What are hot flashes?
Hot flashes are transient sensations of heat, sweating, flushing, anxiety and chills that present themselves in menopausal women. These usually last from one minute to five minutes due to abnormal thermoregulation by a part of the brain called the Hypothalamus, thus causing small elevations in core temperature to lead to a dilatation of blood vessels.1
Causes of hot flashes
Hot flashes are believed to be caused by low level oestrogen as a contributory factor among other triggers. Hot flashes are treated by oestrogen correction which supports that the cause of hot flashes is associated with reduced oestrogen despite no correlation of oestrogen levels in plasma and urine to symptoms.
Oestrogen stimulates the production of serotonin, which in turn acts on increasing norepinephrine, a hormone which affects the hypothalamic thermostat.
The risk factors of hot flashes are age, race and ethnicity, educational level, smoking, cardiovascular risk (including body mass index), and genetics. Obesity, lower economic status and the presence of premenstrual syndrome also account for some risk factors of hot flashes.
Although people assigned female at birth (AFAB)suffer more from hot flashes in mid life than those assigned male at birth (AMAB), both are affected by hot flashes due to hormonal changes that come with ageing. African Americans exhibit a higher occurrence rate compared to Caucasians.
Signs and symptoms of hot flashes
Hot flashes occur as a sudden unexpected sensation of intense heat around the face and upper chest rapidly travelling through the entire body. This sensation lasts from 2 to 4 min and is coupled with profuse sweating, chills, palpitation, and anxiety. The occurrence frequency ranges from sporadic incidents per week to one or two times per hour.
Heat flashes are also known as night sweats which can alter mood and are associated with sleep disturbances, interference in activities of daily living by impacting concentration which reduces the quality of life.
Management and treatment for hot flashes
The management of hot flashes usually involves various combinations of cognitive behavioural therapy (CBT), relaxation therapy, meditation, aromatherapy and the use of acupunture and vitamin supplementation.2
The severity and frequency of the hot flashes is also assessed in order to determine how to manage it. For mild hot flashes, lifestyle practices can be modified by use of fans, avoiding triggers such as spice, caffeine and taking low dose vitamin E.
For severe episodes, hormone replacement therapy (HRT) is the recommended first line therapy. It is given singly as oestrogen if a hysterectomy (removal of the uterus) has been performed or in combination with progestin, another hormone. The HRT benefits numerous symptoms of menopause apart from heat flashes.3
In individuals who do not tolerate HRT well, non-hormonal treatment is available in the form of selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs).
Are hot flashes fatal?
Despite hot flashes reducing the quality of life, they are not fatal. There are many options that can be tried to alleviate the symptoms.
Are hot flashes common?
Hot flashes are very common in the menopausal age group as well as in people who have cancer.4
Can hot flashes be prevented?
Hot flashes can be prevented by keeping fit through exercise, walking or swimming daily. Deep breathing techniques such as yoga and meditation can limit the episodes of hot flashes. Identifying and avoiding any triggers is also important. Hydration and keeping cool also helps to balance the body’s core body temperature.
When should I call a doctor
You should call the doctor when the hot flashes are accompanied with other symptoms, such as chest heaviness, shortness of breath and chest tightness, as this might be due to another underlying condition.
The reason for hot flashes is based on hormonal reduction and chemical reactions that occur as the body ages. There are other conditions that can alter how the hypothalamic thermostat functions resulting in similar symptoms. If the symptoms reduce the individual's quality of life, one should consult a health professional. There are many treatment plans that can be established through modification of lifestyle for minor cases to hormonal therapy for severe cases.
- 0Bansal R, Aggarwal N. Menopausal Hot Flashes: A Concise Review. J Midlife Health. 2019 Jan-Mar;10(1):6-13. doi: 10.4103/jmh.JMH_7_19. PMID: 31001050; PMCID: PMC6459071. Available from: https://pubmed.ncbi.nlm.nih.gov/31001050/
- Johnson A, Roberts L, Elkins G. Complementary and Alternative Medicine for Menopause. J Evid Based Integr Med. 2019 Jan-Dec;24:2515690X19829380. doi: 10.1177/2515690X19829380. PMID: 30868921; PMCID: PMC6419242. Available from: https://pubmed.ncbi.nlm.nih.gov/30868921/
- Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 2014 Jul;142:115-20. doi: 10.1016/j.jsb.mb.2013.08.010. Epub 2013 Sep 4. PMID: 24012626; PMCID: PMC4612529. Available from: https://pubmed.ncbi.nlm.nih.gov/24012626/
- 4. Fisher WI, Johnson AK, Elkins GR, Otte JL, Burns DS, Yu M, Carpenter JS. Risk factors, pathophysiology, and treatment of hot flashes in cancer. CA Cancer J Clin. 2013 May;63(3):167-92. doi: 10.3322/caac.21171. Epub 2013 Jan 25. PMID: 23355109; PMCID: PMC3640615. Available from: https://pubmed.ncbi.nlm.nih.gov/23355109/