Hot Flashes and Health

Hot flashes may be more than annoying.

Does this sound familiar? You’re enjoying a night out with friends, running errands, or sleeping peacefully. The next thing you know, you’re drenched in sweat for no apparent reason. You’re having hot flashes, technically known as vasomotor symptoms (VMS). Vasomotor symptoms are a hallmark of menopause that are called night sweats when they happen during sleep.

What Happens During a Hot Flash

Hot flashes affect about 80% of women during the transition to menopause and may continue for years after menopause occurs. Hot flashes happen when the brain mistakenly thinks the rest of the body is overheating, triggering a chain of reactions to decrease the perceived heat, including sweating, flushing, and chills. Declining estrogen levels are to blame, as they disrupt the brain cells that are responsible for controlling your core temperature. In addition to being uncomfortable, embarrassing, and puzzling, a growing body of evidence suggests hot flashes may be a harbinger of health.

How Hot Flashes Influence Health  

A 2023 study published in Neurology found that having a greater number of hot flashes and night sweats was associated with more white matter hypersensitivities in the brain. White matter hypersensitivities are tiny insults to brain tissue that accumulate with age (and uncontrolled blood pressure). Some studies have linked white matter hyperintensities to a higher chance for stroke, cognitive decline, and Alzheimer’s disease. The study included 226 women ages 45 to 67 who didn’t take hormone therapy, which is considered the best way to treat hot flashes.  Most of subjects were white, so it’s hard to say if the findings apply to all women.

Hot flashes are associated with an increased occurrence of several traditional risk factors for cardiovascular disease, including high blood pressure, insulin resistance and diabetes, and elevated cholesterol and trigyclerides (fat) in the blood.  While there is no published research that proves hot flashes actually cause cardiovascular disease, there is mounting evidence of a link, according to Samar R. El Khoudary, Ph.D., M.P.H., F.A.H.A., professor at the University of Pittsburgh School of Public Health Epidemiology Data Center.

Dr. El Khoudary was one of the investigators involved with the Study of Women's Health Across the Nation (SWAN). The study followed more than 3,300 women for about 20 years. In this ethnically-diverse population, researchers found that hot flashes were linked to a greater risk for heart attack, stroke, and other cardiac events. Women with frequent hot flashes had a 50% greater chance for an event and those with frequent and persistent hot flashes experienced a 77% greater chance, leading the authors to conclude that hot flashes may be a risk factor for cardiovascular disease.  The study also showed that the risk for cardiovascular disease increased when hot flashes started earlier in life or persisted for longer after menopause occurred.

Managing Hot Flashes with Diet

You can’t change the fact that you’re prone to hot flashes, but you can take steps to minimize them and decrease their effects on your heart and brain health.  

The American Heart Association suggests that women track traditional risk factors including blood cholesterol, blood pressure, blood glucose and body weight as these numbers can gradually increase, particularly after menopause occurs. A balanced diet that is largely plant-based, but not necessarily free of lower-fat animal foods, helps to keep these numbers in check when paired with regular exercise. An eating plan that supports heart and brain health is also low in saturated fat, sodium, added sugars and alcohol, and rich in fiber, and it includes at least two servings of seafood weekly.

Weight control can help, too. A study published in Menopause found that weight loss in a group of women with overweight decreased their hot flashes, and a 2023 review from the North American Menopause Society endorses weight loss for treating hot flashes.  It’s important to find an enjoyable way of eating that works for you with adequate calories to maintain a healthy body weight on a longterm basis.

Soy foods may help decrease hot flashes. Tofu, edamame and tempeh contain phytoestrogens, which is plant-based estrogen. Phytoestrogens can produce weak estrogen-like effects in the body, which may reduce hot flashes in some women. Phytoestrogens are also found in flaxseed, peanuts, plums, pears, apples, grapes, spinach, grains, garlic and onion.  

You may have seen the headlines about a 2023 study in which women ate a low-fat, vegan diet with ½ cup cooked soybeans daily and had fewer and less-intense hot flashes. However, it’s hard to say if diet alone was responsible. That’s because the group of women in the study who didn’t change their diets also had fewer and less intense hot flashes.  And, it’s important to note that women on the vegan diet ate about 1,330 calories a day and lost an average of 8 pounds. As mentioned above, weight loss can reduce hot flashes, which is another reason to view the results with caution. While this study offers some hope about soy, the diet is strict and too low in calories to sustain. 

On balance, the research doesn’t support soy foods for hot flashes. However, soy products supply many nutrients that benefit women before and after menopause, such as complete protein, vitamins and minerals. A balanced, plant-based diet that includes a serving of soy daily is more sustainable in the long run and may produce weight loss.

Alcohol and caffeine can trigger hot flashes in some women, so if you are suffering with frequent flashes, try avoiding alcohol and minimizing caffeine and see if that helps. Women who smoke are also at greater risk for hot flashes.

Take Care of Your Heart and Brain

It’s unclear if reducing hot flash frequency and intensity diminishes the potential risk for cardiovascular disease and cognitive issues, but it can make you more comfortable, reduce your stress level, and improve your sleep, all of which will help you have the energy to take care of your health.

If you have hot flashes, talk to your doctor about how to reduce their frequency and intensity. Hormone therapy works best, and some other non-hormonal medications can also be useful for hot flashes.  Other approaches, like cognitive behavior therapy, acupuncture, and regular physical activity, can reduce the stress, anxiety, and depression that may occur with  persistent hot flashes.

Dr. El Khoudary says that women with a history of hot flashes may require more screening to help them to stay as healthy as possible. This may be even more important for African American and Hispanic women, who have hot flashes for longer than Asian and white women, according to the National Institute of Aging.