Hot Flashes: The Coping Guide

Woman suffering a menopause hot flash outdoorsYou’re sitting quietly reading or watching television, minding your own business, doing nothing out of the ordinary, when — boom! A heat wave rises up from your neck and shoulders, your face turns red, and sweat starts pouring.

Then, just as suddenly, the heat recedes, and you feel normal again. Welcome to the not-so-wonderful world of hot flashes — one of the best-known signs of menopause, and definitely one of the most annoying.

Most people have heard of hot flashes and know them as the trademark symptom of menopause. About 75 to 85 percent of American women are estimated to get hot flashes when they’re in menopause. And where premature menopause is concerned, hot flashes tend to be even more prevalent.

Understanding the Menopausal Hot Flash

Many studies indicate that if you go through natural menopause before the age of 51, you have an increased chance of having hot flashes (1). It’s even more common for women who have had their ovaries surgically removed — about 80 to 90 percent of these women typically get hot flashes.

To make matters worse, hot flashes may be more intense physically for those of us in premature menopause (especially if your premature menopause is caused by surgery or cancer treatments) and they can definitely be more troublesome emotionally.

As if it’s not enough that you have to deal with the psychological blow of knowing you’re in menopause prematurely, something that you didn’t expect for a decade or two, you also have to cope with the feeling that your hot flashes are advertising the fact to everyone. When you’re sitting and talking with friends, then start pouring sweat for no apparent reason, you sometimes feel as if you are wearing a sign: “Look at me! I might be young, but I’m menopausal!”

Your Experiences

I had hot flashes so bad I used to say I could melt Antarctica just by lying on it!

— Steph, age 28

I would be teaching in front of the classroom, and I could feel a hot flash coming on. It was embarrassing — all those people looking at me and I would be dripping sweat even if it was cold in the room. I kept hoping no one noticed, but I was sure they did. I mean, they’d have to be blind to have missed it.

— Anna, age 31

Like irregular periods, hot flashes are often one of the first signs you’ll have that your reproductive system is changing. In fact, they may begin before you even notice any menstrual irregularities. I started having hot flashes years before anything else seemed different with my body, and they continued long after other symptoms appeared.

Usually, though, hot flashes are most apparent during the first two years and taper off over time. Some women have hot flashes throughout their lives (don’t worry though — this is very uncommon!), but most women have them for about four years.

So what exactly is a hot flash, and why do we have them?

A young woman struggles to sleep

Scientists aren’t completely sure, but the hypothalamus, the gland that is in charge of your entire endocrine system, appears to be implicated through its role in the regulation of body temperature.

Usually, when your body starts getting too warm, the hypothalamus sends out a signal to cool down, telling your heart to pump more blood, and your blood vessels to dilate and let out heat. Your skin will also start to perspire. It’s your body’s air-conditioning system at work, and it works very well — until you begin menopause.

When you’re in menopause, your estrogen production decreases, which affects the body temperature regulator in the hypothalamus. Instead of sending out the ‘cool down’ signal when your body gets hot as normal, it starts turning on the air conditioner at inappropriate times.

In effect, it resets your body’s thermostat, causing the cooling reaction at a lower temperature than in the past. Your body responds by going through the dilation of blood vessels and sweating in an effort to reset its thermostat back to its normal temperature. In other words, you get a hot flash.

That’s the scientific side. Here’s what it translates to in your body: hot flashes usually start with a hot, prickly feeling in the middle of your back. A heat wave then rises to envelop your back, chest, neck, face, and scalp. Your skin temperature can rise by up to 8 degrees. Often if you touch your skin, it actually feels hot as though you’ve been out in the sun.

Meanwhile, your pulse shoots up, and you start sweating as your body tries to cool itself down. Sometimes you get a flush — your face, neck, and chest turn pink or even deep red. And very often, you suddenly shift from feeling incredibly hot and sweaty to feeling very chilled, even shivering.


The hypothalamus controls the pituitary gland, which in turn is responsible for the secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones may be familiar to you because they work together in the reproductive system and play an important role in fertility.

Night Sweats: The Cousin of Hot Flashes

You may also get the nighttime version of hot flashes, night sweats. Technically, a night sweat is the same as a hot flash — another example of your internal thermostat running amok because of reduced estrogen levels. But for me, and other women I’ve spoken with, there was a marked difference with night sweats.

