What Are Menopausal Hot Flashes? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Hot flashes are the most common of all the menopause symptoms related to hormone changes, but their exact cause is still somewhat unclear.

If the hypothalamus gauges elevated body temperature, blood vessels near the skin’s surface begin to vasodilate (enlarge), which increases blood flow to help lower it. Hot flushes may produce a red color in the face, neck, and chest. They may also trigger sweating and an elevated heart rate.

• A sudden warm feeling that spreads across your chest, neck, and face
• A flushed appearance with red, blotchy skin
• A quicker heartbeat
• Perspiration, primarily in your upper body
• Chills as the hot flash passes
• Feelings of anxiety
• Sudden dizziness or feelings of nausea

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Women over 40 years old who have reached the perimenopausal, menopausal, and postmenopausal stages of life are most prone to hot flashes.

• Current and former cigarette smoking
• Having obesity
• Race
• A history of abuse

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What Causes Hot Flashes Besides Menopause?

They are a common symptom of the menopausal transition. There are no tests to show that you’re having hot flashes, but your doctor can usually identify that you are having them based on your menopausal status and a description of your symptoms.

For a small percentage of women, they may never go away. And it’s not uncommon for hot flashes to pop up again more than a decade after menopause, even in women in their seventies or older. There is no reliable way of predicting when hot flashes will first start or stop.

There are pharmaceutical and lifestyle remedies to help minimize and address hot flashes. Every medication comes with potential side effects and risks; talk to your doctor about the benefits and potential pitfalls of the options available to you.

Note that many of these are used off-label, unless specified as U.S. Food and Drug Administration (FDA) approved for treating hot flashes.

Medication Options

• Hormone Therapy or Hormone Replacement Therapy Hormone therapy, also known as hormone replacement therapy or menopausal hormone therapy, is medication to treat hot flashes and other bothersome menopause symptoms, such as night sweats and vaginal dryness. For hot flashes, hormones are taken via pills, patches, sprays, gels, or a vaginal ring.

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  Hormone therapy is FDA approved as a first line of treatment for hot flashes, with estimates of a 75 percent reduction in vasomotor symptoms.

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   Systemic hormones include estrogens — either the same or similar to the estrogens produced naturally in the body — and progestogens, which include progesterone or a similar compound.

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  Systemic hormones have other benefits, like boosting bone health. If you are having disruptive hot flashes, talk to your doctor or a menopause expert about hormone therapy and other options for treating VMS.
• Selective Serotonin-Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) For women who choose not to or cannot take hormones, nonhormonal drugs approved to treat depression, called SSRIs and SNRIs, have been shown to be effective in treating hot flashes in women who don’t have depression.

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  The only SSRI the FDA has approved to treat hot flashes is paroxetine (Paxil, Brisdelle). Some of the side effects of these medications, such as weight gain and sleep disturbances, overlap with menopause symptoms, so it’s important to discuss these symptoms with your doctor.

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• Oxybutynin (Ditropan XL, Oxytrol) This nonhormonal drug is used for overactive bladder, but it has also been shown to successfully decrease hot flashes. Several studies found that oxybutynin reduces hot flashes by 70 to 86 percent.

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   However, oxybutynin is not considered a drug of choice for people over age 65 due to a possibility of cognitive impairment. So, your doctor may or may not recommend this drug based on your age, health history, risk factors, and other medications.
• Gabapentin (Neurontin, Gralise) An anti-seizure medication, gabapentin is moderately effective in reducing hot flashes.

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  Some of the side effects, such as weight gain and fatigue, may overlap with menopause symptoms. Because of this, your doctor might prescribe a low dose or recommend taking gabapentin in the evening. Other side effects include dizziness, difficulties with coordination, edema, lethargy, and drowsiness.

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• Pregabalin (Lyrica) This is another anti-seizure medication that can be effective in reducing hot flashes. Some people may benefit from this medication, but because of potential side effects (drowsiness, dizziness, trouble focusing, and weight gain), it is important to discuss all available options with your doctor to find what is best for you.

