Hot flashes arise from estrogen-related changes in brain temperature regulation. Estrogen therapy is the most effective treatment and may be appropriate for many symptomatic women after individualized counseling. Nonhormonal medications (certain SSRIs/SNRIs, gabapentin, clonidine), lifestyle changes, CBT, and some complementary approaches offer alternatives. Discuss risks, benefits, and personal goals with a clinician.
What are hot flashes (vasomotor symptoms)?
Hot flashes - often called vasomotor symptoms (VMS) - are sudden feelings of heat, sweating, flushing, and a rapid heartbeat. They typically last from a few seconds to several minutes and can occur occasionally, many times per day, or predominantly at night (night sweats). They are a common symptom of perimenopause and menopause but can also occur after certain surgeries or with some medical treatments.
Why they happen
Hot flashes are linked to falling estrogen levels, which affect the brain's temperature regulation (hypothalamus). The exact mechanism is not fully understood, but the hormonal change narrows the thermoneutral zone so small temperature changes trigger heat-loss responses like sweating and flushing.
Most effective treatments
Hormone therapy (HT)
Estrogen-containing hormone therapy is the most effective treatment for VMS. For many people it provides rapid and substantial relief. Modern guidance favors individualized decision-making: HT is often considered when symptoms are bothersome, particularly for women who are younger than about 60 or who are within about 10 years of menopause onset, but risks and benefits must be weighed for each person. HT carries increased risks (for example, blood clots, stroke, and differences in breast cancer risk depending on the type and duration of therapy), so clinicians typically discuss lowest effective dose and the shortest duration consistent with treatment goals.
Local (vaginal) estrogen preparations are effective and low-risk for treating vaginal dryness and urinary symptoms.
Nonhormonal medications
Several nonhormonal prescription options can reduce hot flashes, including certain antidepressants (SSRIs/SNRIs), gabapentin, and clonidine. One low-dose paroxetine formulation is approved specifically for VMS in some countries. These options may be preferred when HT is contraindicated. 1
Lifestyle and behavioral measures
Simple measures can reduce frequency or severity:
- Dress in layers and keep the bedroom cool
- Avoid triggers such as alcohol, caffeine, spicy foods, and tobacco
- Practice paced breathing, relaxation, or mindfulness
- Cognitive behavioral therapy (CBT) and other mind-body approaches can reduce the bother and improve quality of life
Complementary approaches and herbs
Soy foods and isoflavone supplements show modest and inconsistent benefits for VMS; results vary among studies. Black cohosh, evening primrose oil, and other herbal remedies have mixed evidence and, in some cases, safety concerns (for example liver effects). Always discuss supplements with a clinician before starting them. 2
When to see a clinician
If hot flashes are disrupting sleep, work, or relationships, or start suddenly and severely, seek medical advice. A clinician can review medical history, rule out other causes, and help choose the safest, most effective treatment plan.
- Confirm current professional society recommendations (North American Menopause Society, ACOG) wording on when to initiate hormone therapy and age/years-since-menopause thresholds.
- Verify approval status and specific dosing/indications of low-dose paroxetine (Brisdelle) or other antidepressants for vasomotor symptoms by the FDA and other regulatory agencies.
- Check recent systematic reviews/meta-analyses for the efficacy and typical dosing of soy isoflavones for hot flashes and any consensus guidance.