Hot Flashes - Causes, Symptoms, and Treatment

Introduction

A hot flash is an acute heat sensation that is internal. Hot flushes are more common in women than men. Women may experience pre-indications of hot flushes, or they may strike suddenly. Women may experience tingling sensations in their fingers, increased heart rate, warm temperatures, feverish, and sudden redness and flushing of facial skin.

What Are Hot Flashes?

Hot flashes are sudden-onset, spontaneous, and episodic sensations of warmth usually felt on the upper body (chest, neck, and face) immediately followed by an episode of sweating. Women commonly feel hot flashes during the perimenopausal period and at menopause. The symptoms can sometimes impair the quality of life. Hot flashes are variable in duration, severity, and frequency. Frequency and severity can increase during the transition to menopause. The hot flashes can persist for six months to several years.

What Are the Causes of Hot Flashes?

Hormonal variations in the body are responsible for hot flashes. Hormonal imbalance and hot flashes can be triggered by various factors like-

• Medical conditions - Diabetes, tumors, spinal lesions, or eating disorders.

• Birth control pills or contraceptive medications.

• Spicy foods.

• Alcoholic beverages, hot beverages, and caffeinated drinks.

• Hot environment or wearing tight clothes.

• Habits like smoking.

• Stress and anxiety.

• Pregnancy (the first and second trimesters).

• Underlying thyroid conditions.

• Chemotherapy or radiation therapy.

• Medications like-

  • Osteoporosis drug (Raloxifene).

  • Breast cancer drug (Tamoxifen).

  • Painkiller (Tramadol).

What Are the Symptoms of Hot Flashes?

• A sudden warmth spreads through the chest, neck, and face.

• A flushed appearance with redness on the face and neck.

• Rapid heartbeat.

• Perspiration, mainly on the upper body.

• A chilled or cold feeling as the hot flash lets up.

• Anxiety.

• Tingling in fingers.

Hot flashes can be mild or severe enough to affect women's daily activities and can happen during the day or night. Night-time hot flashes are called night sweats and can cause long-term sleep disruptions. The frequency and intensity of hot flashes can vary among women, and they may last from a minute or two to as long as five minutes.

What Are the Risk Factors for Hot Flashes?

All women who undergo menopause will not get hot flashes, but certain factors that increase the risk of getting hot flashes are as follows-

• Smoking.

• Obesity.

• Race- Hot flashes are more common in certain races of women across the globe.

How Can Hot Flashes Impact Life?

• Hot flashes can impact daily activities and quality of life.

• Night-time hot flashes (night sweats) can cause long-term sleep disruptions.

• Women with hot flashes are at an increased risk of heart disease and bone loss.

How Hot Flashes Are Diagnosed?

Diagnosis is mainly based on the symptoms experienced and whether the woman is in her menopausal transition phase.

Do Hot Flushes Need Treatment?

Some women may not need any treatment at all. For mild symptoms of hot flashes, the woman is encouraged to adopt lifestyle changes first of all, as this is the safest option. If this does not solve the problem, proceed to the hormonal or non-hormonal treatments.

Hormonal Therapy -

• The hormone used primarily to reduce hot flashes is estrogen.

• Women with a hysterectomy can take estrogen, but women with a uterus must take progesterone with estrogen (to prevent endometrial cancer).

• The primary aim of hormonal therapy is to control the symptoms and optimize the quality of life. Therefore, the smallest effective dose of estrogen must be used to balance the risks and benefits of hormone therapy.

• A combination drug- Bazedoxifene with conjugated estrogens, can be used for women who cannot tolerate progesterone-related side effects. Bazedoxifene with estrogen helps avoid the increased risk of endometrial cancer and protects the bones.

• Estrogen therapy is not recommended for women at risk of breast or endometrial cancer, heart disease, stroke, or blood clots.

Non-Hormonal Therapy - A non-hormonal therapy involves–

• Antidepressants - The drugs used for non-hormonal therapy are not as effective as hormone therapy, but they can provide some relief. The side effects of these drugs are- sleeplessness, weight gain, nausea, drowsiness, sexual dysfunction, or dry mouth. Some antidepressants that can be used to treat hot flashes are as follows-

  • Venlafaxine.

  • Paroxetine.

  • Citalopram.

  • Escitalopram.

• Other Prescription Medications -

  • Gabapentin, an anti-seizure medication, is moderately effective in reducing hot flashes. However, side effects can include drowsiness, dizziness, limb edema, and fatigue.

  • Pregabalin is also an anti-seizure medication. Side effects can include dizziness, drowsiness, lack of concentration, and weight gain.

  • Oxybutynin is used to treat urinary conditions, but it may also help relieve hot flashes in some women. Side effects are constipation, nausea, dizziness, dry mouth, and dry eyes.

  • Clonidine. Side effects are drowsiness, dizziness, dry mouth, and constipation. It is mainly used for the treatment of high blood pressure.

• Nerve Block Procedure - A nerve block procedure called stellate ganglion block can be used to treat moderate to severe hot flashes. An anesthetic agent is injected into a cluster of nerves in the neck to relieve pain.

Lifestyle Changes - Certain lifestyle changes can help relieve symptoms in mild cases of hot flashes. Following measures can be taken to modify a sedentary lifestyle-

• Dress in cool cotton clothes with layers so a few layers can be removed to feel warm.

• Staying in a well-ventilated place with open windows, fans, or air-conditioners.

• Avoid hot and spicy food, caffeine, and alcohol.

• Avoid smoking.

• Recognizing the triggers and avoiding them.

• Practice mind-body therapies like- meditation, deep breathing, stress management techniques, and guided imagery.

• Losing weight.

Alternative Medicine - Some alternative approaches include-

• Mind and body approaches

  • Cognitive-behavioral therapy (CBT).

  • Hypnosis.

  • Mindfulness meditation.

  • Acupuncture.

• Dietary supplements

  • Plant estrogens.

  • Black cohosh.

  • Ginseng.

  • Dong Quai.

  • Vitamin E supplements.

Conclusion

Hot flashes are the most common condition that presents during perimenopause. Women should consider counseling and be aware of hormonal changes and their impact on overall health. Women should be aware of the changes around the perimenopausal period, various treatment options, and each therapy's risks, benefits, and alternatives. One should understand hormonal therapy has more significant benefits than associated risks. Particular lifestyle and dietary modifications can also provide some relief. The prognosis of hot flashes is mostly good and not much to worry about as it resolves in most cases in about five years.