April 27, 2023

What Do Hot Flashes Feel Like?

Heat starts in your chest and moves up to your neck and face … and then, the sweating begins

Person sittin on couch suffering from a hot flash, with wet patches showing on shirt.

Nelly’s 2002 hit song “Hot in Herre” wasn’t referring to hot flashes, but with a refrain like that, it might as well have been. When this menopausal symptom hits, it feels like you’re suddenly stuck inside your own personal inferno.

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But what does a hot flash really feel like, and how do you know if you’re having one or if you’re just, you know, kinda toasty? Ob/Gyn and certified menopause practitioner Claudia Mason, MD, explains.

Did you just have a hot flash?

Hot flashes are a vasomotor symptom that may begin when you’re in perimenopause, the period of time that leads up to menopause.

But perimenopause — and the symptoms that accompany it — can actually begin as much as a decade before you hit menopause, which means you could start having hot flashes well before you feel like you’re in the age range for them.

The average age of menopause is 51, so you may begin to experience hot flashes in the lead-up to it. But don’t assume that any time you overheat is an indicator of menopause. If you’re sitting at the pool on a sunny day, you’re probably just hot! And the reverse is true, too: If you’re not of perimenopausal or menopausal age, but are suddenly experiencing hot flashes, it’s time to see a healthcare provider.

“If you’re 21 and on birth control, you’re probably not having perimenopausal hot flashes,” Dr. Mason says. “On the other hand, if you’re 75 and wake up one day to have your first hot flash, that’s also not related to regular menopause. Those are things that need to be investigated for other causes.”

It’s important to make sure your hot flashes aren’t related to another health issue. In some instances, hot flashes can be related to:

  • Thyroid disease.
  • Cancer treatment.
  • Side effects of medication.

But what if your hot flashes are the standard menopausal kind? Dr. Mason explains what they feel like and why they happen.

Symptoms of hot flashes

Hot flashes come on suddenly — literally, a brief flash of hotness that can last anywhere from 30 seconds to five minutes. But what’s going on?

“During perimenopause and menopause, you become very sensitive to very small changes in temperature,” Dr. Mason says. “The brain then triggers the body to start to release heat, and that’s when you have a hot flash.”

Hot flashes usually start with a feeling of heat in your chest, which quickly rises up your neck and to your face. You may also experience:

  • Flushing and redness in your face.
  • Sweating.
  • Rapid heartbeat.
  • Feeling anxious.

It seems counterintuitive, but when it’s all said and done, you may feel the opposite of fiery — even a little bit chilly.

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“All of the blood vessels in your chest and face dilate to release heat, and then, sweating occurs to cool your body,” Dr. Mason explains. “The sweating is a cooling function, but as the sweat evaporates from your skin, it can make you feel chilled.”

Do hot flashes feel different during menopause and perimenopause?

Hot flashes aren’t the same for everyone, and some people never experience them at all. They can also change in frequency and severity during the menopausal transition as you get closer to menopause. It all has to do with the way your hormone levels vary in perimenopause.

“During perimenopause, your ovaries are becoming depleted of eggs, and your body is trying to find the last few eggs that are going to respond to ovulation,” Dr. Mason notes. “As those eggs do respond, they make some estrogen, but it can be hit or miss.”

That causes fluctuating, unpredictable hormone levels, which means that you may go through periods of time when you have symptoms and others when you don’t. Over time, as your body runs out of eggs, your hormone levels flatten out, and your hot flashes, if you have them, are likely to become more frequent for a time.

“The length of time that hot flashes last in the menopause varies from person to person,” Dr. Mason says. “Some people report no symptoms, while others report having hot flashes for many years.”

Managing hot flashes

Menopause is a natural stage of life, not a disease or an illness, which means there’s no cure, per se. “Menopause management is about symptom control,” Dr. Mason states.

With that in mind, the way you handle your hot flashes depends on how bothersome yours get. Some people don’t need to do anything at all, while others require medication to manage severe symptoms. And there’s a whole spectrum in between.

