Everything You Need to Know About Menopausal Hot Flashes

About 1.3 million people enter menopause every year, and according to the North American Menopause Society (NAMS), about 3 in every 4 of them will experience those most-famous-of-all menopause symptoms: hot flashes.

If you’ve never experienced one before, you may assume that it’s a temporary — albeit, intense — sensation of warmth that spreads across the face and body. But in fact, there’s more to it than that.

“Hot flashes go well beyond just getting hot,” says Mary Jane Minkin, MD, clinical professor in the department of obstetrics, gynecology, and reproductive sciences at the Yale University School of Medicine in New Haven, Connecticut, and founder of the website Madame Ovary.

Wondering what you can expect from a hot flash? (Or, more importantly, when will they finally go away?) Here are the answers to some of the most commonly asked questions.

What causes hot flashes during menopause?

Hot flashes may be common, but there’s a lot researchers don’t know about them — including why, exactly, they occur. The leading theory is that menopausal hot flashes are caused by hormonal changes — such as a decline in estrogen levels — that occur before, during, and even after menopause, says Dr. Minkin.

This may then trick your hypothalamus, the region of the brain that controls the body’s internal thermostat, into assuming you’re too hot. In response, your blood vessels widen (vasodilate), which boosts your blood flow and allows more heat to escape to the skin’s surface. The end result: a hot flash.

What can trigger hot flashes?

Hot flash triggers run the gamut from strong emotions, to spicy food and hot drinks, to (you guessed it) heat. Hot baths or too much clothing can trigger a hot flash, likely because they can cause the body’s internal temperature to rise, which causes the blood vessels to dilate, she says.

Other common triggers include alcohol and caffeine; other times, stress can trigger a hot flash. “Some women report emotional triggers such as feeling anxious or angry,” says Kristi Tough DeSapri, MD, a clinical assistant professor of obstetrics and gynecology and internal medicine at Northwestern University in Chicago.

How common are hot flashes related to menopause?

According to the NAMS, about 75 percent of women begin having hot flashes when they enter perimenopause — the roughly four to eight years prior to actual menopause (defined as having gone 12 consecutive months without menstruating). During perimenopause, hormones begin to fluctuate and a person’s periods become irregular and unpredictable.

A study published in the journal Menopause found that of people who have hot flashes, about 9 percent describe them as severe, 56 percent as moderate-intensity, and 33 percent as mild.

At what age do menopausal hot flashes start occurring?

“Generally, the most intense symptoms are one to two years before and after the final menstrual period,” explains Dr. DeSapri. The menopausal transition usually begins between the ages of 45 and 55, and tends to last for about seven years, according to the National Institute on Aging.

How long do people typically experience hot flashes?

For the vast majority of people, hot flashes related to menopause will last anywhere from six months to two years, according to NAMS. Some women, however, can experience them for 10 years, says DeSapri.

Minkin also estimates that about 10 percent of women will have hot flashes beyond 10 years — and, for a small percentage of women, hot flashes will never go away.

Black women may also have more severe hot flashes than white women. Research published in February 2022 from the SWAN study, which tracks approximately 3,300 menopausal women, many of whom were born or grew up during the Jim Crow era, found that Black women were 50 percent more likely to have hot flashes and night sweats compared with white women. (Night sweats are essentially hot flashes that occur while you’re sleeping, waking you up at night.) Their hot flashes also tended to be more frequent, occurring at least every day.

But because each woman is different, there’s no way to tell how long they will last just as there’s no way to predict when or how long a woman will go through menopause.

Could a hot flash be caused by a condition other than menopause?

Yes. Hot flashes can be common in early pregnancy; they can also be a sign of hyperthyroidism (an overactive thyroid). In fact, Minkin tells physicians to give their patients a pregnancy test followed by a thyroid test before assuming their hot flashes are related to menopause.

“You’d be surprised how many women in their late forties are pregnant and experiencing hot flashes,” she says. If a pregnancy test comes back negative, and the thyroid test is normal, then hot flashes may be related to perimenopause or menopause, she says.

Can you do anything for hot flashes?

While menopausal hot flashes can’t be cured, they can be managed. “Too often women are told they have to suffer through hot flashes, but that’s definitely not the case,” says Lauren Streicher, MD, the medical director of the Northwestern Medicine Center for Menopause and the Northwestern Medicine Center for Sexual Medicine in Chicago.

She recommends finding a menopause expert via the NAMS’s directory, which allows you to search based on your ZIP code.

Some lifestyle changes may help ease hot flash symptoms. These include losing weight (for people who need to) and kicking the habit (for people who smoke).

A pilot study published in Menopause: The Journal of the North American Menopause Society found that participants who lost more than 10 percent of their body weight saw a greater reduction in hot flashes than the control group. “The idea is that fat functions as an insulator,” says Minkin. “So the more body fat you have, the harder it is to dissipate the heat from a hot flash.

Likewise, a study in Maturitas: An International Journal of Midlife Health and Beyond found that women who quit smoking were less likely to suffer from hot flashes, less likely to have severe hot flashes, and less likely to have frequent hot flashes than women who continued to smoke, although researchers aren’t sure why smoking makes hot flashes worse.

Another way to treat hot flashes is with hormone therapy. If you have a uterus, hormone therapy contains estrogen and progestin; if you don't have a uterus, having undergone a hysterectomy, it only contains estrogen. (Taking estrogen without progesterone can increase the risk of cancer of the endometrium, or uterine lining, according to the Cleveland Clinic.)

Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) can sometimes be prescribed to help lower the frequency and severity of hot flashes. Most SSRIs are used off-label, but one of them, paroxetine, has been approved by the Food and Drug Administration to treat hot flashes.

In addition to lifestyle changes, some people will also take botanicals such as black cohosh, chasteberry, and red clover. However, according to Dr. Streicher, the benefits (if any) may be due to placebo effect. One study published in May 2014 in Planta Medica concluded that there wasn’t enough data to support using botanicals to ease menopausal symptoms like hot flashes.