By Brittany Allen, APRN, MSN, WHNP-BC, gynecology

A sudden wave of heat in the middle of the day, a racing heart, drenching sweat — if this sounds familiar, you’re not alone. Hot flashes affect up to 80% of women going through the menopausal transition. Yet, they’re still not fully understood.

What is a hot flash?

Hot flashes (occurring during the day) or night sweats (occurring at night) are together called vasomotor symptoms or VMS. They can be one of the first signs that perimenopause has begun, and typically occur first at night before they start occurring during the daytime.

Hot flashes can come on suddenly and vary in intensity, duration and frequency. They can negatively affect your sleep, health and quality of life, and tend to be most disruptive when they make it difficult to get consistent sleep through the night.

Although hot flashes feel different for everyone, they may include:

• Sweating
• Clammy and/or flushed skin
• Chills
• Heart palpitations

Why do hot flashes happen?

Hot flashes start in the brain. Estrogen interacts with the hypothalamus, the part of the brain that acts as your body’s thermostat. When estrogen levels decrease, receptors in the hypothalamus are left open, and another chemical called NKB (Neurokinin B) attaches to the receptors instead. NKB disrupts the hypothalamus’s ability to regulate temperature normally, which is why the decline in estrogen is associated with hot flashes and night sweats.

How common are they, and how long do they last?

While many women never experience hot flashes at all, even as they go through perimenopause, some have symptoms for a few months and others experience them for 10-15 years. Why some women have them and others don’t isn’t fully understood. How much they affect daily life also varies widely from person to person. If hot flashes or other symptoms that might be related to perimenopause are affecting your quality of life, that’s a good reason to talk to your provider.

What triggers a hot flash?

Although hot flashes can occur out of the blue, they also can be triggered by alcohol, caffeine and spicy foods. For some women, heat from physical activity, blow-drying hair, warm drinks or heavy clothing bring on hot flashes. Whether summer heat plays a role is less clear. Ambient heat, like a warm summer day, may also be a factor, though research on women’s experience of perimenopause and menopause just hasn’t caught up yet. 

Some women have certain triggers while others have none. If you notice a pattern, tracking your symptoms can help you and your provider identify what might be setting them off.  

Can symptoms be managed?

One effective way to manage the frequency, duration and intensity of hot flashes is with menopausal hormone therapy (MHT), which typically consists of estrogen and progesterone with or without testosterone. MHT is generally safe, however, because there are possible side effects and risks associated with its use, it is not appropriate for everyone. MHT is most effective when started during perimenopause or within 10 years of menopause (defined as the final menstrual period). It also has a better benefit-to-risk profile when started during this same time window. 

There are also nonhormonal options to help manage VMS, such as NKB blockers (Veozah and Lynkuet), SSRIs and Gabapentin, as well as acupuncture, herbal supplements (black cohosh, feverfew, evening primrose oil, DIM) and other over-the-counter remedies like Estroven. Talk with your provider before starting any of these treatments to ensure they are safe for you specifically.

Other ways to manage your body’s heat surges:

• Wear natural, breathable fibers instead of synthetic materials (rayon, polyester and nylon)
• Keep a portable fan in your purse or gym bag
• Use a cooling towel to cool the back of your neck
• Lower the temperature in your bedroom at night
• Stay hydrated
• Avoid your triggers

There is help for hot flashes

Whether you’re experiencing your first hot flashes or trying to manage ongoing symptoms, you don’t have to push through them. Talk to your provider about treatment options — they can help you understand the benefits and risks of each one.

Brittany Allen practices at The Portland Clinic’s Northeast and Beaverton locations. She specializes in women’s health, with a focus on perimenopause/menopause management, and is certified in bioidentical hormone therapy pellet placement.