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December 19, 2011
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Hot Flashes

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Hot Flash Causes

Anxiety Worsens Hot Flashes

Medical Author: Melissa Stoppler, M.D.
Medical Editor: William C. Shiel, Jr, MD, FACP, FACR

Controlling lifestyle stress and anxiety may help reduce the number and severity of hot flashes associated with menopause, according to doctors at the University of Pennsylvania.

Hot flashes are perhaps the most troublesome symptom associated with approaching menopause and are experienced by a majority of women during the transition to menopause. Menopause - the ending of menstruation - is defined as having 12 consecutive months without a menstrual period and occurs at an average age of 51.

Researchers studied over 400 Caucasian and African American women between 37 and 47 years of age who still had regular menstrual cycles. The women took tests that measured their anxiety levels at the start of the study and again following a six-year period. After six years, many of the women were experiencing hot flashes and irregular menstrual periods, two signs of approaching menopause. The women's anxiety scores were directly correlated with the severity and frequency of hot flashes, even when factors such as blood estrogen levels, cigarette smoking, and stage of menopause were taken into account. Those women with the highest anxiety levels reported almost five times as many hot flashes as less-anxious women, and women with moderate anxiety had hot flashes three times as often as those with normal levels of anxiety.

Read more about anxiety and hot flashes »

What are hot flashes?

A hot flash (is a feeling of warmth that spreads over the body that begins, and is most strongly felt, in the head and neck regions. Hot flashes are a common symptom experienced by women prior to, and during the early stages of the menopausal transition. However, not all women approaching the menopause will develop hot flashes.

What causes hot flashes?

The complex hormonal changes that accompany the aging process, in particular the declining levels of estrogen as a woman approaches menopause, are thought to be the underlying cause of hot flashes. A disorder in thermoregulation (methods the body uses to control and regulate body temperature) is responsible for the sensation of heat, but the exact way in which the changing hormone levels affect thermoregulation is not fully understood.

While hot flashes are considered to be a characteristic symptom of the menopausal transition, they can also occur in men, and in circumstances other than the perimenopause in women as a result of certain uncommon medical conditions that affect the process of thermoregulation. For example, the carcinoid syndrome results from a type of endocrine tumor that secretes large amounts of the hormone serotonin and can cause hot flashes. Hot flashes can also develop as a side effect of some medications and can sometimes occur with severe infections or cancers that may be associated with fevers and/or night sweats.

What are the symptoms of hot flashes?

  • Hot flashes are typically brief, lasting from about 30 seconds to a few minutes.

  • Redness of the skin, known as flushing, may accompany hot flashes.

  • Excessive perspiration (sweating) can also occur; when hot flashes occur during sleep they may be accompanied by night sweats.

The timing of the onset of hot flashes in women approaching menopause is variable.

  • While not all women will experience hot flashes, many normally menstruating women will begin experiencing hot flashes even several years prior to the cessation of menstrual periods.

  • It is impossible to predict if a woman will experience hot flashes, and if she does, when they will begin.

  • About 75% of women experience hot flashes at some point in the menopausal transition.


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  • Related Diseases & Conditions

