., Lewis, T. T., Hood, M. M., Thurston, R. C., Avis, N. E., Burnett-Bowie, S. M., ... & Harlow, S. D. (2022). Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN). Menopause, 29(6), 667-675.

28. Nakamura, K., Hoshi, H., Kobayashi, M., Fukasawa, K., Ichikawa, S., & Shigihara, Y. (2022). Dorsal brain activity reflects the severity of menopausal symptoms. Neuropsychobiology, 81(1), 72-80.

29. Gibson, C. J., Shiozawa, A., Epstein, A. J., Han, W., & Mancuso, S. (2023). Association between vasomotor symptom frequency and weight gain in the Study of Women's Health Across the Nation. Menopause, 30(2), 123-130.

30. Avis, N. E., Crawford, S. L., Greendale, G., Bromberger, J. T., Everson-Rose, S. A., Gold, E. B., ... & Study of Women's Health Across the Nation. (2001). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine, 161(3), 531-540.

31. Jacobson, D. E., Boulay, A., Rosen, J., Jia, X. D., Pickar, J. H., Palacios, S., ... & Maki, P. M. (2022). Fezolinetant for the treatment of vasomotor symptoms associated with menopause: a systematic review and meta-analysis. Menopause, 29(9), 1022-1030.

32. Chiu, H. Y., Pan, C. H., Shyu, Y. K., Han, B. C., & Tsai, P. S. (2015). Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause, 22(2), 234-244.

33. Ayers, K. L., Cordell, H. J., Lansdell, B., Malik, N., Hurst, J. R., Hall, I. P., & Sayers, I. (2019). Genetic variation in POMC and AGRP in relation to hot flashes and night sweats in women with breast cancer. Menopause, 26(3), 259-266.

34. Thurston, R. C., Sowers, M. R., Chang, Y., Sternfeld, B., Gold, E. B., Johnston, J. M., & Matthews, K. A. (2008). Adiposity and reporting of vasomotor symptoms among midlife women: the study of women's health across the nation. American Journal of Epidemiology, 167(1), 78-85.

35. Thurston, R. C., Bromberger, J. T., Joffe, H., Avis, N. E., Hess, R., Crandall, C. J., ... & Matthews, K. A. (2008). Beyond frequency: who is most bothered by vasomotor symptoms?. Menopause, 15(5), 841-847.

36. Basu, R., Dodge, R., Stohrer, J. M., & Karavite, D. J. (2001). Factors associated with the use of complementary and alternative medicine by people with type 2 diabetes. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(7), M417-M422.

37. Freeman, E. W., Sammel, M. D., Lin, H., & Gracia, C. R. (2011). Temporal trends in menopausal hot flashes and their relationship to endogenous reproductive hormones. The Journal of Clinical Endocrinology & Metabolism, 96(10), 3093-3099.

38. Reeves, A. N., Lewis, T. T., Hood, M. M., Thurston, R. C., Avis, N. E., Burnett-Bowie, S. M., Cortés, Y. I., Neal-Perry, G., & Harlow, S. D. (2019). Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN). Menopause, 26(6), 613-621.

39. Kahleova, H., Znayenko-Miller, T., Uribarri, J., Schmidt, N., Kolipaka, S., Hata, E., ... & Barnard, N. (2023). Dietary advanced glycation end-products and postmenopausal hot flashes: A post-hoc analysis of a 12-week randomized clinical trial. Menopause, 30(4), 385-392.

40. Kahleova, H., Holtz, D. N., Strom, N., La Reau, A., Kolipaka, S., Schmidt, N., ... & Barnard, N. D. (2023). A dietary intervention for postmenopausal hot flashes: A potential role of gut microbiome. An exploratory analysis. Menopause, 30(4), 376-384.