Q. Is facial flushing without sweat a symptom of the perimenopausal phase?

Answered by
Dr. Sameer Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 07, 2022

Hello doctor,

My recent blood work showed my estradiol at 24 pg/mL and my FSH at 77 IU/L. For the last four months, I have had two hot facial flushes a month in which my face turns bright red and hot, and then red patches on my knuckles and elbows. Both my gynecologist and dermatologist think it is because of the histamine released during stress. This happens twice a month, lasts for ten minutes, and goes away by itself. Seven days ago, I stopped taking Vitamin D supplements as I got bloodwork done, and my vitamin D was at the high end of the normal. My orthopedist asked me to stop taking vitamin D. Two days ago, I felt anxiety, and 30 minutes later, hot facial flush, my face turned red (no sweating), but this time, I stayed calm through it, and there were no breakouts on my elbow or knuckles. I called my gynecologist, and she did a hormone blood panel immediately. My estradiol was 24 pg/mL, and my FSH was 77 IU/L. She said the facial flushing going red is vasomenoapusal, and even though I do not sweat when my face gets bright red and hot, she said it was still a hot flush. I do get hot flushes at other times and sweat, but my face does not get red. Do you think dropping the vitamin D caused the return of the facial flush as it helps regulate hormones? Can I get menopausal facial flushing without sweating? Three doctors have said yes, but one doctor said it is not menopausal if I do not sweat. I am not sure why he is saying this. I have an IUD for spot bleeding. I must be careful with HRT as sometimes it cramps my legs. My gynecologist said we could start with a hormonal estrogen spray when flushing happens. The doctor who insists that this is not menopausal is causing my anxiety to trigger. He ran a lot of tests. All my autoimmune tests came back normal. I have a normal CBC, normal metabolic, normal hepatic panel, normal tryptase (tested five days ago), normal 5 HIAA, normal metanephrines, normal catecholamine, and normal colonoscopy done a year ago. Does all of this sound perimenopausal to you? Kindly suggest.



Welcome to

The flushing you are experiencing is likely a hot flush, and it is possible to get it without sweating. The menopausal status can be confirmed with high FSH (follicle stimulating hormone), LH (leutinizing hormone), and AMH (anti-müllerian hormone) levels. Also, if you have attained menopause already, then the intra-uterine device (IUD) can be removed safely, as you would not be spotting or menstruating. Moreover, it secretes minimum progesterones into the blood regularly, which, if used in isolation from estrogen, in postmenopause can lead to medicinal endometrial hyperplasia. I hope it helps.

Thank you.

Hello doctor,

I am not in the menopause-perimenopausal phase. I had a short period two months ago. My doctor keeps frightening me and running tests. My gynecologist is wonderful and is a good listener. She was diplomatic and said maybe he ran tests to rule out other conditions, but she reassured me he was wrong, saying facial flushing without sweating is menopausal. I feel as if now I have my confirmation.



Welcome back to

As I said, if you wish to confirm again, then a hormonal test of FSH (follicle stimulating hormone), LH (leutinizing hormone), and AMH (anti-müllerian hormone) levels can be done again. Also, a short therapy with estrogen supplementation can be offered to check if the frequency of facial flushing decreases and if it does. It reconfirms the perimenopausal hot flushing status. I hope this helps.

Thank you.

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