Many women experience the intense warmth of hot flashes as they transition through menopause, making it a significant change in life. Affecting roughly 75% of women, these sudden surges of heat can occur during the day or night. Night sweats, the term for hot flashes that happen while asleep, can severely disturb rest and lead to feelings of exhaustion.
The typical age for menopause in the United States is around 51, but symptoms often start in the years leading up to this stage, known as perimenopause. For some women, hot flashes may persist well into their later years. Medical interventions, including nonhormonal treatments, along with lifestyle changes, can offer relief. It’s essential for women to address these symptoms, as they can have a significant impact on daily life and well-being.
What Are Sudden Heat Waves?
Sudden heat waves, often affecting women going through menopause, are intense sensations of warmth that primarily involve the upper body. This heat usually targets areas like the chest, neck, and face. Episodes are generally brief, lasting from one to five minutes, and can occur multiple times a day, ranging from one to over ten instances.
People experiencing these heat waves also often notice symptoms like wet or flushed skin, feelings of anxiety, a quickened heartbeat, and sweating. After the wave of intense warmth, many people feel a chill. This chill can be as uncomfortable as the heat and sweating that came before it.
The reasons behind these heat waves are not entirely known. The hormone estrogen plays a significant role, especially during menopause when estrogen levels drop. This drop affects a small part of the brain called the hypothalamus. The hypothalamus helps control the body’s temperature. When estrogen levels fluctuate or decrease, it disrupts how the hypothalamus regulates temperature.
Key Points about Sudden Heat Waves:
- Duration: 1 to 5 minutes per wave
- Frequency: 1 to 10+ times daily
- Accompanying Symptoms:
- Wet or flushed skin
- Anxiety
- Quick heartbeat
- Sweating
- Chills
When a person experiences these heat waves, the body’s core temperature rises quickly. To cool down, the blood vessels near the skin’s surface widen, leading to redness and flushing. Sweat glands become more active to help cool the body through the evaporation of sweat.
Sometimes, the body’s attempts to cool down go too far, causing a noticeable drop in internal temperature. This leads to shivering as the body tries to warm up again. Additionally, the heart rate may increase temporarily as the body works to manage its temperature.
These temperature changes can feel very unpleasant. Unlike the cozy warmth of sitting by a fire, the body’s heat waves are uncomfortable. People experiencing them may feel a surge of adrenaline along with heart palpitations, sweating, and anxiety.
Can Lifestyle Changes Ease Hot Flashes?
Many women find that certain lifestyle adjustments can ease the discomfort of hot flashes. Here are some practical suggestions:
- Sleeping Environment: Reduce the temperature in the bedroom at night. Use a fan for added comfort.
- Hydration: Drink a small amount of cold water before going to sleep.
- Bedding Adjustments: Layer bedding so it can be modified easily during the night.
For those who share a bed, extra blankets can be placed on the side of the partner who does not experience night sweats. An electric blanket may also be considered for your partner’s side.
To further manage hot flashes, carrying a portable fan is useful. Some may consider mind-body techniques like cognitive behavioral therapy (CBT) or hypnosis.
While comprehensive studies on these methods are lacking, experts suggest they may offer relief. Dr. Taylor advocates for these strategies despite the absence of hard evidence, highlighting the value of being proactive. Taking charge of the situation may empower individuals, providing some comfort in managing hot flashes.
Are There Treatments for Hot Flashes?
Hot flashes can be managed with two main types of medications: hormonal and nonhormonal treatments. Each type addresses the symptoms in different ways.
Hormonal Treatments: These are commonly known as menopausal hormone therapy and come in two classes. The first class, estrogen-only, is used by women without a uterus. The second class combines estrogen and progesterone and is suitable for those with a uterus. Both classes contain natural and synthetic hormones.
The goal is to alleviate hot flashes linked to decreased estrogen levels. These treatments are also effective for other symptoms like sleep issues, vaginal dryness, and pain during intercourse. Hormonal medications approved by the Food and Drug Administration are available in several forms: pills, injections, patches, and creams. Research indicates that oral forms are particularly effective in reducing hot flashes and night sweats. For vaginal issues, using hormones through vaginal delivery is considered more beneficial.
