Hot Flashes: Why They Happen and What a Primary Care Visit Can Do

What it involves

MedlinePlus lists hot flashes, usually worst during the first one to two years, among the common symptoms of menopause, along with night sweats and skin flushing. It says menopause is the time when periods stop, most often between ages 45 and 55, and is complete after a year without a period.

Who this is for

• Women in their 40s and 50s with sudden waves of heat, flushing or night sweats
• Patients whose periods have become irregular and who want to know if this is menopause
• Adults whose sleep is broken by sweating at night
• Anyone with hot flashes who is not sure whether a medicine, thyroid or another condition is involved

What to expect

• Questions about your periods, how often the flashes come, what triggers them and how they affect your sleep and mood
• A review of your medicines, health history and family history
• Blood tests when they will help, such as hormone levels or a thyroid check, as your provider decides
• A discussion of lifestyle steps and treatment options, including the benefits and risks of each

Why hot flashes happen

The MedlinePlus encyclopedia explains that during menopause the ovaries stop releasing eggs and the body makes less of the hormones estrogen and progesterone, and that lower levels of these hormones cause the symptoms. Periods often become irregular for one to three years before they stop. Symptoms vary a great deal from woman to woman and can last five years or more. Some women have almost none, and others have symptoms that are moderate to severe, so a plan has to fit the person.

What else comes with menopause

Along with hot flashes, MedlinePlus lists night sweats, skin flushing, sleeping problems, a pounding or racing heart, mood swings, headaches, joint aches, vaginal dryness, urine leakage and, in some women, forgetfulness. Poor sleep is often a result of the night sweats rather than a separate problem. If the sweating is the main complaint, the night sweats guide covers other causes, and the guide to excessive sweating covers sweating that happens in the daytime.

When hot flashes are not menopause

Feeling flushed and sweaty has other causes, which is why a visit is worth having. MedlinePlus lists too much thyroid hormone, certain medicines and infection among the reasons a person may feel overheated and sweat heavily, and it says menopause can also be brought on by chemotherapy or by hormone blocking therapy for breast cancer. Hot flashes in a man, or in a woman who is not near menopause, deserve a closer look. A provider may order thyroid tests and other blood work to sort it out.

Self-care steps MedlinePlus suggests

MedlinePlus patient instructions suggest dressing lightly and in layers, keeping the room cool, and slow deep breathing when a flash begins, at about six breaths a minute. It also suggests relaxation techniques, eating at regular times, avoiding caffeine after the early afternoon, limiting alcohol, which can worsen symptoms and disrupt sleep, and not smoking. Regular exercise helps keep bones strong, and the bone density screening guide explains why bone health becomes part of the conversation after menopause.

Treatment options your provider may discuss

MedlinePlus says treatment may include lifestyle changes, hormone replacement therapy, or both, depending on how bad the symptoms are, your overall health and your preferences. It says current guidelines support hormone therapy for hot flashes in women who recently entered menopause, that the benefits and risks need to be weighed using your whole medical and family history, and that it should not be used longer than necessary. It also notes that a class of antidepressant medicines has been shown to help with hot flashes. Any prescription is a decision made together at the visit.

When to call sooner

MedlinePlus advises reporting any new vaginal bleeding, or bleeding that comes more often or is heavier, right away. A racing, irregular or pounding heartbeat with chest pain, shortness of breath or fainting should be treated as an emergency rather than as a hot flash, and the heart palpitations guide explains those warning signs. Mood changes that feel heavy or hopeless deserve their own visit, and the depression screening guide describes how that is approached.

Sources

• MedlinePlus: Menopause (medical encyclopedia)
• MedlinePlus: Managing menopause at home (patient instructions)
• MedlinePlus: Menopause (health topic)