What causes hot flashes during menopause?

If you’re in your late 40s or 50s, you may have found yourself asking, “Why am I suddenly overheating?” You’re not alone. Hot flashes are one of the most common symptoms during perimenopause and menopause. They’re completely normal, but that doesn’t make them any less frustrating.

Hot flashes happen because your hypothalamus (the part of your brain that works like an internal thermostat) gets thrown off balance during hormonal changes. As your estrogen levels shift, your body’s internal temperature regulation becomes less steady. This can lead to sudden waves of heat that may be eased with lifestyle changes and, if needed, medical support like hormone therapy.

Hot flashes might be a normal part of menopause, but it doesn’t mean you have to “just tough it out.” We’ll help you understand why they’re happening and offer some practical tips to reduce their intensity and help you start feeling more like yourself again. 

What is a hot flash?

Hot flashes, also known by their medical name “vasomotor symptoms,” are a sudden feeling of intense warmth, most often in your chest, neck, and face. If they occur at night, they’re called night sweats.

They often come with other symptoms such as:

• Sweating
• A flushed face or skin
• A racing heartbeat
• Sometimes, even chills once the heat passes
  

For some women, hot flashes are mild and just a temporary inconvenience. For others, they can be intense enough to drench clothes or sheets in sweat. Almost every woman going through perimenopause or menopause experiences them to some degree. And while they can last up to 10 years, they typically change in frequency and severity over time.

What causes hot flashes?

Hot flashes are tied to fluctuating estrogen levels. During perimenopause and menopause, your hormone levels fluctuate wildly, and your estrogen levels drop. Estrogen helps your hypothalamus regulate body temperature. When estrogen levels rise and fall unpredictably, your hypothalamus can misfire. It thinks your body is overheating and signals you to cool down by opening blood vessels and making you sweat.

When hormones spike and drop unexpectedly, as they do during perimenopause and menopause, it’s difficult for your body to regulate its temperature. This leads to sweating and those sudden and almost electric heat sensations. That’s why hot flashes feel like a sudden surge of heat, almost like your body has flipped on a switch.

“Hot flashes are one of the most common symptoms of menopause, affecting up to 80% of women, with some women experiencing more than 10 a day,” explains Dr. Sheryl Ross (Dr. Sherry), Chief Medical Officer of Women’s Health here at QuickMD.  They tend to last an average of five minutes, but, as Dr. Sherry notes, “Everyone experiences hot flashes differently; some are less explosive or disruptive, but not for others.” 

She adds, “It’s important to remember everyone has an individualized experience going through the perimenopause and menopause transition, so your experience can be a lot different than your closest girlfriends.”

What do hot flashes feel like?

The tell-tale sign of a hot flash is how quickly they appear. Like their name suggests, they come on in a flash and bring:

• A swell of heat in your upper body
• Clammy or damp skin
• Flushed face or chest
• A pounding or racing heartbeat
• Profuse sweating
  

While hot flashes often occur without warning, some women feel an anxious “aura” just before one begins, or chills afterward. Most last about five minutes, but in the moment, they can feel much longer.

How long do hot flashes last?

There’s no single timeline. Some women begin having hot flashes in perimenopause and continue for years after menopause. Others may only have them briefly as they approach menopause.

“Hot flashes begin in perimenopause and can persist for 7-10 years,” mentions Dr. Sherry. “Since perimenopause occurs up to 10 years before the menopause transition, many suffer from hot flashes for longer periods of time, depending on the time perimenopausal symptoms appear.” 

The good news? They often become less frequent and less intense over time. 

Treatment & relief options

Hot flashes can feel overwhelming, but there are many ways to manage them. Some women find that simple lifestyle changes and at-home remedies make a big difference, while others benefit from medical treatments. You may need a little trial and error to discover what works best for your body.

