You’re having dinner with friends when suddenly heat rises in your body. You start sweating. Your face will turn red and you may even feel your heart racing. They ask, “Is it hot in here or is it just me?” It’s just you – but definitely not just you.
Hot flashes and night sweats, also known as vasomotor symptoms (VMS) of menopause, are associated with perimenopause and menopause. VMS affects 8 in 10 women over 40 and can last an average of 7 years, sometimes even up to a decade. Approximately one in three women report having up to 10 hot flashes per day. And each menopausal hot flash can last one to five minutes. In Native American and Black women, symptoms may last longer and the severity may be worse.
VMS can affect your mood, cause anxiety, and affect your sleep. This can impact your ability to concentrate, work, or be present in relationships. Fortunately, menopause symptoms are receiving more and more attention.
Read: 7 Menopause Tips from the Pros >>
What happens to your body during a hot flash?
As you enter perimenopause and menopause, your estrogen levels begin to decline. This drop in estrogen can affect your brain’s thermoregulatory center, which helps regulate body temperature, said Robin Noble, MD, an ob-gyn and chief medical advisor for the nonprofit organization Let’s Talk Menopause.
Before perimenopause, when we run up the stairs or are stressed about something, our body temperature can fluctuate. But we can manage this without causing a hot flash. “As our estrogen drops, our thermoregulatory zone narrows. There is less wiggle room and changes in body temperature are less tolerated,” Noble said.
Menopausal hot flashes can occur anytime, anywhere, day or night, and they can range from a mild feeling of warmth to an incredibly bothersome feeling that makes you sweat. Your skin may feel clammy and you may experience chills and fear after the flash.
Hormone therapy for hot flashes
Hormone therapy (HT) is widely considered the gold standard for the treatment of menopause and VMS. HT treats menopause symptoms by replacing estrogen and progesterone in your body.
The two main types of HT are:
- Estrogen therapy: This hormone treatment replaces estrogen that the body no longer produces during menopause. Estrogen therapy alone can increase the risk of uterine cancer, so people who no longer have a uterus can take estrogen-only therapy.
- Combination therapy: Combination therapy is a mixture of estrogen and progestin. This is recommended for women who still have a uterus. The progestin in combination therapy protects the uterine lining from the negative effects of estrogen.
The safest way to estrogen therapy is through the skin, with patches, gels, mucous membrane rings or creams. There are also estrogen tablets, but they slightly increase the risk of stroke. Progestogen is often administered orally or vaginally.
In addition to relieving hot flashes, hormone therapy can also protect other areas of the body. HT can have positive effects on bone health, cardiovascular disease, diabetes, joint pain, and skin and hair changes. Because HT can also help regulate your mood, it can also be helpful in relieving symptoms of anxiety and depression.
However, hormone therapy carries some risks and is not for everyone. If you have certain types of cancer, are at high risk of blood clots, or have had a stroke or other cardiovascular disease in the past, you may need to consider other options.
Non-hormonal medications for hot flashes
Some women are unable to take HT, while others may prefer not to. There are now two types of FDA-approved non-hormonal medications on the market that treat moderate to severe menopausal hot flashes.
Both nonhormonal drugs work by blocking pathways in the brain’s temperature control center.
- Elinzanetant (brand name Lynkuet) is a dual NK1 and NK3 receptor antagonist.
- Fezolinetant (brand name Veozah) is an NK3 receptor antagonist.
Both medications have been shown to reduce moderate to severe menopausal hot flashes and improve sleep quality.
Note: Because elinzanetant and fezolinetant are processed by the liver, you will need to have a blood test every three months to check your liver enzymes.
Talk to your doctor about hot flashes
When you’re struggling with hot flashes, it may seem like there’s no end in sight. That’s why it’s important to find a healthcare provider (HCP) who will listen to your concerns and help you make an informed decision.
Here are some ways to prepare for your appointment:
- Track your symptoms for a few weeks before your appointment
- Write down your questions so you don’t forget them
- Share your preferences for hormonal or non-hormonal medications
If your doctor dismisses your symptoms or doesn’t listen to you, it may be time to look for a new one. To find a menopause-certified HCP near you, search the Menopause Society directory by zip code. Or look for a telemedicine expert. Because there is more choice, there is no reason for anyone to struggle with hot flashes.
This educational resource was created with support from Bayer, a member of the HealthyWomen Corporate Advisory Council.
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