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Have you ever felt like your body suddenly turned up the thermostat, causing your skin to flush and your heart to race? If so, you may have experienced a hot flush, a common symptom of menopause that affects millions of women worldwide. But what exactly is a hot flush, and why does it happen? In this blog, we will explore the physiology behind hot flushes, the potential causes, and how to manage this often uncomfortable and disruptive symptom.

What is a hot flush?

I could feel my cheeks turning red and my skin starting to flush

Hot flushes (also known as hot flashes) are best described as an intense and sudden surge of upper body heat, typically associated with menopause. Hot flushes are a very common complaint, with around 80 per cent of women experiencing hot flushes and night sweats at some point in midlife. Doctors frequently use the presence of hot flushes, along with irregular periods, to diagnose perimenopause (the period leading up to menopause) in women over the age of 45.

My first hot flush - at the age of 44 - was quite unexpected and overwhelming. I was at work, seated quietly at my desk when I suddenly felt a prickling sensation in the middle of my back. At first, I didn't think much of it, but within seconds, the prickling turned into a sudden balloon of heat that rose up my back and quickly spread throughout my upper body. It was like someone had turned on a heater inside me, and the heat was rapidly rising up to my face. I could feel my cheeks turning red and my skin starting to flush.

As the heat intensified, I felt a wave of anxiety wash over me. I tried to stay calm, taking deep breaths, but the heat just kept rising. After what seemed like an eternity (but which was actually only a couple of minutes) the heat eventually subsided, and the prickling sensation began to fade, leaving me feeling drained and exhausted.

While my first experience was pretty typical, each woman is unique, which means symptoms can - and do - vary from individual to individual. For some, it can cause excessive sweating and blotchy skin, while others may experience heart palpitations, chills or intense anxiety. Some lucky women can go through menopause without ever experiencing a single hot flush.

Why do hot flushes occur?

The exact cause of hot flushes is not fully understood, but it is likely to be related to changes in hormone levels during perimenopause and menopause. As oestrogen levels decline, the body's thermostat - the hypothalamus - becomes more sensitive to changes in temperature. This can trigger a hot flush, which causes blood vessels in the skin to dilate, leading to a sensation of heat and sweating. In addition to physical symptoms, some women may experience emotional symptoms, such as anxiety, irritability, or a sense of unease.

Risk factors associated with hot flushes include being overweight or obese, lower education, ethnicity, anxiety and smoking. Women may also experience hot flushes as a side effect of cancer treatments, such as chemotherapy.

Frustratingly, hot flushes can occur at any time of day or night. Women who experience hot flushes are more likely to report sleep disturbances, which can further exacerbate other menopausal symptoms, such as fatigue and mood changes. In fact, a study of the impact of hot flushes on sleep in perimenopausal women found that the presence of hot flushes accounts for almost 70% of night-time awakenings in perimenopausal women!

What can I do to prevent hot flushes?

For others, the sheer frequency and intensity of hot flushes can negatively impact their work, their relationships, and their personal self-worth.

For some women, hot flushes are a bearable inconvenience. For others, the sheer frequency and intensity of hot flushes can negatively impact their work, their relationships, and their personal self-worth. Either way, reducing the impact of hot flushes can be a game-changer, leading to enhanced mood, better sleep, and overall improved well-being.

Common triggers for hot flushes in women include:

Stress
Spicy foods
Alcohol
Caffeine
Smoking

Avoiding these triggers can be a good place to start for women who are experiencing milder symptoms. In my case, I found that avoiding alcohol and caffeine, especially at night, was enough to manage my symptoms, and keep the hot flushes at bay.

Other lifestyle strategies that have been found to be effective in reducing hot flushes include aerobic exercise, yoga and cognitive behavioural therapy.

For some women, as menopause approaches, lifestyle changes alone may not be enough to alleviate hot flushes. In these cases, women may consider Menopause Hormone Therapy (MHT). Hormone therapy must be prescribed by your GP, and the type of hormone therapy prescribed will depend on a number of factors, including the severity of your symptoms, age, medical history and health risks, as well as your personal preferences.

Whether or not you decide to go down the hormone therapy path is a personal decision that should be made in consultation with your trusted health professional.

Summary

Hot flushes (also known as hot flashes) are intense and sudden surge of upper body heat, typically associated with menopause. They may be accompanied by sweating, blotchy skin or other symptoms.

If you’re experiencing hot flushes and wondering what the heck is going on, you're not alone - you’re one of 80% of women who will experience one at some point during menopause. While menopause may be inevitable due to hormone changes, hot flushes don’t have to ruin your life. From avoiding triggers, through to more proactive lifestyle and hormone-based strategies, there is help. Talk to your doctor to see what's right for you.

References/Citations

Thurston, R.C. and Joffe, H. (2011) “Vasomotor symptoms and menopause: Findings from the Study of Women's health across the nation,” Obstetrics and Gynecology Clinics of North America, 38(3), pp. 489–501. Available at: https://doi.org/10.1016/j.ogc.2011.05.006.

de Zambotti, M. et al. (2014) “Magnitude of the impact of hot flashes on sleep in perimenopausal women,” Fertility and Sterility, 102(6). Available at: https://doi.org/10.1016/j.fertnstert.2014.08.016.

Biglia, N. et al. (2019) “Non-hormonal strategies for managing menopausal symptoms in cancer survivors: An update,” ecancermedicalscience, 13. Available at: https://doi.org/10.3332/ecancer.2019.909.

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