Hot flash

Hot flash

Hot flashes (also known as hot flushes, or night sweats if they happen at night) are a symptom of the changing hormone levels that are considered to be characteristic of menopause.


Hot flashes, a common symptom of menopause and perimenopause, are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes for each occurrence. The sensation of heat usually begins in the face or face and chest, although it may appear elsewhere such as the back of the neck, and it can spread throughout the whole body. Some women pass out if the effects are strong enough. In addition to being an internal sensation, the surface of the skin, especially on the face, becomes hot to the touch. This is the origin of the alternative term "hot flush," since the sensation of heat is often accompanied by visible reddening of the face. Excessive flushing can lead to rosacea.

The hot-flash event may be repeated a few times each week or constantly throughout the day, with the frequency reducing over time. Hot flashes may begin to appear several years before menopause starts and last for years afterwards. Some women undergoing menopause never have hot flashes. Others have mild or infrequent flashes. The worst sufferers experience dozens of hot flashes each day. In addition, hot flashes are often more frequent and more intense during hot weather or in an overheated room, the surrounding heat apparently making the hot flashes themselves both more probable and more severe.

Severe hot flashes can make it difficult to get a full night's sleep (often characterized as insomnia), which in turn can affect mood, impair concentration, and cause other physical problems. When hot flashes occur at night, they are called "night sweats." As estrogen is typically lowest at night, some women get night sweats without having any hot flashes during the daytime.

Types of hot flashes

Some menopausal women may experience both standard hot flashes and a second type sometimes referred to as "slow hot flashes" or "ember flashes." The standard hot flash comes on rapidly, sometimes reaching maximum intensity in as little as a minute. It lasts at full intensity for only a few minutes before gradually fading.

Slow "ember" flashes appear almost as quickly but are less intense and last for around half an hour. Women who experience them may undergo them year-round, rather than primarily in the summer, and ember flashes may linger for years after the more intense hot flashes have passed.

In younger women

Younger women who are menstruating or expecting to menstruate soon (the premenstrual period typically lasts one week) may encounter hot and/or cold flashes. These episodes do not usually last long, with feelings of cold and heat alternating over the course of as short as a minute. Hot and cold flashes for younger women tend to occur only during times of menstruation or premenstruation (when estrogen is typically lowest). If they occur at other times in a young woman's menstrual cycle, then it might be a symptom of a problem with her pituitary gland; seeing a doctor is highly recommended.

In younger women who are surgically menopausal, hot flashes are generally more intense than in older women, and they may last until natural age at menopause.


Hormone replacement therapy (HRT)

Hormone replacement therapy may relieve many of the symptoms of menopause. However, HRT may increase the risk of breast cancer, stroke, and dementia and has other potentially serious short-term and long-term risks.

The U.S. FDA and women's health advocates recommend that women who experience troublesome hot flashes try alternatives to hormonal therapies as the first line of treatment. If a woman chooses hormones, they suggest she take the lowest dose that alleviates her symptoms for as short a time as possible.

Selective estrogen receptor modulators (SERMs)

SERMs are a category of drugs that act selectively as agonists or antagonists on the estrogen receptors throughout the body. PhytoSERMs are SERMs that originate from a natural source, and have been scietifically proven to have the same mode of action as chemically derived SERMs, thus making them relatively safer than other types of treatment. Available SERMs which are currently used for treating hot flushes include:

  • Femarelle (DT56a) - an effective phtoSERM which affects estrogen receptors in the brain agonistically, thus alleviating hot flushes, while having no effect on estrogen receptors in the breast and uterus , which makes it safe.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a class of antidepressants most commonly used in the treatment of depression, and some personality disorders. They been found as efficient in alleviating hot flashes. SSRIs are commonly accompanied by side effects such as nausea and headaches.


Although there is some conflicting evidence concerning the effectiveness of isoflavones, a few products can be found in the market belonging to this category. Isovlafones can be produced from soy, red clover, ginseng, black cohosh and St. John’s wort. The two soy isoflavones believed to have an important role in relieving menopausal symptoms are genistein and daidzein. These compounds are also known as phytoestrogens. The half life of the active metabolites of these molecules is about eight hours, which partially explains why some studies have not consistently shown effectiveness of soy products for menopausal symptoms. Although red clover (Trifolium pratense) contains isoflavones similar to soy, the effectiveness of this herb for menopausal symptoms at relatively small concentrations points to a different mechanism of action.

Other Phytoestrogens

It is believed that dietary changes that include a higher consumption of phytoestrogens such as soy, red clover, ginseng, black cohosh and yam may relieve hot flashes. Note that severe side effects of liver function have been reported with the use of Black Cohosh.

  • Ginseng - Very few good quality studies exist on the effect of ginseng for relief of menopausal symptoms; however, hundreds of years of anecdotal evidence exists using ginseng as part of tonics made by Chinese herbalists. In a large double-blinded randomized controlled trial, reduction in hot flashes was not statistically significant but showed a strong trend towards improvement.
  • St. John’s wort - has long been used to treat symptoms of depression. There is ample evidence that the mechanism of action of this herb is similar to that of SSRIs. Research pending publication, presented by the authors at this year’s American College of Obstetrics and Gynecology’s Annual Clinical Meeting shows that Tao Formulations’s Harmony product relieves hot flashes in 83.5% of women with a 89.4% reduction in hot flash severity.

Lifestyle changes

Other lifestyle changes may help as well. These include avoiding caffeine, hot drinks, chocolate, spicy or hot foods and alcohol. Dressing in layers is a common-sense approach that seems to help. Although there is some debate about this in the medical literature, some evidence exists that regular exercise can reduce hot flashes and that yoga can help by teaching women to control their body's response to the stresses that can lead to bothersome hot flashes.


It has been speculated that hot flashes are considerably less common among Asian women, possibly due to their soy rich diets .

Hot flashes in men could be a possible sign of low testosterone. Men who are castrated can also get hot flashes. Men with prostate cancer who are undergoing hormone therapy with antiandrogens, also known as androgen antagonists, which reduce testosterone to castrate levels, can have hot flashes as the most common side effect.


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