Hot Flushes: Navigating the Heat During Menopause


Menopause is a milestone in a woman’s life, signifying the end of your reproductive years. Along with this transition comes a variety of physical and emotional changes, one of the most notable are vasomotor symptoms, also called hot flashes or night sweats. Let’s explore what hot flushes are, and delve into the why of this symptom.

What are Hot Flushes?

They appear as sudden-onset, spontaneous, and episodic sensations of warmth usually felt on the chest, neck, and face immediately followed by an outbreak of sweating. But they can also manifest as a similar sensation of warmth at night, that causes you to wake up or make it difficult to fall asleep.

They are the most common reason women seek medical care during the perimenopausal period, especially if the symptoms impair quality of life. Almost 50 to 85% of women older than 45 years are affected by them. The mean increment in core body and skin temperature is 0.5°C and 0.25 – 3°C during a regular hot flush attack.

The duration and intensity can vary, but these episodes can be quite discomforting and disruptive to your daily life.

Why does Menopause bring on hot flushes? 

Hot flushes and night sweats occur due to the fluctuation and eventual decline of estrogen levels, a key female hormone. Estrogen plays a crucial role in the body, and many organs do have estrogen receptors. This decline in female hormones is due to the lack of production in the ovaries which then disrupts the regulation of the body’s temperature.

What does Science say about the causes of Hot Flushes?

The physiological mechanisms (what happens in the body) that trigger hot flushes are complex.  Research suggests that hot flushes are caused by a series of events that are triggered by the lack of estrogen production which leads to a disruption in the regulation of the body’s temperature at the level of the nervous system.

1. Estrogen fluctuation is the first Domino: 

What researchers are thinking is that ovarian estrogen withdrawal is the initial mechanism leading to hot flashes. As mentioned before, in Menopause there is a lack of production of this hormone by the ovaries which leads to a landslide of symptoms. Many organs in our body have estrogen receptors, and that is the reason that menopause can bring on a myriad of symptoms, in addition to hot flushes.  

2. Hypothalamus Miscommunication: 

The hypothalamus is part of the brain whose main purpose is to regulate the temperature in the body. This contains thermoregulatory centers that monitor the body’s temperature. 

In menopause, the decline in estrogen confuses these centers, because estrogen modulates multiple interrelated components for this thermoregulation, including heat dissipation, heat production, and core body temperature,

Recent studies show that when there’s an increase in core temperature exceeding the sweating threshold the hypothalamus mistakenly perceives the body as overheating, triggering responses to cool it down in excess, causing the typical vasomotor symptoms. 

3. Vasomotor Instability:

 After the imbalance of hormones affects the hypothalamus in its temperature regulation, it triggers the characteristic redness and warmth. This is caused because of the dilation of blood vessels in different areas of the body. This is the reason why we call these also vasomotor symptoms and that is why you might find yourself feeling very warm and red. 

4. Sweating Response: 

The body’s attempt to cool down during a hot flush involves an increased sweating response. This can be sudden and profuse, further contributing to discomfort and feelings of warmth.

The Impact on Women

In the life of menopausal women, hot flushes can range from mild and tolerable to moderate and bothersome, or severe and debilitating. Over time, you might feel that they tend to become less intense. Although many women experience hot flushes for a few years, some may have them for decades. It remains unclear why some women experience severe hot flushes for many years while others do not have them or only experience a few mild ones that pass quickly. In Functional Medicine we know that hot flushes are also affected by Blood sugar instabilities and Stress levels. 

If your hot flushes are mild, moderate or severe, you can benefit from lifestyle changes. Most importantly quit sugar and refined carbohydrates, mange your stress, limit caffeine and alcohol, eat at least 7 cups of greens and vegetables a day and move at least 30 min a day . You can also consider taking an over-the-counter remedy or a prescription medication, based on your physician’s opinion, including hormones, to help manage your symptoms.

Coping with Hot Flushes: Managing lifestyle changes.

Studies have found that women experiencing hot flushes have a more sensitive thermostat in the brain, which means the temperature range  where they  feel comfortable is narrower than compared to other women. Staying cool, reducing sugar and alcohol and reducing stress are key lifestyle changes to manage your hot flushes. Some women may find relief with some of the following options:

Avoiding hot rooms, beverages, and foods, alcohol, caffeine, excessive stress, and smoking.

Dressing in layers of lightweight, breathable materials that allow for perspiration. Remove or add layers as needed for temperature control.

Using cooling products like sprays, gels, and Chillow pillows.

Engaging in regular exercise to reduce stress and promote restful sleep, avoiding vigorous activity close to bedtime.

Exploring relaxation techniques such as meditation, yoga, qigong, tai chi, biofeedback, acupuncture, or massage to lower stress levels.

Practicing slow, abdominal breathing (inhaling through the nose and exhaling through the mouth) when a hot flush begins, with only 5 to 7 breaths per minute, much slower than usual.

Trying various strategies to stay cool while sleeping, such as wearing lightweight, breathable sleepwear and using layered blankets that can be easily adjusted. Using a fan and keeping a pack of ice or a bag of frozen peas under your pillow can also help. Turn your pillow frequently to ensure your head rests on a cool surface. If you wake up during the night, drink cold water and use relaxation techniques like meditation or calm breathing to aid in falling back asleep.

Maintaining a healthy weight through regular exercise to decrease hot flushes and improve overall health, as overweight women tend to experience more hot flushes.

In Conclusion

Hot flushes during menopause can be challenging, but understanding the causes behind them can empower women to navigate this important phase in their life more effectively. By adopting a proactive approach, seeking support, and implementing lifestyle changes, women can manage hot flushes and embrace this new chapter of their lives with grace and resilience. Remember, every woman’s journey through menopause is unique. Embrace the change and prioritize your well-being.

About Me

Dr. Christina Enzmann is a gynecologist and a certified member of the North American Menopause Society.

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