Hot Flashes: Causes, Triggers, and Management Strategies

Hot flashes (vasomotor symptoms) affect up to 85% of women during menopause transition. Also occur in men on androgen deprivation therapy (ADT) for prostate cancer.

Pathophysiology

• Estrogen decline → hypothalamic thermoregulatory center narrowing of **thermoneutral zone**.
• Small core temperature rise → disproportionate heat‑dissipation response (vasodilation, sweating).
• Neurotransmitters: norepinephrine, serotonin, neurokinin B (NKB) implicated.

Common Triggers

• Stress, anxiety.
• Hot beverages, spicy foods.
• Caffeine, alcohol.
• Warm environments, tight clothing.
• Smoking.

Management

Approach	Options
Lifestyle	Layered clothing, fan, cool room, avoid triggers, paced breathing, weight loss, smoking cessation
Non‑hormonal Rx	Gabapentin, pregabalin, SSRIs/SNRIs (paroxetine, venlafaxine, escitalopram), oxybutynin, fezolinetant (NK3 antagonist – new)
Hormone Therapy (HT)	Estrogen ± progestin – most effective; individualize risk/benefit (age, time since menopause, uterine status)
Complementary	CBT, hypnosis, acupuncture (mixed evidence); black cohosh, soy (inconsistent)

For Men on ADT

• Similar triggers; HT contraindicated.
• Megestrol acetate, cyproterone, gabapentin, SSRIs, fezolinetant.

Individualize treatment; reassess annually. Hot flashes typically resolve over 2–10 years but can persist decades.