Understanding Hot Flashes Caused by Hormonal Changes During Perimenopause
Written by Rania Jaber, MPH, MSc in Global Health
Are you at the natural stage of entering perimenopause? Have you started experiencing sudden waves of heat that leave you flushed, sweaty, or uncomfortable? Do you wake up during the night feeling hot and drenched in sweat? If so, you are not alone.
Hot flashes are among the most common symptoms of menopause. Approximately three out of four women experience them in the years leading up to menopause, known as perimenopause. While hot flashes are a normal part of the menopausal transition, their frequency and severity vary widely from one woman to another. Some women experience only occasional mild episodes, while others find that hot flashes interfere with sleep, daily activities, and overall quality of life.
Although hot flashes are common, they do not have to be something you simply endure. Understanding why they happen, what triggers them, and which treatment options are available can help you manage your symptoms more effectively.
This article explains what hot flashes are, their causes, common triggers, risk factors, and how to relieve these symptoms with lifestyle changes or available treatments.
This information is intended for educational purposes only and should not replace professional medical advice.
What Are Hot Flashes?
Hot flashes are sudden feelings of intense heat that usually affect the face, neck, chest, and upper body. They may be accompanied by:
Sweating.
Chills after the episode passes.
Flushed or reddened skin.
Cool, damp skin.
A rapid heartbeat.
Feelings of unease and anxiety.
Most hot flashes last between one and five minutes, although the duration and intensity can vary. The medical term for hot flashes is vasomotor symptoms, which refers to changes in blood vessel function that affect body temperature regulation
While some women experience brief, mild hot flashes, others may struggle with severe symptoms that interfere with their daily lives.
When Do Hot Flashes Usually Start?
Hot flashes commonly begin during perimenopause, the transition leading up to menopause. Perimenopause often starts in the age of 40s or early 50s, although some women experience symptoms earlier or later. As menopause approaches, menstrual periods become irregular until they eventually stop completely. Hot flashes may begin several years before menopause and can continue afterward.
How Often Do Hot Flashes Occur, and How Long Do They Last?
The frequency of hot flashes varies from one woman to another. Some women experience several episodes each day, while others may have only a few each week. Each episode can last anywhere from 30 seconds to 10 minutes, mostly lasting around five minutes. Most women who have hot flashes have them daily.
There is no rule for how long you will have hot flashes. Researchers once believed that they typically last between 6 months and two years. However, newer studies suggest they may continue for seven years or longer, with some women experiencing symptoms for more than a decade.
On average, women experience hot flashes for approximately seven years. Some continue to have them well into their 60s and 70s, although symptoms usually become less frequent over time.
Risk Factors
Multiple factors may increase the risk of experiencing hot flashes, including:
Smoking tobacco.
Obesity or excess body weight.
Family history.
Certain ethnic backgrounds, with some studies finding that black women report more frequent and longer-lasting hot flashes, while Asian women report lower rates.
Individual experience may vary significantly regardless of risk factors.
How Does Menopause Cause Hot Flashes?
The exact causes of hot flashes are not fully clear. However, researchers suggest that hormonal changes that occur before, during, and after menopause play a central role.
Researchers have long observed the effect of female hormones on body temperature. For example, during a normal menstrual cycle, body temperature fluctuates slightly in response to changing estrogen and progesterone levels. During menopause, levels of estrogen and progesterone decrease. These hormonal changes affect the hypothalamus, the part of the brain responsible for regulating body temperature.
When estrogen levels decline, the hypothalamus becomes more sensitive to even a small increase in body temperature. As a result, it may trigger a cooling response, such as:
Widening of blood vessels near the skin.
Increased blood flow to the skin.
Sweating.
A sensation of intense heat.
Rarely, other causes besides menopause cause hot flashes and night sweats, such as medication side effects, thyroid gland problems, some cancers, and side effects of cancer treatment
Common Triggers of Hot Flashes
A trigger can set off or worsen a hot flash. Common triggers include:
Warm environments or hot weather.
Overheating from heavy clothing.
Consuming alcohol or caffeinated drinks.
Eating spicy food.
Drinking hot drinks.
Feeling stressed.
Taking hot showers or baths.
Smoking cigarettes.
A diet high in added sugar.
Identifying and avoiding your triggers may help reduce the frequency and intensity of hot flashes.
Possible Complications of Hot Flashes
Hot flashes are not usually harmful, but they can affect quality of life. Potential complications include:
Poor sleep due to recurrent night sweats.
Daytime fatigue.
Difficulty concentrating.
Mood changes.
Reduced quality of life.
Some studies have found an association between frequent or severe hot flashes and an increased risk of cardiovascular disease and bone loss, although more research is going on to understand this relationship.
Lifestyle Changes to Relieve Hot Flashes
Keep yourself cool
Dress in layers that can be removed easily.
Wear loose-fitting cotton clothing and pyjamas.
Carry a portable fan.
Sip ice water when the hot flash hits.
Lower indoor room temperature.
Change your bed sheets to lighter fabrics.
Avoid taking very hot baths or showers.
Avoid common triggers
Limit the consumption of coffee and alcohol.