Nonhormonal Treatments: There are two FDA-approved nonhormonal medications specifically targeting hot flashes.
- Paroxetine (Brisdelle®): A specific type of antidepressant known as a serotonin reuptake inhibitor (SSRI). It modifies serotonin levels, which plays a role in controlling body temperature. This medication is taken as a daily pill and was found to offer some relief from hot flashes. It was approved for this specific use in 2014.
- Fezolinetant (Veozah®): Approved in 2023, this medication works on the neurokinin 3 receptor, influencing temperature regulation in the brain. Taken daily, it has been shown to significantly ease the intensity of hot flashes. However, as of December 2024, it includes a strong warning due to rare but significant liver damage risks.
Other Nonhormonal Options: Certain medications, though not approved specifically for hot flashes, are prescribed by doctors for off-label use. These include other SSRIs like citalopram (Celexa®) and escitalopram (Lexapro®), as well as gabapentin (Neurontin®), initially used for treating seizures.
Summary of Treatments
| Type | Medication | Use and Notes |
|---|---|---|
| Hormonal | Estrogen, Progesterone | Addresses hot flashes and other menopausal symptoms |
| Nonhormonal | Paroxetine (Brisdelle®) | Reduces frequency and severity of hot flashes |
| Fezolinetant (Veozah®) | Significantly reduces hot flash severity; warning for liver risk | |
| Off-Label Options | Citalopram, Escitalopram, Gabapentin | Used for effectiveness against hot flashes despite not being approved for it. |
These diverse treatments give multiple options to those seeking relief from hot flashes. Choosing the best approach often depends on individual medical history and personal needs.
Which Medications for Hot Flashes Are Most Effective?
Managing hot flashes is crucial for many. Menopausal Hormone Therapy (MHT) is widely recommended by healthcare professionals. While it may not completely eliminate symptoms, adjusting the dosage can significantly reduce them.
Veozah is noteworthy as a nonhormonal medication that approaches the effectiveness of estrogen-based treatments. Other nonhormonal options, like paroxetine and selective serotonin reuptake inhibitors (SSRIs), do not match the effectiveness of hormonal treatments. Though there is a lack of direct comparison studies between these medications, MHT stands out due to its reliability.
Selecting Medication for Hot Flashes
When dealing with hot flashes, it’s important to determine if medication is necessary. If the episodes are both mild and not frequent, medication might not be needed. Severe hot flashes that interfere with daily life can require more attention.
Health Conditions and Risks:
- Women with a history of breast cancer should avoid menopausal hormone therapy (MHT). Studies indicate that these individuals have increased chances of developing new or recurring breast cancer when on hormone therapy.
- MHT is also not advised for women who have a higher likelihood of stroke, blood clots, or who are more than ten years past the beginning of menopause.
Nonhormonal Alternatives:
For those unable to use hormone therapy, nonhormonal treatments are considered safe. Many women opt against hormones due to findings from a well-known Women’s Health Initiative study, which was halted early in 2002. This study suggested increased risks like breast cancer and heart disease for older women on hormone therapy more than a decade after menopause began. However, these findings were based mostly on women over the age of 60, who are already at a higher risk for such conditions.
Current Recommendations:
Medical professionals now support hormone therapy for perimenopausal and early menopausal women within the first ten years after menopause onset, since the benefits are considered to outweigh the risks for women under 60.
Dose and Duration:
For those starting hormone therapy, the current advice is to choose the lowest dosage necessary and to use it for the shortest duration possible.
Customizing Treatment Options:
Selecting the right treatment requires assessing the variety and intensity of symptoms and taking into account the individual health risks each woman faces. The objective is to find a solution that maximizes benefit while minimizing risk.
For instance:
- If a woman experiences hot flashes, reduced sexual interest, and vaginal dryness early in menopause, starting with MHT in forms like patches, pills, or vaginal rings can be beneficial as it addresses all three concerns.
- If vaginal dryness and discomfort are the only issues, without any hot flashes, vaginal estrogen might be sufficient.
The key is individualized care, aimed at finding treatments tailored to the specific needs of each woman.
Important Considerations:
Making informed decisions about treatment requires knowledgeable discussion with healthcare providers. It’s essential to weigh the possible benefits and risks, considering personal health history and preferences.