When I had a hot flash during the day, the heat and sweating was restricted to the middle of my back and up. When I had night sweats, everything poured sweat — even my knees it seemed!

Pensive mature woman lying on bed

Night sweats are particularly debilitating because they interfere with your sleep. You may wake up numerous times during the night feeling overheated. You toss off the covers to cool down, then have to pull them back on when the sweat passes because you’re now freezing having been warm just moments earlier.

In some cases, your sheet, pillow, and nightwear may get wringing wet. In fact, many women have to get up in the middle of the night to change clothing. After all that tumult, you may wake up in the morning feeling as though you haven’t slept at all when you desperately wanted a recuperative sleep.

Your Experiences

Every night I would get drenched. I would wake up in the morning with the worst case of bad hair since it had matted from all the sweating. I had circles under my eyes. Worst of all, I didn’t know why I was getting these night sweats. I looked them up in a medical symptoms checker, and the one thing I kept noticing was that night sweats were a sign of cancer. I actually spent a few months wrongly convinced that I had cancer — which only made me have more trouble sleeping!

— Elizabeth, age 29

As you would imagine, there’s also an emotional toll to dealing with hot flashes and night sweats. Not only might you feel like you are advertising your menopausal state, but you also might find it difficult to remain psychologically cool when your body is on fire.

Many of the emotional signs of menopause, such as irritability, the feeling of being out of control, and extreme fatigue, are either tied to hot flashes or exacerbated by them. And because your heart rate often increases when you’re having a hot flash, it’s even easy to fall into a full-fledged hot-flash-induced anxiety attack.

But no matter how unpleasant it all is, most of us going through premature menopause will have to deal with hot flashes. The severity and frequency of them, though, varies from person to person. You may get hot flashes only during the day; or only get night sweats, or you may be in for a double whammy and get both.

You may get dozens of hot flashes each day or only a few — or only a few each month. About a third of all women get 10 or more a day. Some lucky women don’t get full-fledged hot flashes but just get a slightly warm feeling now and then.

In general, though, there are a few rules of thumb with hot flashes:

  • In the very early stages of premature menopause, most women start with a mildly overheated feeling as opposed to full-fledged hot flashes.
  • Hot flashes usually worsen when you stop having your period, and your estrogen levels drop.
  • If you are in premature menopause because of surgery or cancer treatments, chances are you’ll suffer from worse hot flashes because of the suddenness of the change in your hormonal environment.
  • Smokers also tend to have worse hot flashes, probably because smoking affects estrogen production in the body.
  • It has been noted that heavier women generally have a better time with hot flashes than their thinner counterparts. This old anecdotal belief has been backed up by recent research.

Aside from these specifics, however, overall hot flashes are a fact of life where premature menopause is concerned.

The good news about hot flashes is that they can be controlled by hormone replacement therapy (HRT) and also to varying extents by natural herbs and supplements. But there are some other things you can do in your daily routine to help you deal with these dreaded ‘power surges.’

How To Cope

Try to reduce stress

It’s not easy when you’re bright red and sweating dozens of times a day, but keeping as calm as possible actually helps cut down on the number and severity of hot flashes, while stress tends to increase them.

If you find yourself getting stressed out and feel that telltale prickly heat sensation at the back of your neck, breathe deeply, close your eyes, even try mental imagery — just try to let all your tension out, and often your hot flash will burn out more quickly.

Exercise regularly

A recent study indicated that aerobic (cardio) exercise helps temporarily raise your estrogen levels, which in turn helps prevent hot flashes.

Watch what you consume

Cut back on alcohol, caffeine, and spicy foods — these have all been linked to hot flashes.

Pay attention to what you wear

Natural fibers breathe better than synthetics, which helps when you’re in the throes of a hot flash. Wear layers, so you can peel off outer garments when a hot flash hits and put them back on when you get a chill. Loose-fitting clothes also usually help your body cool off faster. And avoid restrictive clothing like turtlenecks.

Stay cool at night

Have cold water by your bed ready to drink at the first sign of a sweat. Use cotton sheets and cotton nightwear (men’s t-shirts can be a great choice — cool and absorbent!). As with your clothing, sleep under layers, so you can kick off extra bedcovers when you get hot and replace them when the chills start.

Cooling off

Splash cold water on your face and wrists when a hot flash starts — this helps your body cool down more quickly.

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