It starts as a warm glow in the head or neck region. It slowly radiates down the body, slowly increasing in temperature. The feeling can last for about 30 seconds or several minutes. 

What we’re referring to is a condition called a hot flash, a symptom of perimenopause or menopause that arrives to announce that the end of a woman’s fertility is either approaching or has arrived. While not every woman gets them (an estimated 70 percent do), hot flashes are common and don’t really cause any physical complications beyond sweating and an uncomfortable feeling. There are, however, psychological ramifications to their arrival because many women believe they are a harbinger of the onset of old age. 

Depending on when the symptoms occur and what else is happening, hot flashes can be a sign of perimenopause (which can happen as early as the 30s for some women) or menopause, which happens to women when their menstrual periods become extremely irregular or cease entirely (usually in the late 40s or early 50s).

The main effect of perimenopause that estrogen levels will rise and fall in uneven cycles. That means menstrual cycles will be shorter or longer, and ovulation may not happen in some instances.

When You Visit the Doctor

Doctors will usually look for incidents of self-reported uncomfortable warmth that vary in length, intensity and frequency. In some cases, so-called “night sweats” keep women from uninterrupted and restful sleep. They also may test blood to check hormone levels and make sure that some underlying condition -- cancer or inflammation -- is not causing hot flashes. Tell the doctor about any medications currently being ingested because many have side effects that can wreak havoc with body temperature and mimic hot flashes.


One of the reasons doctors ask so many questions and conduct tests is to make sure that hot flashes are medically based. Although there are no definitive studies that link any particular action to hot flashes, there are a surprising number of other conditions that cause them, including:

1. Smoking – There has been research linking smoking to the earlier onset of perimenopause. That means that menopausal symptoms, including hot flashes, will manifest earlier.
2. Stress -- Yes, there are hormones that can be triggered by stress reactions to work, school, life issues, relationships and other situations. This can trigger an occasional hot flash.
3. Food -- If you fuel your body to the limit by overeating or eat something spicy the body is not accustomed to, the digestive furnace can be turned up, creating a hot flash sensation.
4. Restrictive clothing -- Sure, fashion is fun, and everyone wants to look good at the club. But binding the body in uncomfortable ways can create stress, which in turn can let loose hormones that can produce hot flashes.
5. Alcohol - As we are reminded many times, alcohol is a drug. Too much of a good thing or the right sort of alcoholic drink can trigger a body reaction, resulting in a hot flash.
6. Caffeine - The stimulant found in coffee, tea, soft drinks and some foods can stimulate the body’s productions of certain hormones.

Of course, other factors play a role in whether hot flashes will manifest. Things like family history, cancer treatments or a hysterectomy without removing the ovaries can all create conditions where hot flashes are possible.


Beyond hot flashes, perimenopause and menopause can be accompanied by mood changes, irritability, depression, vaginal dryness, bladder issues, decreased fertility (in the case of perimenopause) and sexual issues, including lessened desire and difficulty becoming aroused. If the cause of hot flashes is indeed perimenopause or menopause, then the patient is also at risk for osteoporosis, a bone-wasting disease, and higher cholesterol levels.

Hot Flash Treatments

The onset of hot flashes is not fully understood, so there are no foolproof treatments that can prevent them, particularly if they are not menopause related.

Hormone treatments with estrogen are typically used to treat hot flashes and other perimenopause or menopause symptoms.

Hormone therapy – Administered via skin patches, creams or pills that may ease some of the symptoms of perimenopause and/or menopause, including hot flashes. The woman’s medical history and whether the woman still has a uterus will determine the dose, which is typically a lower dose to start. There have been studies linking estrogen therapy to an increased risk of heart attacks, strokes and breast cancer, but many doctors believe that the studies focused on post-menopausal women. The treatments, researchers believe, do not have the same effect on younger, pre-menopausal women.

Vaginal estrogen – Available as a topical cream, taken orally or inserted into the vaginal canal, these treatments provide small doses of estrogen.

Antidepressants -- If estrogen can’t be taken, some doctors prescribe mood-enhancing serotonin reuptake inhibitors (SSRI), which can elevate mood and help with hot flashes.


Neurotonin -- Gabapentin is a drug taken for seizures, but one of its off-label uses is reducing hot flashes.

Unless they are related to tight clothing, the type of foods eaten, alcohol or smoking, hot flashes can’t be prevented. Beyond the medical treatments listed above, there are some alternative hot flash treatments that are gaining in popularity. Some of the treatments have been evaluated in clinical trials and have been effective.

Treatments include:

1. Phytoestrogens -- These are chemical compounds found in soy, chickpeas and lentils and are derived from plants. While they have lower levels of estrogen hormones, they can be effective for some.
2. Vitamin E -- Available in pill or liquid form, this vitamin can bolster the immune system and help with hot flashes.
3. Black Cohosh -- This is an herbal preparation that is good for short-term treatment of menopausal issues, including hot flashes. It is very popular in Europe and is just gaining a foothold in the United States.
4. Licorice -- A tasty treat, the compounds have also proved effective in reducing hot flashes in many women.