Hot flashes (also called "heat waves") are the most commonly reported symptom during perimenopause and menopause — affecting up to 80% of women. They last a mean duration of 7-9 years, and persist more than 10 years in one-third of women.

Why they happen:

Estrogen fluctuations affect the area of the brain that regulates body temperature (the hypothalamus). The brain "thinks" you are overheating and triggers cooling mechanisms — vasodilation, sweating, sensation of heat. The mechanism involves neurokinin B and KNDy neurons in the infundibular nucleus.

What the 2023 Menopause Society (NAMS) position statement says:

  • Vasomotor symptoms occur in up to 80% of menopausal women, last a mean of 7-9 years (over 10 years in 1/3)
  • Nonhormone prescription therapies (fezolinetant, paroxetine, SSRIs/SNRIs, gabapentin, oxybutynin): Level I or I-II evidence
  • CBT and clinical hypnosis: Level I evidence for reducing VMS bother
  • Over-the-counter supplements are NOT recommended due to lack of rigorous evidence
  • A low-fat plant-based diet with half-cup cooked soybeans showed 88% VMS reduction vs 34% control in one small trial (N=84), but dietary modification overall not recommended for VMS due to limited data

What works (hormonal):

  • HRT reduces hot flash frequency by ~75% — most effective option

What works (non-hormonal):

  • Fezolinetant: FDA-approved, ~50-60% reduction
  • SSRIs/SNRIs: 25-69% reduction depending on agent
  • Gabapentin: 40-60% reduction, best for night sweats
  • CBT and clinical hypnosis: Level I evidence

Lifestyle:

  • Avoid alcohol, caffeine, spicy foods
  • Keep cool: fans, layered clothing, cool bedroom
  • Paced breathing at onset of a flash