    • Night Sweats
      • Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
    • Menopause
      • Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
    • Carcinoid Syndrome and Carcinoid Tumor
      • A carcinoid tumor is a tumor that develops from enterochromaffin cells. The important characteristic of carcinoid tumors that sets them apart from other gastrointestinal tract tumors, is their potential to cause the carcinoid syndrome. Local symptoms may include abdominal pain, intestinal bleeding, and intestinal obstruction. However, often symptoms of the carcinoid syndrome can be more devastating than the local symptoms. There are many options for the treatment of carcinoid tumors and carcinoid syndrome.
    • Stress Management Techniques
      • Stress may be considered as any physical, chemical, or emotional factor that causes bodily or mental unrest and that may be a factor in disease causation. An important goal for those under stress is the management of stress in our lives. Elimination of stress is unrealistic, since stress is a part of normal life. We can however, learn to manage stress through techniques such as exercise, relaxation, meditation, time management, and support systems so that we have control over our stress and its effects on our physical and mental health.
    • Alternative Treatments for Hot Flashes of Menopause
      • Hot flashes are experienced by many women, however, not all women undergoing menopause experience hot flashes. A hot flash is a feeling of warmth that spreads over the body. Treatment for hot flashes include hormone replacement therapy and alternative prescription medications such as SSRIs (Effexor, Paxil, Prozac), clonidine (Catapres), megestrol (Megace), and gabapentin (Neurontin). Few alternative treatments for hot flashes (for example phytoestrogens - isoflavones, black cohosh, and vitamin E have been scientifically studied.
    • Premenstrual Dysphoric Disorder (PMDD)
      • Premenstrual dysphoric disorder (PMDD) is considered to be a severe form of premenstrual syndrome (PMS). PMDD has also been referred to as late luteal phase dysphoric disorder. The cause of PMDD is unknown. Some of the common symptoms of PMDD (not an inclusive list) include: mood swings, bloating, fatigue, headache, irritability, headache, breast tenderness, acne, hot flashes and more. Treatment for PMDD is with medication to treat the symptoms of PMDD.
    • Male Menopause
      • Male menopause refers to the decline in testosterone production in men. As men age, they often experience many of the same symptoms that women experience in menopause. Testosterone replacement therapy may relieve some of these symptoms.
    • Menstruation
      • Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
    • Premature Menopause
      • Premature menopause is when a woman goes through menopause before the age of 40 because of genetics, illness, or a medical procedure. Symptoms of premature menopause include irregular or missed periods, mood swings, hot flashes, periods that are heavier or lighter than usual, vaginal dryness, bladder irritability, incontinence, dry skin, eyes or mouth, sleeplessness, and decreased sex drive. Though premature menopause cannot be reversed, the symptoms can be managed with methods similar to those used for natural menopause.
    • Vaginal Dryness
      • Vaginal dryness and vaginal atrophy occurs in women during perimenopause, menopause, and postmenopause. With vaginal atrophy, the lining of the vaginal wall becomes thinner, drier, less elastic, and light pink to bluish in color. Symptoms of vaginal atrophy include vaginal dryness, itching, irritation, and/or pain during intercourse. Treatment options for vaginal dryness and vaginal atrophy include hormone treatment and over-the-counter vaginal lubricating and moisturizing products.
    • Premature Ovarian Failure (POF)
      • Premature ovarian failure (POS) is the cessation of normal functioning of the ovaries in women under the age of 40. Premature ovarian failure may be caused by follicle depletion or dysfunction. The most common symptom of premature ovarian failure are irregular periods. There is no "treatment" that will restore the ovarian function, but there are treatments that my relieve symptoms.
    • Premature Menopause (Medical Procedural Causes)
      • Surgical menopause happens when a premenopausal woman has her ovaries removed in a surgical procedure called a bilateral oophorectomy. An abrupt menopause follows, with women often experiencing more severe menopausal symptoms than if they were to go through natural menopause. Chemotherapy and pelvic radiation therapy may also cause menopause by damaging the ovaries.
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Hot Flashes

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) can be considered to be a severe form of premenstrual syndrome (PMS). Both PMS and PMDD are characterized by unpleasant physical and psychological symptoms that occur in the second half of a woman's menstrual cycle, most commonly in the days preceding the menstrual period. Fatigue, mood changes, irritability, and abdominal bloating are among the most common symptoms of PMS and PMDD, but numerous other symptoms have been reported. Whereas the symptoms of PMS may be troubling and unpleasant, PMDD may cause severe, debilitating symptoms that interfere with a woman's ability to function.

PMS is much more common than PMDD. PMS may affect to 30% of women with regular menstrual cycles, while only 3% to 8% of these women have true PMDD.

PMDD has been previously medically referred to as late luteal phase dysph...

Read the Premenstrual Dysphoric Disorder (PMDD) article »







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