Hot flashes — those sudden surges of hot skin and sweat associated with menopause and perimenopause — start for most women in their 40s. If that’s news to you, take a deep breath. 

First, hot flashes occur less frequently in perimenopause (the pre-menopause years) than during menopause. Second, there are several ways you can manage these heat spikes to lessen their impact on your daily life.

Wen Shen, M.D., M.P.H., a Johns Hopkins gynecologist who specializes in perimenopause and menopause, shares information about hot flashes and steps you can take to minimize their affect. 

Q: What is a hot flash?

A: Hot flashes are the quick bursts of hot skin and often drenching sweat that last anywhere from 30 seconds to about five minutes. Your face and neck may turn red, your heart rate may increase and you will most likely break out in a sweat. Night sweats are the same thing, only you’re asleep and are jolted awake by the heat and sweat sensation consuming your body.

These sudden bursts, especially at night, can cause fatigue, irritability and even forgetfulness. For 10 to 15 percent of women, hot flashes are so severe that they disrupt normal functions, such as leading a meeting or sticking to a schedule. If you feel your daily activities are impacted by hot flashes, make sure to speak with your gynecologist.

Q: How long will I get hot flashes?

A: On average, you may be looking at 10-15 years of living with hot flashes. Though they are sporadic, their unpredictability is very frustrating. Let’s look at what you can expect:

• 40s: This is when most women start perimenopause. Some hot flashes and night sweats begin. (For some, perimenopause starts in the 30s.)
• 46-53: In the U.S., this is the average age for menopause, which is defined as 12 straight months with no period. Hot flashes tend to be most frequent in the two years after menopause.
• Late 50s: Most women continue to have hot flashes anywhere from 4-10 years after menopause. But most of these will decrease in frequency and severity.

Q: What causes hot flashes?

A: The exact causes of hot flashes are still unknown, but they are thought to be related to changes in the brain’s thermoregulatory center, which controls heat production and loss, and is influenced by your hormones. During perimenopause, hormones start acting like a rollercoaster, with progesterone and estrogen levels changing in wide variations. These ups and downs don’t settle down until almost 10 years after menopause.

Q: How can you control hot flashes?

A: There are several ways to deal with hot flashes. Since hormone levels are changing all the time, we don’t treat the hormone levels — we treat the symptoms. Start with lifestyle changes, but if that doesn’t work, talk to your gynecologist about prescription medication.

Lifestyle

1. Keep Yourself Cool.

• Dress in layers so you can easily remove clothes if you get hot. 
• Wear natural fibers instead of synthetic materials.
• Carry a portable fan in your purse. 
• Use cold water and pre-treated wipes to cool the back of your neck when you feel a hot flash coming on. 

2. Avoid Triggers.

• It may take you a while to figure out your triggers. For most women, they include coffee and red wine.
• Review your medications with your provider. Certain high blood pressure and cholesterol medicines are known to cause hot flashes.

3. Acupuncture: Research has shown that acupuncture can be highly effective for resolving hot flashes. In a study funded by the National Institutes of Health, hot flashes were reduced by almost half for 50 percent of women over eight weeks of acupuncture treatment.

Prescription Medications

If lifestyle changes don’t help you manage hot flashes, talk to your gynecologist about medication. 

1. Menopause Hormone Therapy: This is really the gold standard for treatment options — it is the most effective way to make sure hot flashes are manageable. There is a multitude of options, and your gynecologist can recommend a treatment that meets your needs. 
2. Nonhormonal Medications: For women who do not wish to use hormone therapy, or cannot use it due to medical problems, there are nonhormonal medications such as gabapentin, selective serotonin reuptake inhibitors (SSRIs) and clonidine.
3. New Drugs: There are new drugs and injections being tested that may take care of specific menopausal symptoms. Especially if you cannot take hormone therapy because it may be harmful to you (a medical contraindication) or if you did not find relief with the other medications, these new drugs may be helpful. Talk to your provider to find out if you qualify to use them. 

Hot flashes are an unavoidable part of being a woman. But with lifestyle choices and perhaps help from your gynecologist, you can manage them with minimal disruption to your life.