Hot Flashes, Anxiety and Menopause: What’s the Connection?

You get a rush of heat. Then, you start to sweat. Out of nowhere, it feels like your body temperature has gone up by at least 10 degrees. There’s no doubt about it: You’re having a hot flash.

It’s only natural that this feeling could set off another bodily alarm: anxiety.

The real question is: Could these two be connected? Hot flashes are a common symptom of menopause and perimenopause. But could anxiety — the feeling of intense worry and nervousness — be a trigger that makes them worse?

Women’s health specialist Pelin Batur, MD, breaks down the connection between anxiety and hot flashes, including how you can manage both.

What are hot flashes?

A hot flash is a common vasomotor symptom that occurs during menopause and perimenopause (aka the lead-up to menopause, which can begin as much as a decade beforehand).

It usually feels like breaking out in a sweat and feeling suddenly very hot — like you just walked into a sauna. You may also start experiencing night sweats, waking you up from a dead sleep in a pool of sweat.

The “why” behind hot flashes and night sweats isn’t exactly clear, but they’re thought to be linked to the decrease in estrogen levels that come with menopause.

“As you approach menopause, your ovaries gradually produce less and less estrogen,” Dr. Batur explains. This typically begins in your mid-40s, though it’s different for everyone.

During this time, hormonal changes can affect your body’s ability to control its own temperature.

Does anxiety cause hot flashes?

Yes and no. As your body is going through times of stress and uneasiness, it’s common for anxiety to trigger physical symptoms in the rest of your body, too — and menopause can be one of those times. But it depends on the type of anxiety you experience.

A 2016 study suggests that anxiety may be a good predictor of hot flashes. In particular, it showed that people who have somatic anxiety symptoms (meaning you have physical reactions to anxiety, like stomachaches, headaches and dizziness) had a higher chance of experiencing hot flashes.

“This connection to hot flashes is especially true for events like panic attacks, where your heart rate and breathing rate are likely to spike even more,” Dr. Batur notes.

Some examples of physical anxiety symptoms are:

• Heart palpitations.
• Upset stomach or nausea.
• Muscle tension.
• Shortness of breath.
• Feeling light-headed or dizzy.

Are you experiencing menopause, anxiety or both?

Which came first, the chicken or the egg? Anxiety or hot flashes? The answer is … it can go both ways.

“Anxiety can sometimes trigger a hot flash, and the opposite is also true: A hot flash can often lead to feelings of anxiety,” Dr. Batur explains. “The sudden rush of warmth and other physical symptoms of hot flashes can be really distressing.”

Hot flashes tend to hit you, in, well, a flash. So, when you experience a rise in temperature, you may be caught off guard and start to feel nervous or self-conscious.

In a study from 2005, researchers followed 436 premenopausal women for six years and found that people with anxiety were three to five times more likely to have hot flashes than women without. Though the study is two decades old, anxiety is on the rise among U.S. adults, so it’s likely as relevant as ever.

In other words, if something else causes a hot flash, it may cause a domino effect and trigger feelings of anxiety as well. And if you’ve been feeling hot flashes come and go for a long time, you may start anticipating these flashes to hit you at any moment.

Hot flashes can cause both physical and emotional anxiety, depending on the person. Here are some common signs of non-physical anxiety symptoms:

• Feelings of nervousness and restlessness.
• Having trouble sleeping due to racing thoughts.
• Obsessive and worrisome thoughts.

How to decrease anxiety and stress during menopause

If you’re experiencing intense anxiety, it’s probably touching many parts of your life. Treating your anxiety can improve your quality of life, and it may help you reduce your hot flashes, too.

Dr. Batur shares some ways to keep physical and emotional anxiety symptoms at bay.

Cognitive behavioral therapy (CBT)

One type of therapy Dr. Batur recommends is cognitive behavioral therapy (CBT), a form of structured talk therapy that can relieve both psychological and physical symptoms of anxiety.

“This type of therapy helps to correct harmful or illogical patterns of thinking,” she explains. “It helps with both stress and anxiety, and it teaches you to calm your nervous system.”

Medications

If your anxiety-induced hot flashes are becoming severe, medication may be able to help. But these decisions should be made in thoughtful conversation with a healthcare provider.

“Medications like antidepressants, benzodiazepines and beta-blockers can be effective at reducing anxiety, but they should always be used with caution,” Dr. Batur says.

Meditation and mindfulness

Learning mindfulness and relaxation techniques can help you learn to manage your anxiety symptoms. There are a variety of practices you can try, all with the goal of soothing your mind and grounding your body:

1. Deep breathing exercises.
2. Journaling.
3. Meditation.
4. Yoga.

“All of these practices can help calm the mind and reduce an elevated heart rate,” Dr. Batur says.

Get plenty of rest

Menopause can wreak havoc on your sleep schedule.

If you’re struggling to stay cool throughout the day, your hot flashes are probably invading your bedtime, too. This sudden rise in heat can affect your sleep, so it’s important to find strategies that will help you get the rest you need.

“Forty to 50% of people experience sleep disturbances or insomnia during the menopausal transition,” Dr. Batur notes. “Sleep disorders can cause anxiety, and anxiety can cause a person to sleep poorly.” In other words, it can become a bit of a vicious cycle.

If you’re not able to get seven to eight hours of sleep, take naps as needed to help with lost nighttime sleep and seek relief for night sweats.

Talk about it

Having anxiety about your anxiety? Don’t keep it bottled up. Find someone you can talk to about any anxious feelings you may be having.

This could be a close friend who understands your situation or a licensed therapist (or both!). The goal is to find a way to make sense of any anxious feelings and how they’re affecting you emotionally and physically.

How to manage hot flashes

There are also steps you can take to address hot flashes directly, including:

• Nonhormonal medications: Two nonhormonal medications are approved by the U.S. Food and Drug Administration (FDA) specifically to treat vasomotor symptoms: Veozah™ (fezolinetant) can help with moderate to severe hot flashes and night sweats; Brisdelle (paroxetine mesylate), an old-fashioned antidepressant, is approved in an ultra-low dose to treat menopause-related hot flashes and night sweats.
• Hormone therapy (HT): “Many people in their 40s and 50s can safely try hormone therapy for their symptoms,” Dr. Batur says.
• Other prescription medications: Some medications that are FDA-approved for other purposes can help with symptoms of menopause, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), anti-epileptics, clonidine and oxybutynin. Talk with a healthcare provider about whether any of these are appropriate for you.
• Natural remedies: Some people experiencing hot flashes find relief from treatments like herbs and supplements, including black cohosh. But many show that in the vast majority of people, supplements aren’t helpful for menopause.

You can also make small changes in your day-to-day life, like:

• Adjusting your diet: Incorporating certain foods into your meals may help extinguish those rushes of heat. And what you don’t eat is just as important; try cutting out spicy foods, sauces and caffeine to see if it will help avoid triggering hot flashes.
• Lowering the temperature: Bring down that thermostat! If your house is feeling too warm, adjust it to help avoid hot flashes or lessen their fiery impact. A cooling fan by your desk, couch or bed (or all three) can also help.
• Avoiding exercising in the heat: Take a pass on that hot yoga class. If you’re experiencing repeated hot flashes, it’s best not to exercise in a hot room or outdoors under the hot sun.

Whether your anxiety is causing your menopausal hot flashes to flare up or it’s the other way around, there are ways to cope with both. For the best results, use tactics to manage your hot flashes while also addressing your anxiety — and don’t be afraid to seek professional help for either or both of these issues. Relief is possible, and you deserve it.