How to Tell If You’re Having Hot Flashes From Menopause

Whether you’ve been randomly sweating during the day or waking up soaked in the middle of the night, heating up on the regular could make you wonder if you’re approaching menopause. Good question. Hot flashes, which can happen when your estrogen levels start to dip, are a tell-tale sign of this hormonal milestone.

But these uncomfortable, sweat-drenched episodes can happen for plenty of other reasons too. Understanding what you’re experiencing — menopause or otherwise — can help you pinpoint the best way to manage them.

Below, learn from ob-gyns about what causes these sudden temperature changes, what they feel like, and how to tell if you’re experiencing a hot flash that could be related to menopause.

• Anna Barbieri, MD, is an assistant clinical professor of obstetrics and gynecology at the Icahn School of Medicine at Mount Sinai in New York City
• Barbara Schroeder, MD, is an OB-GYN with UTHealth Houston.

• What, exactly, is a hot flash?
• How to tell if your hot flash could be related to menopause
• What to do if you're having hot flashes

Hot flashes are basically a sensation of heat that can last anywhere from several seconds to a few minutes, Anna Barbieri, MD, assistant clinical professor of obstetrics and gynecology at the Icahn School of Medicine at Mount Sinai, tells Allure. Often, a hot flash starts as a feeling of heat in the chest and spreads up the torso into the face. You may feel flushed or turn red, and you might also start to sweat. “It feels like being suddenly embarrassed by something with your face turning red,” says Barbieri.

You may also experience night sweats, which are hot flashes’ nocturnal siblings. “Night sweats are the same principle, but they happen at night,” says Barbara Schroeder, MD, an ob-gyn with UTHealth Houston. “You get really warm so you throw the covers off, and then you may have chills as your body loses body heat.” Some women will sweat so profusely that they wake up drenched and have to change their pajamas, or even their sheets.

According to the North American Menopause Society, as many as 75% of North American women have hot flashes during perimenopause. How often these episodes happen can vary from person to person. A woman in the menopause transition, who is not on birth control or hormone replacement therapy, will experience hot flashes, on average, four to five times a day — but Barbieri says some people experience them less than that, and sometimes people have far more (up to 20 a day).

So why does this happen as you get closer to menopause? According to Schroeder, doctors aren’t 100% sure, but they do have some theories. Estrogen starts to drop significantly as you approach menopause, and this appears to have an effect on your hypothalamus, the part of your brain that’s responsible for regulating your body temperature.

“When estrogen goes down, it removes a brake on the hypothalamus, and we think it starts to fire irregularly and doesn’t interpret the temperature signals in a stable way,” says Barbieri. In other words, your body mistakenly starts to think you’re overheating, so you start sweating to keep you from getting too hot.

Hot flashes can happen for other, non-menopause reasons too. Barbieri says you might notice feeling hotter just before your period (when estrogen naturally starts to dip). And if you take birth control, you might have a hot flash when you take the placebo sugar pills because your estrogen levels are falling rapidly. Thyroid conditions and (rarely) certain cancers can cause hot flashes, and you can also experience them when you have an infection. An anxiety attack can also cause sudden flushing and sweating but those symptoms are usually accompanied by an increased heart rate and shortness of breath, which you won't experience with a hormone-driven hot flash.

Most of the time, Barbieri says, persistent hot flashes are associated with changes in estrogen leading up to menopause. But if you’re not totally sure, a few key factors can help you determine whether your hot flashes might be tied to menopause — and prompt you to reach out to your medical provider for support if needed.

Your age is one of the most important clues that your hot flashes are associated with menopause. While certain factors, like smoking or chemotherapy, could cause your estrogen levels to start dipping sooner, according to Schroeder, most people start to notice menopause-related symptoms in their early- to mid-forties. So if you’re 25 and you have one hot flash, menopause is unlikely. Schroeder says the age menopause happens to you is genetically predetermined, so it could be worth checking in with your older relatives who’ve been through menopause to see when it happened for them.

By definition, menopause is when you stop getting periods (because you’ve stopped ovulating). Perimenopause is the process leading up to that, and Barbieri says it can last around a decade. During that time, you’ll definitely see changes in your menstrual cycle. Your cycle could be erratic and unpredictable if your estrogen levels are on the decline, Barbieri says. You might also skip the bleeding phase altogether if you're inching closer to life without a period.

If you have one hot flash, or it only happens before your period, don’t be quick to assume you’re approaching menopause. When your estrogen declines, you’ll likely notice persistent symptoms that get more intense over time.

“The longer you go without a period, the less estrogen you have, and the symptoms start happening,” says Schroeder. Your period might vanish for months at a time, and then reappear. When that happens, you might notice hot flashes dissipating because your estrogen levels are rising again — but as your cycle gets longer and longer, you might start having hot flashes more frequently.

Hot flashes probably won’t be the only sign of getting closer to menopause. As your estrogen levels start declining, Barbieri says you may also notice other symptoms of hormonal changes, such as sleep disruption, fatigue, anxiety and depression, hair loss, dry and itchy skin, and vaginal dryness.

Menopause-related hot flashes can be super uncomfortable, but the good news is, they’ll stop eventually. According to Barbieri, hot flashes and night sweats usually stop two years after your last period as your hormones stabilize. Until that point, there’s a lot you can do to manage them.

The most commonly prescribed form of medical treatment is hormone therapy, which involves adding estrogen into your body to help control your symptoms. Hormonal birth control is one form of hormone therapy, but women who aren’t trying to prevent pregnancy often choose transdermal estrogen supplementation, through a patch or cream, which doesn’t have the same risk of blood clotting. Barbieri says estrogen therapy isn’t safe for everybody, such as some people with a history of breast cancer, so there are also non-hormonal medications your medical provider can prescribe — for example, drugs usually used to treat neurological conditions. Other drugs, Schroeder says, work by blocking certain receptors in your hypothalamus thought to aggravate hot flashes.

Lifestyle changes can also make a big difference in keeping menopause-related hot flashes at bay. Simple tweaks like wearing lighter clothing, keeping a fan running, and staying hydrated can help you stay cool, says Barbieri. Reducing alcohol intake, cutting down on caffeine, and skipping the spicy food can also reduce the severity of hot flashes. If you smoke, try to quit, because smoking is known to accelerate menopause (and make symptoms worse).

Not getting the relief you need, or just need help understanding what’s going on and how to deal with it all? Don’t hesitate to reach out to your ob-gyn, who should be able to help you figure out if you’re actually approaching menopause, find the right treatment, and ensure your overall well-being as you get older. As Barbieri puts it: “Menopause is a time in life where we see a number of other health concerns come up, so it’s a great time to take a more holistic assessment of your health.”

More on menopause:

• Gabrielle Union Opens Up About Hair Loss and Hot Flashes
• I Went Through Menopause at 29
• The Science Behind Why You Sweat Less as You Age

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