Is It a Hot Flash?

By Kristen Wolfe, MD, OB/GYN

When you hear the words “hot flash,” you may picture a woman suddenly turning bright red, drenched in sweat, and frantically fanning herself. That certainly can happen. But many hot flashes are far more subtle, especially early in perimenopause.

Some women describe a warm wave moving across the chest, neck, or face. Others simply notice that they are suddenly much hotter than everyone else in the room. At night, a hot flash may look like waking up warm, throwing off the covers, or repeatedly moving a leg in and out of bed. Not everyone wakes up with soaked pajamas or sheets. A mild hot flash may cause a distinct feeling of heat without any visible flushing or sweating at all.

What is happening in the body?

Hot flashes and night sweats are collectively called vasomotor symptoms. During the menopause transition, changing estrogen levels affect temperature-regulating pathways in the hypothalamus, the part of the brain that acts like the body’s thermostat. The comfortable range between “too cold” and “too hot” becomes narrower.

A small change in core temperature can then trigger the body to release heat by widening blood vessels near the skin and increasing sweating. This may be followed by chills or shivering as the body tries to warm itself again.

A typical hot flash is a sudden sensation of heat, often strongest in the upper body, that lasts about one to five minutes. It may come with facial or chest flushing, sweating, a racing heart, anxiety, or a cold chill afterward. Experiences vary widely, however. Some women have occasional warm waves. Others have repeated episodes that interrupt meetings, exercise, or sleep.

Hot flashes are common, affecting up to 80 percent of women during menopause, and they can last much longer than many people expect. The average duration is approximately seven to ten years. They may begin while periods are still regular, and their intensity can change over time.

Does every feeling of warmth count?

Not necessarily. Feeling generally warmer all day, becoming overheated only during exercise, or having persistent heat intolerance may have other explanations. Thyroid disease, medications, sleep disorders, and other medical conditions can sometimes mimic or worsen menopause symptoms.

The good news is that you do not have to wait until symptoms become severe to discuss them. Keeping a brief record of when the heat occurs, how long it lasts, what happens at night, and how it affects your life can clarify the pattern.

At Evermore Women’s Health we help women understand whether subtle changes may be part of perimenopause or menopause, consider other possible causes, and choose treatment based on their symptoms, health history, and preferences.