Understanding Hot Flashes

Hot Flashes: What’s Behind the Heat?

By: Bryan Warner, M.D.

Hot flashes are easily among the best-known symptoms of menopause, but do you really know what they are? What’s happening, and what can you do about them? Do all women experience them the same way, or do different women have different hot flashes?

What Is a Hot Flash?
A hot flash is a warm sensation or flushed feeling that can occur anywhere, but is most frequently felt in the face or upper portion of the body. Generally, when you have a hot flash, the blood vessels in your skin open up, allowing more blood to flow through your skin. This causes the characteristic red flush and warmth. While you usually feel a hot flash on your skin, some women experience warmth that rises up from deep within. In either case, this increasing warmth can cause perspiration, but perspiration does not accompany all hot flashes.

What’s Happening?
While many different things can cause hot flashes, particularly in different settings and different people, the vast majority of hot flashes that occur in my patients are due to hormone fluctuations, such as those that occur in and around menopause and andropause (the male menopause). When you’re undergoing hormone decline – whether that’s a decline in estrogen, progesterone or testosterone – the change in your hormone levels can reset the body’s thermostat in the hypothalamus, which is the part of the brain that helps regulate appetite and body temperature.

The body reacts to these hormonal changes as if it’s overheated. Blood vessels in the skin open up, causing increased blood flow to the skin, in an attempt to dissolve or dissipate some of the heat. And that makes you feel hot. However, your body temperature is not actually elevated – and your body’s attempt to dissipate the heat may actually lower your temperature slightly. So, for example, your temperature may drop from 98.6 to 98.2 during a hot flash.

Hot Flash Triggers
Many different things can trigger a hot flash. Emotional triggers, such as embarrassment, are among the most common. Other hormonal issues can also be triggers for hot flashes. For example, if you take too much thyroid hormone for hypothyroidism, you may have a hot flash. Elevated cortisol levels due to stress can also lead to hot flashes. Other potential triggers include fluctuating blood sugar levels, any kind of adrenaline surge, alcohol and foods that contain MSG.

Many medications can also trigger hot flashes. Niacin, a cholesterol drug, is among the most commonly known of these. The Viagra family of medicine can also lead to hot flashes, as can certain high blood pressure medicines known as calcium channel blockers.

Beating Hot Flashes
Unfortunately, there’s not much you can do in the midst of a hot flash except to wait it out. It will end in just a few minutes – most don’t last longer than three to five minutes. However, there are steps you can take to prevent hot flashes from occurring in the first place.

Many foods can trigger hot flashes or make them worse, so pay attention to what you’re eating. Among the most common food culprits behind hot flashes are foods that contain MSG or that are hot or spicy. You may also notice fewer, less intense hot flashes if you avoid certain meats – especially hot dogs, lunch meats or bacon, all of which are common foods that have been preserved with nitrates.

Hot flash relief frequently comes down to hormones. Hormonal fluctuations are probably the most common causes of hot flashes, especially if you’re between the ages of 30 and 60. So get your hormones tested and, if you have any imbalances, adjust your hormone levels. Getting your hormones balanced is probably the best way to handle and prevent hot flashes.

Beyond Hormones
While hormone imbalances are by far the most common cause of hot flashes that I see in my practice, there are other causes, as well. Some other causes of hot flashes can be very serious. For example, hot flashes are symptoms of some forms of cancer. That’s why it’s very important that we never assume that hormonal imbalances are the only cause.

My evaluation includes a careful history, physical exam and screening lab tests, such as a complete blood count, chemistry panel and thyroid, cortisol and adrenal function tests, as well and ensuring that you have had appropriate cancer screening. If I discover that your hot flashes are caused by some condition beyond what I can manage, then I make sure that we help you get the right care with the appropriate doctor or specialist.

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