“I like to describe hot flashes as being kind of like salsa,” Dr. Mason poses, “They come in mild, medium and hot varieties.” She explains:

  • Mild is one to four hot flashes per day, with little disruption to your everyday life. “People in this category generally manage pretty well on their own,” she says.
  • Medium is up to eight hot flashes per day. If you fall into this category, you may be able to get by with lifestyle changes and symptom management (we’ll get to all of that in a moment). Or you may want to ask your healthcare provider if you’re a candidate for medication or other treatment.
  • Hot is anything more than 12 hot flashes a day. “At this point, hot flashes become very disruptive,” Dr. Mason says, “and this is when you really want to ask your doctor about hormone therapy or other treatment options.”

Hormone therapy

There are two primary types of hormone therapy (HT):

  • Estrogen therapy alone is for people who’ve had a hysterectomy. You take a low dose of estrogen every day by pill, patch or in some other form.
  • Estrogen/progesterone hormone therapy is for people who have a uterus. It involves a combination of estrogen and progesterone, or a synthetic form of it called progestin.

Which type is right for you will depend on, well, you. If your hot flashes are moderate to severe, make an appointment to have an in-depth discussion about it with your healthcare provider.

“That conversation has to take into consideration your feelings, your medical history, your symptoms and other individual details,” Dr. Mason says.

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If you begin menopause under age 50 (early menopause) — and certainly under age 40 (premature menopause) — you’re likely to begin hormone replacement therapy (HRT). This treatment replaces some of the hormones your body has lost, which eases your symptoms (including hot flashes) and lowers your risk of health conditions associated with premature or early menopause.

Non-hormonal medications

Not everyone is a candidate for hormone replacement therapy. But other medications that affect the thermoregulatory zone of your brain have been found to reduce hot flashes, too.

“Sometimes, people will say, ‘Hey, Doc, I started blood pressure medication and my hot flashes went away,’” Dr. Mason shares. “New research and medication development are looking at medications that target that part of the brain.”

Other ways to manage your hot flashes

Lifestyle changes and small, everyday hacks can help anyone who’s experiencing hot flashes. The obvious (and significant) downside is that many of these options cost money. But if you’re on the mild end of the hot flashes spectrum, they can go a long way toward easing your discomfort without involving any medications.

Here’s what Dr. Mason suggests:

  1. Carry a portable fan: It’ll feel like a lifesaver when hot flashes hit on the go.
  2. Keep your home cool: Turn on ceiling fans or air conditioning, when possible.
  3. Stay cool at night, too: To help with night sweats (hot flashes that happen while you’re asleep), wear lightweight pajamas. If you’re able, may also want to invest in cooling linens or pillows and mattress covers filled with cooling gel.
  4. Identify and avoid your triggers: These might include spicy foods, alcohol, caffeine, tight clothing and smoking.
  5. Manage your stress: Easier said than done, we know. But do your best to manage stress, which can also trigger hot flashes.
  6. Focus on healthy foods: One study showed that people who followed the Mediterranean diet were 20% less likely to experience hot flashes and night sweats than those who didn’t. Eating a balanced diet can help you manage your symptoms, too.

See a trusted healthcare provider

Dr. Mason adds that it’s also important to know what not to do.

“We really need to be aware of predators who target people in menopause,” Dr. Mason warns. “There are all kinds of so-called medications out there that haven’t been approved by the U.S. Food and Drug Administration (FDA), and clinics and companies charge a lot of money with lots of promises that they’ll help.”

Be wary of any entrepreneur or brand that claims to be able to solve all your problems with hormones by dispensing unapproved treatments. And be on the lookout for financial conflicts of interest.

Instead, she says to talk to a licensed healthcare provider who can help you find the right treatment for you. The North American Menopause Society offers a directory of Certified Menopause Practitioners across the continent. You can also start with your primary care provider or Ob/Gyn, if you have one.

“So many people have learned not to address or talk about their menopause symptoms, and they just suffer in silence,” Dr. Mason notes. “But treatments are available. Your healthcare provider has lots of guidance for you.”

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