Cue up Johnny Cash’s “Ring of Fire” because once you’ve started experiencing hot flashes, that’s exactly what it feels like you’ve walked (err, fallen) into.
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When you think of hot flashes, you may immediately think of menopause, and it’s true that they’re one of the most common symptoms associated with this time of life. But hot flashes can actually begin before you’ve entered menopause — when you’re in perimenopause, the lead-up to it.
Women’s health specialist Pelin Batur, MD, explains what it means when you start having these vasomotor symptoms (hot flashes and night sweats), including what kind of treatments are available.
Starting menopause
To be in menopause requires that you haven’t had a period for a full 12 months (assuming there’s no other medication or medical condition that causes you to skip periods). In the United States, the average age for entering menopause is 51.4 years, with a typical range of 45 to 55. But perimenopause, or the lead-up to menopause, can start much sooner.
“The symptoms can actually start a decade before menopause,” Dr. Batur says. On average, though, perimenopause starts about four years before your period actually stops. This is when menopause-like symptoms — including hot flashes — make their grand debut.
Hot flashes during perimenopause
Not everyone who goes through menopause will experience vasomotor symptoms like hot flashes and night sweats, but an estimated 75% do. And the hormone fluctuations associated with menopause can be so pronounced that even if you’re having regular menstrual cycles, you may still begin having hot flashes.
“Hot flashes are the sudden sensation of heat, and they may or may not be associated with flushing and sweating,” Dr. Batur says. When you’re having a hot flash, it can feel like your body is on fire from the inside out, like you’re radiating heat through your skin.
You can even have hot flashes in your sleep. “Night sweats can be very disruptive to the sleep cycle,” Dr. Batur notes. “Many women find that they can’t get through the night as well as they could before.”
Treatments for hot flashes
If your hot flashes are negatively impacting your quality of life, it’s time to see your doctor. Here are three treatments they might recommend, depending on your other health conditions and concerns.
1. Hormone therapy
“For many women, the best treatment is hormone therapy,” says Dr. Batur. “It’s the most effective treatment that can even out the hormonal ups and downs that are common during perimenopause.”
Hormonal therapies aren’t recommended for everyone, including women with certain kinds of cancers. Those who’ve had blood clots, a stroke or a heart attack may be more limited in the types of hormones that they can use, too. But for most women who are healthy, she says, the treatment is a safe way to deal with the uncomfortable side effects of perimenopause.
2. Prescription medication
If you can’t (or don’t want to) go on hormone therapy, other medications may help. They’re all U.S. Food and Drug Administration (FDA)-approved for other reasons but have been found to help with hot flashes, too.
“Some antidepressants have been shown to be beneficial and are our go-to’s for women who are, for example, breast cancer survivors,” Dr. Batur explains. “These are women who sometimes have the worst symptoms but who can’t use hormonal options.”
Other options include an anti-seizure medication called gabapentin and a bladder leakage medication called oxybutynin.
3. Alternative therapies
Cognitive behavioral therapy (CBT), a type of talk therapy, may help. “In well-designed studies, cognitive behavioral therapies — where you focus on your thoughts about hot flashes — have actually been shown to be helpful,” Dr. Batur says.
Some women also say they find relief from hypnosis and acupuncture, though Dr. Batur says several studies suggest that acupuncture may not treat hot flashes any more than a placebo. Still, if you want to try them, it’s safe to do so. “It’s just a time and cost investment,” she cautions.
Beware of supplements for menopause
Many women turn to herbs and supplements to fight hot flashes. However, research has so far found little evidence that they’re effective.
“Studies show that most of them don’t show much benefit over placebos,” Dr. Batur says. “And remember: Just because you get them at the health food store, doesn’t necessarily mean they’re safe.”
Other causes of hot flashes
Hot flashes are usually related to menopause, but not always. In some cases, they can be caused by thyroid disease or cancer treatments, and they can also be a side effect of certain medications. This is another reason why it’s important to talk to your doctor about hot flashes when they begin.
How long do hot flashes last?
Hot flashes can be a part of your life for months or even years.
“Some women stop having hot flashes about a year after their periods stop,” Dr. Batur says, “but it’s more common for them to stop seven to 12 years after menopause.” For about 9% of women, hot flashes can continue indefinitely into their older years.
No matter how long you have them, though, one thing remains true: If hot flashes are having a negative impact on your quality of life, it’s time to seek treatment. You don’t have to put up with that burning ring of fire.
