What Are Menopause Cold Flashes?

Francesca Turner, DO, an obstetrician-gynecologist at Broadlawns Medical Center in Des Moines, Iowa, and a fellow of the American College of Obstetricians and Gynecologists (ACOG), describes cold flashes as “brief, self-limited episodes in which a person suddenly experiences an intense sensation of cold that may be accompanied by shivering, and the urge to bundle up.”

Dr. Turner notes that cold flashes are part of a broader category of vasomotor symptoms, or VMS, which includes hot flashes and night sweats.

The first time Cynthia Halow, a woman in her fifties in Denver, started having cold flashes, she thought she was coming down with the flu. But when Halow took her temperature, she didn’t have a fever.

The chills began a few months after her very last menstrual period. It never occurred to her that her sudden chills could be related to menopause.

“It was odd,” says Halow, the founder of PersonalityMax, a website that specializes in personality tests. After experiencing these chills several more times, Halow decided to do her own research — and learned that “cold flashes” can be another symptom of menopause.

A cold flash can occur either on its own or immediately following a hot flash, Turner says.

No evidence suggests that cold flashes alone are associated with negative outcomes. Still, VMS as a group has well-known negative effects on sleep, mood, daytime function, and quality of life, Turner says. “These downstream effects — insomnia, impaired concentration, and mood disturbance — can be clinically important and are the usual reason to treat VMS.”

Emerging research has also linked severe or persistent VMS — not isolated cold flashes — to worse patient-reported outcomes and even long-term cardiovascular risk,” she adds.

“Your doctor should therefore assess the frequency, severity, timing (day vs. night), and impact of cold or hot flashes, and manage them as part of the overall VMS syndrome when they impair sleep or daily life.”

As with hot flashes, it’s thought that cold flashes are linked to the drop in estrogen levels that occurs during menopause. When this happens, the hypothalamus, which regulates body temperature, may become more sensitive to small changes in body temperature, causing it to “overreact” with a cold (or hot) flash.

“With lower estrogen levels, the hypothalamus’s range of acceptable temperatures becomes narrower,” Turner says. “Small fluctuations in core temperature that previously would not elicit a response now trigger the body’s responses to extreme heat or cold.”

Turner says that ACOG and The Menopause Society emphasize that, in the typical age group for menopause, these hormonal changes are the most common cause of VMS, including cold flashes.

But she notes that the following factors can also contribute to cold flashes, particularly in women who are too young for menopause or experience an abrupt onset of cold flashes unrelated to the menstrual cycle, among other factors:

• Side effects from medications or other substances
• Endocrine or metabolic disorders, such as thyroid disease or hypoglycemia
• Infectious or inflammatory diseases
• Cardiopulmonary or oncologic causes, such as some rare cancers
• Psychiatric causes, including panic disorders
• Pregnancy

While there’s no way to prevent cold flashes completely, there are ways to cope with them and mitigate the symptoms. These include both lifestyle changes and medications.

Lifestyle Changes

Some lifestyle approaches may reduce the number of cold flashes you experience, while others may help you recover faster.

• Wear layers. Keep a jacket or shawl handy to slip on when you feel cold and take off after the chill passes.
• Drink it off. When a cold flash occurs, a hot beverage like tea or warm milk will warm your body. Feeling hot? Drink some ice water to cool down and possibly prevent a rebound cold flash.
• Try mindfulness. Wen Shen, MD, MPH, the director of the Women's Wellness and Healthy Aging Program and an associate professor of gynecology and obstetrics at Johns Hopkins Medicine in Baltimore, says some of her patients have experienced fewer cold flashes after starting a mindful meditation practice. Not only could mindful meditation help prevent the anxiety that may trigger a hot flash, but it can also help you cope with the episode itself (something that can also be anxiety-provoking).
• Avoid hot flash triggers. Anything that can trigger a hot flash — like alcohol and spicy food — can also trigger a rebound cold flash.

Nonhormonal Medications

Currently, the only nonhormonal drug approved by the U.S. Food and Drug Administration (FDA) to treat hot flashes is paroxetine, a selective serotonin reuptake inhibitor (SSRI) that’s typically used to treat depression. It has been shown to significantly reduce hot flashes as well as cold flashes. (Other SSRIs are sometimes used off-label to treat hot flashes.)

Hormonal Medications

Your doctor may also prescribe hormone therapy (low doses of estrogen and progesterone) to ease hot or cold flashes. These are the primary ovarian hormones that decline in menopausal women.

• A cold flash is a menopausal symptom characterized by sudden chills that can feel like the onset of a flu-like illness.
• Cold flashes may occur on their own or follow a hot flash.
• If lifestyle changes aren’t enough to manage your cold flashes, speak with your healthcare provider about medications that may relieve your symptoms.