What Are Hot Flashes?
Hot flashes (flushes) are episodes of intense warm feeling on the face and upper trunk that last from few seconds to few minutes. They are not the same as the low-grade fever, which usually lasts at least for several hours, and can be detected by the thermometer, while hot flashes cannot be.
Hot flashes may appear in menopausal women and in healthy middle aged men for different reasons. It can also affect any person or any age during periods of psychological stress and with some diseases.
Non-Hormonal, Non-Disease Causes of Hot Flashes
One theory suggests that hot flashes are one form of thermoregulation – the way how the body gets rid of excessive heat (1). When the thermoregulation center in the brain detects increased internal heat, or even increased blood flow through it, it triggers the release of substances (prostaglandins, serotonin) in circulation that will cause dilation of the skin vessels. This way the blood comes near the body surface and release the heat into environment.
A hot flash will last or keep repeating until core body temperature falls to the level determined with thermoregulation center that acts like a thermostat. The other theory says that hormonal or other substances cause instability of the skin blood vessels. It is believed that this sudden widening of the blood vessels with increased blood flow to the body surface that is perceived as a hot flash.
What Can Trigger a Hot Flash:
- Emotional or other stress where adrenaline (epinephrine) is released, and sympathetic nerves are stimulated
- Psychological instability, panic attack
- Heat from hot shower, hot weather, hot room, hot, caloric or big meal, etc.
- Smoking, and marijuana aggravates hot flashes (2)
- Using electric blanket in bed
- Spices, like hot chili pepper (containing capsaicin), and various food additives that stimulate blood flow through the brain
- Any stimulant
- Alcohol, caffeine, energy drinks
- Certain medications: anti-depressants, anti-anxiety drugs, diuretics, nitrates, high pressure pills, raloxifene, anti-androgens (e.g. cyproterone in treatment of prostatic cancer), withdrawal of morphine, dilaudid, or tamoxifen (in treatment of breast cancer)
- Certain remedies (check an information leaflet for side effects)
- Young menstruating women may experience hot or cold flashes in premenstrual period
Hot Flashes in the Female and Male Menopause
It seems that normal levels of estrogen and testosterone in the blood allow rise of the core body temperature for about 1.8°C without causing hot flashes. When estrogen (in female menopause) or testosterone (in male menopause) falls under the certain level, the rise of the core body temperature for 0.8°C can trigger a hot flash (1). Smoking can aggravate hot flashes in menopausal women (1).
Hot flashes may appear few years before or after the menopause, and the level of estrogen or testosterone levels may not be necessary decreased at the time. Hot flashes appearing sporadically, like once in a month are not likely to be related with menopause and do not require some special treatment.
Not all women have hot flashes during menopause.
Hot Flashes in Certain Diseases
Substances that trigger hot flashes (serotonin, prostaglandines) can be released in some diseases (1,2):
- Hypergonadotropic ovarian failure, familial or sporadic
- Cancers: carcinoid, medullary carcinoma of thyroid, pancreatic carcinoma, pheochromocytoma (cancer of adrenal medulla), brain tumors
- Systemic mast cell disease
- Spinal cord injury
Symptoms of Hot Flashes
Main characteristics of hot flashes:
- Hot flashes may appear every hour or only few times a week. They may last for few seconds to several minutes and may vary in intensity. They are common in the morning and at night (2).
- Menopausal hot flashes may last from few months to several years, symptoms tend to decrease with time, but in some women may be lifelong.
- It may be preceded with an uneasy feeling, an “aura“.
- They may be accompanied by a rapid heartbeat, nausea, dizziness, mood swings, anxiety, depression, headache, weakness or a feeling of suffocation.
- Redness or sweating (flushing) may be barely notable, or prominent. Flushing appears on the upper part of the body: face, chest, back of the neck, and eventually spreads over the entire body.
- Chills may appear on the end of a flash
- If they happen during the night, they are called night sweats – they may disturb sleeping.
- There is no symptoms between flashing episodes.
- Long term flashing may result in acne rosacea.
Prevention of Hot Flashes
Hot flashes can be prevented by:
- Avoiding unnecessary stress, hot shower, hot or big meals for three hours before bed
- Having a cold shower before bed
- Practising deep, slow abdominal breathing (6-8 times in a minute for 15 minutes) in the morning, or when flashes are expected can help (1)
- Learning how to cope with stress
- Avoiding high-calorie or big meals, and suspicious spices and additives
- Lowering night room temperature without adding additional blankets
- Wearing cotton clothes and pajamas, avoiding wool and synthetics
Treatment of Hot Flashes
Hot flashes is a symptom and does not always require treatment. The decision to treat hot flashes depends on the severity and underlying cause.
Hormone replacement therapy (HRT) is commonly prescribed for menopause but this is not only for reducing hot flashes. HRT is also effective in managing the other symptoms of menopause and associated complications like the increased risk of heart disease and reduced bone mass density. Anti-anxiety drugs and antidepressants may be used for hot flashes associated with psychological stress or depression.
Due to the side effects associated with drugs, many people search for an alternative approach. There are a number of nutritional supplements purported to help ease hot flashes. This has not always been proved to be effective. At times non-drug approaches may be considered for managing hot flashes particularly when it is associated with psychological stress. Stress management programs may be helpful in this regard.
Always consult with a doctor before undertaking any therapy.
Disorders with Symptoms Resembling Hot Flashes
Diseases with low grade fever that can be confused with menopausal hot flashes:
- Food allergies
- Ciguatera fish poisoning
- Cancer of any type, including metastases
- Viral (atypical) pneumonia
- Palmar hyperhidrosis – excessive sweating of hands