Reproductive hormones like estrogen, progesterone, and many others, play a significant role in the overall physiology of women. Their importance is felt when they start to get depleted, beginning in the early to mid 40s. Several unpleasant symptoms start to become apparent, as the body struggles to cope with the transition. One such symptom is a hot flash, also known as Vasomotor Symptoms (VMS)
A hot flash is a common symptom of approaching menopause. It is also quite common in those who have already reached menopause. Young women usually do not have hot flashes, but it is not a rare occurrence either, although they have fewer episodes as compared to older women. It can occur at any time during the day or night. Women who have a hot flash at night often wake up suddenly, feeling the need to take off their clothes and open a window to let in some cool air. Such an episode lasts only for a few minutes.
The physiological cause for hot flashes is related to a brief disturbance of the heat-regulating mechanism in the hypothalamus located in the brain. This disturbance is due to the dropping levels of estrogen in the body, but exactly how the heat-regulating mechanism is influenced by this is not clearly established as yet.
Primary Ovarian Insufficiency (POI) is a condition in which the ovaries malfunction or function erratically. It is characterized by irregular periods and other symptoms due to lack of sufficient estrogen in the body. Not surprisingly, it causes hot flashes.
Menopause induced due to surgical removal of the uterus causes hot flashes. This is because of the withdrawal caused by drastic reduction in the level of estrogen in the body.
If a young women is on chemotherapy treatment for cancer, it induces menopause, which causes hot flashes. Drugs like Tamoxifen, especially, are associated with this.
Premenstrual Syndrome (PMS) is associated with hot flashes in many young women.
Non Estrogen-related Causes
A hot flash is one of the symptoms of many diseases, especially those of the endocrine system. In hot flashes occurring due to some of these diseases, there is no perspiration, and they are characterized as ‘dry’ flashes.
Certain brain tumors
Thyroid cancer (medullary)
Consumption of foods containing chilies, nitrites and sulfites
Various drugs (especially of the vasodilator class)
Pancreatic cancer of the islet cells
Excessive consumption of alcohol
Renal cell cancer
Episodes of anxiety
Hormone Replacement Therapy (HRT): The hormones estrogen and progesterone, depleted due to early induction of menopause are given in combination in a certain dose in this therapy. Its effects are immediate, and the symptoms of hot flashes get rapidly alleviated after instituting HRT. However, the risks associated with HRT are too severe for it to considered as a long-term option.
Apart from the standard HRT, some new therapies have emerged that employ slightly modified versions. A therapy in which only low-dose estrogen or low-dose estrogen with medroxyprogesterone can be used for hot flashes. An intravaginal ring that releases estrogen for absorption in the body is another new option that has been developed, and can be used for preventing hot flashes.
Antidepressants: This is not a treatment for hot flashes per se, but it helps control the depression brought on by estrogen-withdrawal during menopause. Thus, this is a part of the supportive treatment of hot flashes. The antidepressants Venlafaxine, Selective Serotonin Reuptake Inhibitors (SSRIs) like Fluoxetine, Paroxetine, etc., can be used for tackling depression.
Soy-derived Products: Soy contains natural estrogens like phytoestrogens and isoflavones, that are thought to be beneficial as substitutes for the estrogen that the body is unable to produce, but as yet, their effectiveness has not been established beyond doubt.
Gabapentin: This is a drug used in the treatment of seizures, but has shown effectiveness in reducing hot flashes too. The mechanism by which such an effect is accomplished, is not clear.
Clonidine: This is usually used in the management of hypertension. It has proven effective in reducing the frequency of hot flashes, but has several side-effects too.
Black Cohosh: Black Cohosh is a herb widely used in Europe for the management of hot flashes. However, controlled studies have failed to establish its effectiveness for treating hot flashes.