Hot flashes are most often caused by hormone changes in menopause, and can also come from medicines or other conditions. See a doctor if they bother you.
Common cause
Menopause: about 75% of women have hot flashes. Estrogen decline affects the brain’s temperature control.
Other causes
- Perimenopause.
- Medicines such as tamoxifen and antidepressants.
- Thyroid problems.
- Infections.
- Spicy food, alcohol and stress.
- In men, low testosterone treatment.
Duration
Average 7 years.
Treatment
Hormone therapy, SSRIs and cooling strategies.
See a doctor
If hot flashes are severe or happen before age 40.
Menopause
Hot flashes are the most common symptom of menopause and perimenopause, affecting about 75% to 80% of women in menopause transition. They are sudden feelings of heat in the face, neck and chest, often with sweating, flushing, rapid heartbeat and sometimes chills afterward. Low or fluctuating estrogen affects the brain’s temperature control center in the hypothalamus.
Duration
A major study, the SWAN study (Study of Women’s Health Across the Nation), found hot flashes last a median of 7.4 years, and can persist for over a decade in some women, particularly if they begin early in perimenopause.
Triggers
Alcohol, caffeine, spicy food, stress, hot weather, tight clothing and smoking.
Other causes
- Thyroid overactivity (hyperthyroidism).
- Medications, including tamoxifen, aromatase inhibitors, opioids, some antidepressants and niacin.
- Cancer treatments and surgery removing the ovaries.
- Infections, with fever.
- Anxiety and panic attacks.
- Low blood sugar.
- Carcinoid syndrome, pheochromocytoma and other rare tumors.
- Men can have hot flashes with low testosterone or androgen deprivation therapy for prostate cancer.
Treatment
- Lifestyle: dress in layers, keep the bedroom cool, use fans, avoid triggers, exercise and maintain a healthy weight.
- Menopausal hormone therapy is the most effective treatment, with risks and benefits depending on age and health history.
- Non-hormonal prescription options: low dose SSRIs/SNRIs (paroxetine, venlafaxine), gabapentin and fezolinetant (Veozah), approved by the FDA in 2023.
- Cognitive behavioral therapy and clinical hypnosis show benefit.
See a doctor if
Hot flashes disrupt sleep or daily life, begin before age 40, are accompanied by weight loss, fever, rapid heartbeat or night sweats, or you are unsure of the cause.
Typical menopause facts
Hot flashes affect around 75 percent of women in menopause, according to the Menopause Society. They often last 7 years or longer, and in some women more than a decade. The average age of menopause in the US is 51. A hot flash is a sudden feeling of heat, often in the face, neck and chest, with flushing and sweating, lasting from 1 to 5 minutes.
Other causes and options
Hot flashes can also be caused by thyroid disorders, infections, certain medications such as tamoxifen and some antidepressants, anxiety, and in men by androgen deprivation therapy. Triggers include alcohol, caffeine, spicy food, stress and warm rooms. Menopausal hormone therapy is the most effective treatment for many women, with risks that depend on age and health. Non hormonal options include fezolinetant (approved by the FDA in 2023), certain SSRIs and gabapentin. See a doctor for frequent flashes with weight loss, palpitations or night sweats.
Based on data from the Menopause Society and the US Food and Drug Administration
