Menopause & hot flashes

What it is

Menopause is the final menstrual period, usually around age 51 in the US. Hot flashes start in the hypothalamus: without estrogen's brake, KNDy neurons that release neurokinin B become overactive and narrow the comfortable temperature range, so small rises in core temperature trigger flushing and sweating.

Symptoms

• Sudden heat across the chest, neck and face

• Sweating and flushing, sometimes palpitations

• Chills as the episode fades

• Night sweats that break up sleep

How long it lasts

In the SWAN cohort, the median total duration of frequent hot flashes was about 7.4 years, and longer in those whose symptoms began early in the transition.

Treatment

Hormone therapy is the most effective treatment. For healthy people under 60 or within 10 years of menopause, The Menopause Society concludes the benefits generally outweigh the risks. Estrogen is paired with a progestogen when you have a uterus. Non-hormonal options include fezolinetant and elinzanetant, which block neurokinin signaling, low-dose paroxetine, other SSRIs or SNRIs, gabapentin and oxybutynin. CBT and clinical hypnosis also have good evidence.

Living with it

• Dress in layers and keep the bedroom cool

• Notice your triggers, such as alcohol, heat or spicy food

• Protect sleep: a regular wake time helps

Clinical pearls

• Herbal products such as black cohosh have inconsistent evidence.

• Compounded "bioidentical" hormones are not FDA-regulated for dose or purity.