Hot Flashes

Hot flashes may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the endocrine system may also involve other body systems.

Hot flashes may accompany other symptoms affecting the endocrine system, such as the menopausal transition in women and midlife hormonal changes in men including:

• Changes in mood, personality or behavior

• Changes in self-image

• Changes in thinking patterns

• Sleep disruption

• Sweating

Hot flashes may accompany symptoms related to other body systems or other medication side effects including:

• Constipation

• Dry mouth

• Fever

• Flushing

• Rash

• Sleep disruption

In some cases, hot flashes may occur with other symptoms that might indicate a serious condition that should be evaluated immediately in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, has hot flashes along with other serious symptoms including:

• Difficulty concentrating

• Excessive sweating

• High fever (higher than 101°F)

Hot flashes arise from changes in the body’s levels of estrogen and testosterone. Changes in hormone levels can result from normal processes of the body, such as menopause. Changes in hormone levels can also occur as a result of cancer or its treatments, specifically ovarian, testicular, prostate, and breast cancer.

Hot flashes may arise from ovarian, testicular, prostate, or breast cancer and their treatment including:

• Chemotherapy

• Hormone therapy

• Oophorectomy (surgical removal of the ovaries)

• Orchiectomy (surgical removal of the testes)

• Radiation therapy

• Side effects of medications, such as certain steroids or antidepressants

Hot flashes can also be caused by normal aging processes including:

• Changes in function of the hypothalamus

• Changes in thyroid hormone levels

• Menopause

In some cases, hot flashes may be a symptom of a serious condition that should be evaluated immediately in an emergency setting. These include:

• Cancer of the ovaries or testes

• Hyperthyroidism

• Pituitary adenoma

Hot flashes are usually not an urgent medical matter. However, they can be very bothersome and interfere with your quality of life. Make an appointment with your doctor if hot flashes are affecting your sleep or daily activities.

Women younger than 45 years of age should see their doctors if they begin having hot flashes. This could be a sign of early or premature menopause. Going through menopause at too young an age carries health risks that may require hormonal treatment.

Your doctor will likely be able to diagnose hot flashes using your description of the problem. This may raise the question of whether or not you are in menopause. To verify that you are going through this life transition, your doctor may order blood tests to check your hormone levels.

Your doctor may also ask you several questions related to your hot flashes including:

• Are you still having periods? When was your last one?

• How long have you been experiencing hot flashes?

• Are your hot flashes bothersome?

• Do your hot flashes interrupt your sleep?

• What, if anything, seems to make your hot flashes better or worse?

• Do you have any other symptoms of menopause?

• Are you aware of any family or personal history of hormone imbalance?

• Are you currently being treated for any type of cancer?

• What medications are you taking?

It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

In general, doctors recommend making lifestyle changes before trying medications for hot flashes. If hot flashes continue to be bothersome, several treatment options are available.

Hormone replacement therapy (HRT) is very effective for relieving hot flashes. The goal of HRT is to even out hormone levels to improve menopause symptoms, including hot flashes. Typically, HRT is a combination of estrogen and progesterone. If a woman no longer has a uterus, HRT may consist of estrogen alone. However, HRT is not right for every woman and some women should not take it due to risks of the treatment. This includes women at risk of heart attack, stroke, or certain cancers, such as breast cancer.

If HRT is not an option or a woman does not want to take hormones, there are other options. The only nonhormonal treatment for hot flashes with FDA (U.S. Food and Drug Administration) approval is paroxetine (Brisdelle). It is a low-dose formulation of an SSRI (selective serotonin reuptake inhibitor) antidepressant. However, several other antidepressants and other medicines may be effective for hot flashes including:

• Citalopram (Celexa), an antidepressant
  
• Clonidine (Catapres, Kapvay), a medicine for blood pressure that may help with hot flashes in some women
  
• Escitalopram (Lexapro), an antidepressant
  
• Gabapentin (Neurontin, Gralise), an anti-seizure medicine
  
• Oxybutynin (Ditropan XL, Oxytrol), a medicine for overactive bladder that may provide some hot flashes relief
  
• Pregabalin (Lyrica), an anti-seizure medicine
  
• Venlafaxine (Effexor), an antidepressant

Some complementary treatments may help some people to better deal with the symptoms of hot flashes. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments.

Complementary treatments are not a substitute for traditional medical care. Be sure to notify your doctor if you are using nutritional supplements or homeopathic remedies as they may interact with the prescribed medical therapy.

Complementary treatments with some evidence supporting their use in easing hot flashes include:

• Acupuncture, which has shown mixed results in studies
  
• Cognitive behavioral therapy, which may improve how hot flashes affect you by helping you learn to control how much they bother you
  
• Mindfulness and mind-body techniques, such as meditation, hypnosis, and deep breathing, may improve how hot flashes affect you.

Several supplements and herbal products are also popular for managing hot flashes. This includes plant estrogens, soy, black cohosh, and vitamin E. Study results for these and other supplements have been mixed. In addition, some women should not take any product that could have actions similar to estrogen. Always talk with your doctor before trying supplements for hot flashes. Supplements can have harmful side effects and drug interactions.

While hot flashes themselves do not generally lead to any serious complications, they may interrupt sleep, cause embarrassment, or interfere with daily life. Hot flashes can also cause significant discomfort. Because hot flashes may sometimes be due to serious diseases, such as cancer of the ovaries or testes, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your healthcare professional design specifically for you to reduce the risk of potential complications including:

• Anxiety and depression

• Distress and discomfort

• Embarrassment

• Insomnia

• Social isolation

• Spread of cancer