Hot Flashes Treatment, Symptoms, Medication, Relief, Remedies, Meaning (original) (raw)

What are hot flashes?

A hot flash is a characteristic symptom of menopause.

A hot flash is a characteristic symptom of menopause.

A hot flash is a sensation of heat that begins in the head and neck regions. Hot flashes are a common symptom experienced by women before and during the early stages of the menopausal transition. However, not all women approaching menopause will develop hot flashes.

How long do hot flashes last?

Hot flashes are typically brief, lasting from about 30 seconds to a few minutes.

The question of how long a woman's lifetime hot flashes last is a different one. Traditionally, it was believed that women only experienced hot flashes for a few years. More recent data suggest that many women may experience hot flashes for longer periods.

What causes hot flashes?

The complex hormonal changes that accompany the aging process, in particular, the declining levels of estrogen as a woman approaches menopause, are thought to be the underlying cause of hot flashes. A disorder in thermoregulation (methods the body uses to control and regulate body temperature) is responsible for the heat sensation, but the exact way in which the changing hormone levels affect thermoregulation is not fully understood.

Hot flashes are considered to be a characteristic symptom of the menopausal transition. They also occur in men and in circumstances other than perimenopause in women (such as young women or during pregnancy) as a result of certain uncommon medical conditions that affect the process of thermoregulation. For example, carcinoid syndrome, which results from a type of endocrine tumor that secretes large amounts of the hormone serotonin can cause hot flashes.

Hot flashes can also develop as a side effect of some medications and sometimes occur with severe infections or cancers that may be associated with fevers and/or night sweats.

What are symptoms of hot flashes?

The timing of the onset of hot flashes in women approaching menopause is variable.

SLIDESHOW Menopause & Perimenopause: Symptoms, Signs See Slideshow

How are hot flashes diagnosed?

Hot flashes are a symptom, not a medical condition. Taking a thorough medical history, the healthcare professional will usually be able to determine whether a woman is having hot flashes. The patient will be asked to describe the hot flashes, including how often and when they occur, and if there are other associated symptoms.

A physical examination together with the medical history can help determine the cause of the hot flashes and direct further testing if necessary.

Blood tests may be performed if the diagnosis is unclear, either to measure hormone levels or to look for signs of other conditions (such as infection) that could be responsible for the hot flashes.

What are the treatments for hot flashes?

There are a variety of treatments for hot flashes such as:

Some of these have not been tested by clinical studies, nor are they approved by the US Food and Drug Administration (FDA).

Hormone therapy for hot flashes

Traditionally, hot flashes have been treated with either oral or transdermal (such as a patch) forms of estrogen. Hormone therapy (HT) or postmenopausal hormone therapy (PHT), formerly referred to as hormone replacement therapy (HRT), consists of estrogens alone or a combination of estrogens and progesterone (progestin). All available prescription estrogen medications, whether oral or transdermal, are effective in reducing the frequency of hot flashes and their severity. Research indicates that these medications decrease the frequency of hot flashes.

However, long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive hormone therapy. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.

More recently, it has been noted that the negative effects associated with hormone therapy were described in older women who were years beyond menopause, and some researchers have suggested that these negative outcomes might be lessened or prevented if hormone therapy was given to younger women (before or around the age of menopause) instead of women years beyond menopause.

The decision regarding starting or continuing hormone therapy, therefore, is an individual one in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman's medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.

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Bioidentical hormone therapy for hot flashes

There has been increasing interest in recent years in the use of so-called "bioidentical" hormone therapy for perimenopausal women. Bioidentical hormone preparations are medications that contain hormones that have the same chemical formula as those made naturally in the body. The hormones are created in a laboratory by altering compounds derived from naturally-occurring plant products. Some of these so-called bioidentical hormone preparations are U.S. FDA-approved and manufactured by drug companies, while others are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. These individual preparations are not regulated by the FDA, because compounded products are not standardized.

Advocates of bioidentical hormone therapy argue that the products, applied as creams or gels, are absorbed into the body in their active form without the need for "first pass" metabolism in the liver and that their use may avoid potentially dangerous side effects of synthetic hormones used in conventional hormone therapy. However, studies to establish the long-term safety and effectiveness of these products have not been carried out.

Other prescription drug treatments for hot flashes

What natural and home remedies treat hot flashes?

Some women report that exercise programs or relaxation methods have helped to control hot flashes, but controlled studies have failed to show the benefit of these practices in relieving the symptoms of hot flashes. Maintaining a cool sleep environment and the use of cotton bedclothes can help ease some of the discomfort associated with hot flashes and associated night sweats.

Many women turn to alternative therapies, including herbal products, vitamins, plant estrogens, and other substances, for the treatment of hot flashes. Doctors can be reluctant to recommend alternative treatments because these nonprescription products are not regulated by the FDA (like prescription medications), and their ingredients and strength can vary from manufacturer to manufacturer. For products that are not regulated by the FDA, testing, and proof of safety are not required for the marketing of these products. Long-term, scientifically controlled studies for these products are either lacking or have not proved the safety and effectiveness of many of the so-called natural or alternative remedies.

Some alternative treatments, however, have been evaluated in well-designed clinical trials. Alternative treatments that have been scientifically studied with some research include phytoestrogens (plant estrogens, isoflavones), black cohosh, and vitamin E.

Black cohosh for hot flashes

Black cohosh is an herbal preparation that is becoming more and more popular in the U.S., and the North American Menopause Society does support the short-term use of black cohosh for treating menopausal symptoms, for a period of up to six months (because of its relatively low incidence of side effects when used over the short-term).

Some studies have shown that black cohosh can reduce hot flashes, but most of the studies have not been considered to be rigorous enough in their design to firmly prove any benefit. There also have not been scientific studies done to establish the long-term benefits and safety of this product. Research is ongoing to further determine the effectiveness and safety of black cohosh.

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Soy and other plant sources for menopause symptoms

Isoflavones are chemical compounds found in soy and other plants (such as chickpeas and lentils) that are phytoestrogens, or plant-derived estrogens. They have a chemical structure that is similar to the estrogens naturally produced by the body, but their effectiveness as estrogen has been determined to be much lower than true estrogens.

Some studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. In particular, women who have had breast cancer and do not want to take hormone therapy (HT) with estrogen sometimes use soy products for relief of menopausal symptoms. However, some phytoestrogens can have anti-estrogenic properties in certain situations, and the overall risks of these preparations have not yet been determined.

There is also a perception among many women that plant estrogens are "natural" and therefore safer than hormone therapy, but this has never been proven scientifically. Further research is needed to fully characterize the safety and potential risks of phytoestrogens.

Is it possible to prevent hot flashes?

While the development of hot flashes cannot be prevented, the treatment methods described in the above section may be able to reduce their incidence and severity.

Medically Reviewed on 4/12/2023

References

Santen, Richard J. "Menopausal hot flashes." UptoDate. Apr. 27, 2020. http://www.uptodate.com/contents/menopausal-hot-flashes.