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• Neurokinin 3 Receptor Antagonists In May 2023, the FDA approved fezolinetant (Veozah), a nonhormonal oral compound used to treat moderate to severe VMS.

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  This medication works by managing the cause of hot flashes in the brain’s signaling. Studies have shown a rapid and substantial reduction in VMS frequency and severity as well as improvements in health-related quality of life.

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  Note that on September 12, 2024, the FDA issued a warning that fezolinetant could cause a rare but serious liver injury.

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  Women experiencing symptoms such as new-onset fatigue, jaundice, nausea, and vomiting should stop taking the drug.
• Neurokinin 1 and Neurokinin 3 Receptor Antagonists In October 2025, the FDA approved elinzanetant (Lynkuet) to treat moderate to severe VMS.

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   This medication also works by managing the brain’s chemical signaling to prevent hot flashes. It has minimal side effects.

Complementary and Alternative Remedies for Treating Hot Flashes

More research is needed to support their use for the treatment of hot flashes. There are fewer safety concerns with psychological treatment, dietary changes, and exercise approaches for menopause symptoms.

• Hypnosis
• Cognitive behavioral therapy
• Exercise

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Lifestyle changes such as these may help prevent hot flashes, and they may also aid with other unwelcome menopause symptoms, such as difficulty sleeping or mood issues.

Managing a Hot Flash in the Moment

Running cold water on your wrists may help relieve discomfort. If you carry a hand-held fan, you can use it to help cool off. See more tips and suggestions in the prevention section.

Menopausal hot flashes may be correlated with other health issues.

• Heart Disease Research has shown a link between vasomotor symptoms like hot flashes and an increased risk of cardiovascular disease. A study published in the Journal of the American Heart Association found that frequent and persistent vasomotor symptoms were associated with a higher risk of future cardiovascular disease, and that vasomotor symptoms may be a novel female-specific heart disease risk factor.

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  Plus, every time your heart rate increases, your blood pressure goes up; because of this, women who experience hot flashes are more likely to have damaged blood vessels.
• Lower Bone Density The decrease of estrogen that occurs with menopause can cause bone loss. Some women can lose up to 20 percent of bone density in the first seven years postmenopause.

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• Perimenopausal Depression The early and late stages of perimenopause — as well as the first few years after menstruation stops — are vulnerable times for the development of depressive symptoms and episodes, and midlife depression often occurs in combination with vasomotor symptoms like hot flashes.

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• Migraine A study including more than 3,000 women found the correlation between hot flashes and migraine is significant, and the more severe your hot flashes are, the more likely you are to report severe migraine attacks.

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   More recent research shows that women who experience both migraine attacks and hot flashes are at higher risk of stroke and heart attack.

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• Cognitive Function and Mood Disorders The relationship between night sweats, sleep, and cognitive function has been challenging for researchers to deconstruct. Some research suggests that vasomotor symptoms can lead to fatigue, irritability, depression, and memory dysfunction.

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• Insomnia and Other Sleep Problems Hot flashes and other vasomotor symptoms such as night sweats can disrupt sleep, and research shows that they contribute to insomnia and other serious sleep problems that many women develop in midlife.

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• Try to maintain a healthy weight. Hot flashes are associated with a higher body mass index (BMI). Women who are overweight or have obesity may experience more frequent and severe hot flashes.

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• Rethink your bedroom setup. Keep the thermostat lower in your bedroom if hot flashes keep you up at night. Use a fan, drink small amounts of ice water before turning in, and layer your bedding so you can shed or add blankets if needed.
• Avoid alcohol, spicy foods, hot beverages, and caffeine; they may trigger or worsen vasomotor symptoms.
• Quit smoking.
• Explore mind-body practices. Some early stage research has shown that hypnotherapy and mindfulness meditation could help manage hot flashes.

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