Here are some options to consider:

• Wear breathable layers. Choose light, breathable fabrics like cotton or moisture-wicking blends. Layers make it easy to adjust quickly if a flash starts. Some women even keep a small fan handy to get relief on the spot. For an even more fashion-meets-function approach, Dr. Sherry suggests, “There are many cooling products on the market that may ease the disruption of hot flashes. Cooling scarves and vests, iced neck wraps, breathable fabrics, moisture-wicking undergarments, shirts and socks, and UV-resistant tops and cover-ups can help minimize the symptoms of hot flashes as they occur.”
• Stay hydrated. Hot flashes often cause sweating, which means your body loses fluids. Drinking plenty of water throughout the day helps you stay cool and replace what you lose. Herbal teas served cold can be soothing, too.
• Watch your food and drink triggers. Spicy dishes, hot beverages, and caffeine can all make hot flashes worse for some women. Spicy foods in particular can cause hot flashes due to a chemical called capsaicin, which produces heat. Dr. Sherry notes that, “Capsaicin makes the blood vessels dilate and fill with blood, which causes a warm sensation. Hot flashes and sweating can occur as a result of this phenomenon. Avoiding foods containing capsaicin is one way to avoid hot flashes while eating spicy foods.” This doesn’t mean you have to skip your morning coffee or Taco Tuesdays. Just stick to one cup of coffee and steer clear of jalapenos to keep hot flashes at bay. Keeping a simple food diary for a week or two may help you notice patterns and avoid common triggers.
• Limit red wine. While not all alcohol will trigger a hot flash, Dr. Sherry notes that red wine, in particular, can be an issue. “Drinking red wine causes the blood vessels to relax, vasodilate, and expand, making you feel warm or flushed.  Some experience intense hot flashes, while others only feel warmer. Limiting the amount of red wine or other alcoholic beverages that cause a similar effect should be part of your hot flash treatment management.”
• Try cooling techniques. A splash of cool water on your wrists, neck, or face can calm a hot flash as it starts. Some women use cooling pillows or gel packs for extra comfort, especially at night.
• Consider supplements. If you have mild symptoms, you may benefit from some dietary supplements, including soy extracts, rhubarb, and pollen extract. They can be helpful, but it can be difficult to maintain consistent results with them. Some women also benefit from ginseng, maca, cannabinoids, and black cohosh. Typically, these can work well as added support, not as your only treatment. Always talk with your provider before starting supplements, since they may not be safe for everyone and can interact with other medications.
• Mind-body therapies. Cognitive behavioral therapy (CBT), mindfulness, or even clinical hypnosis can help. These approaches don’t stop hot flashes, but they can make them feel less disruptive by lowering stress and giving you tools to cope.
• Maintain a healthy weight. Research shows women with a higher body mass index (BMI) often experience more frequent or severe hot flashes. Even small amounts of weight loss can help reduce intensity and improve overall well-being.
• Hormone therapy. For women whose symptoms are frequent or severe, hormone therapy is often the most effective treatment for managing menopause symptoms. By restoring declining estrogen levels, HRT helps your hypothalamus regulate temperature more smoothly. It can dramatically reduce both hot flashes and night sweats.
• Other medications. If hormone therapy isn’t an option for you, certain nonhormonal prescription medications (such as some antidepressants, gabapentin, or Veozah) may provide relief. Your provider can help decide if these are a good fit.
  

In instances when you may not be able to benefit the most from these options, you can also work with your healthcare provider to find other medications that offer relief. Read about estrogen for menopause symptoms. 

When to get professional help

Hot flashes are a normal part of the menopause transition, but “normal” doesn’t mean you have to just put up with them. If they start interfering with your sleep, daily routines, or emotional well-being, that’s a sign it may be time to reach out for help.

Speaking with a licensed provider can rule out other possible causes of your symptoms, walk you through treatment options, and tailor a plan that fits your life. For many women, that means exploring Menopause Hormone Therapy (MHT). For others, it may involve nonhormonal medications or lifestyle changes supported by counseling.

Here at QuickMD, we understand how disruptive hot flashes and menopause can be. With a simple virtual visit, you can connect with a licensed provider online who listens to your story, answers your questions, and helps you find relief.