Review your medications with your healthcare provider, as certain medications, such as high blood pressure and cholesterol medications, may influence hot flashes.
Avoid smoking.
Learn which foods or situations trigger your symptoms.
Healthy lifestyle habits
Manage stress.
Practice relaxation techniques and deep breathing exercises.
Exercise regularly.
Healthy diet.
Maintain a healthy weight.
Prioritize quality sleep.
How Can Food Help Manage Hot Flashes
What you eat may influence the frequency and severity of hot flashes. Foods that may help:
Mediterranean diet
The Mediterranean diet emphasizes fruits and vegetables, whole grains, nuts, olive oil, and healthy fats. Research suggests that women who follow this eating pattern may be less likely to experience hot flashes and night sweats.
Soy-based products
Soy contains compounds called phytoestrogens, which may mimic the effect of estrogen in the body. Soy- based products that may help with hot flashes: Tofu, edamame, soy milk, and tempeh.
Other phytoestrogen-rich foods
Whole grains such as oats, barley, and wheat.
Seeds like flaxseeds and sesame seeds.
Legumes such as lentils and other beans.
Various berries, such as strawberries, blueberries, and blackberries.
Vegetables
Eating a variety of vegetables can support weight management, which may help reduce hot flashes.
Omega-3-rich foods
Foods rich in omega-3 fatty acids may support overall health and help relieve menopausal symptoms. Examples include:
Salmon, herring, and other fish.
Flaxseeds.
Chia seeds.
Avocados.
Cooling foods
Some women find that some kinds of fruits and vegetables, mainly the ones with a higher water content, may help them cool down. Examples include:
Apples.
Bananas.
Cucumber.
Carrots.
Lettuce.
Pears.
Watermelon.
Food That May Worsen Hot Flashes
Ultra-processed foods may contribute to health problems such as elevated blood pressure, which can worsen hot flashes in some women.
Examples of processed foods include:
Fast food.
Sugary drinks.
Baked goods.
Fried foods.
Caffeinated drinks.
Alcohol.
Spicy food.
Commercial baked goods.
When Should You See a Healthcare Provider?
Try lifestyle changes that may help relieve symptoms first, but you should consult your healthcare provider if your hot flashes:
Are severe or frequent.
Interfere with your sleep.
Affect your daily activities.
Are accompanied by other symptoms such as shortness of breath or tightness of the chest.
Occurs suddenly after years without symptoms after menopause.
Treatment Options for Hot Flashes
If you are experiencing hot flashes that are affecting your quality of life, your healthcare provider can provide treatments. Treatment options include:
Prescription medications
Hormone replacement therapies, which help relieve menopausal symptoms by compensating for hormones that decline during menopause.
Non-hormonal prescription medication. While they are not made for the treatment of hot flashes, these medications can relieve the symptoms. For example, some kinds of antidepressants, such as Fluoxetine (Prozac), and other medications prescribed specifically for vasomotor symptoms.
There are newly approved medications to treat hot flashes: fezolinetant (Veozah) and enlinzanetant (Lynkuet) that act on brain receptors involved in temperature regulation. These are FDA-approved to treat moderate to severe hot flashes.
Non-prescription over-the-counter therapies
Some women choose complementary or alternative therapies, although evidence supporting their effectiveness remains limited.
Examples of these therapies include:
Evening primrose oil.
Black cohosh.
Soy (plant estrogen) supplements.
Acupuncture.
Vitamin E.
It's advised to consult your healthcare provider before starting supplements or herbal therapies, as they may interact with other medications or may not be for everyone.
Can Hot Flashes Be Prevented?
Hot flashes can't be prevented, but identifying personal triggers and maintaining healthy lifestyle habits may help reduce their frequency and severity.
Final Thoughts
Hot flashes are a common symptom of hormonal changes that occur during perimenopause and menopause. While they can be uncomfortable and disruptive, understanding their causes and triggers can help you take steps to manage them more effectively.
Simple lifestyle changes, such as staying cool, exercising regularly, maintaining a healthy weight, managing stress, and avoiding personal triggers, may help reduce the frequency and intensity of symptoms. Medical treatments are available for women who have severe hot flashes that significantly affect their sleep, daily activities, and overall quality of life. These treatments include hormonal and non-hormonal options.
Every woman's experience with perimenopause and menopause is unique. With the right information, support, and treatment plan, hot flashes can often be managed successfully, helping you navigate this stage of life with greater comfort and confidence.
Sources
Cleveland Clinic. Hot Flashes.
ScienceDirect. Sex hormone effects on autonomic mechanisms of thermoregulation in humans.
BodyLogicMD. The Role Of Estrogen in Hot Flashes in
Cleveland Clinic. Does Having Hot Flashes Mean I’ve Started Menopause?
Modern Menopause. Difference Between Menopause and Perimenopause: What You Need to Know
Everyday Health.Perimenopause and Menopause: What’s the Difference?
Harvard Health Publishing. Perimenopause: Rocky road to menopause
JOHNS HOPKINS MEDICINE.Managing Hot Flashes: Tips from a Menopause Expert
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Memorial Sloan Kettering Cancer Center. Managing Your Hot Flashes Without Hormones
