What Causes Hot Flashes?

This bothersome symptom affects millions of women in menopause, sometimes for several years

Jessica Migala,

AARP

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En español

Published February 17, 2026

illustration of a woman sitting on her bed at night, appearing distressed and sweating from a hot flash

Hugo Herrera

If there’s one symptom that’s commonly associated with menopause, it’s the hot flash.

It’s estimated that 75 to 80 percent of midlife women experience these sudden and intense sensations of heat in the face, neck and chest. And for some, these fiery flares can persist for several years — seven to nine, on average, research suggests.

Why do hot flashes happen in the first place? We spoke with women’s health experts to understand what’s happening in the body that triggers the sudden surge of heat.

How hot flashes happen

Scientists don’t know exactly why hot flashes occur — or why some women get them, and others don’t — but there is some understanding of what’s going on in the body during the big transition that can trigger temperature changes. And a lot has to do with declining estrogen levels.

Levels of this hormone plummet during perimenopause and menopause, and experts suspect that a hot flash originates from neurons in the brain’s hypothalamus that are sensitive to estrogen, says Dr. Susan Loeb-Zeitlin, director of the Women’s Midlife Center at Weill Cornell Medicine in New York City. These are called KNDy neurons.

“When estrogen is low, these neurons are more active,” she explains. “These neurons then fire to the area of the brain, called the hypothalamus, that’s responsible for heat regulation.”

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Small changes in body temperature impact other systems in the body, including the cardiovascular system, says Dr. Monica Christmas, associate professor of obstetrics and gynecology and director of the Menopause Program at UChicago Medicine.

A bump in your body’s core temperature can cause your heart rate to increase and blood vessels to dilate. What’s more, you start sweating to cool yourself down.

Common hot flash triggers

While your body’s temperature control is out of balance, a number of things can trigger a hot flash, including:

Alcohol
Caffeine
Exercise
Hot drinks
Spicy foods
Smoking
Stress
Taking a hot shower
Warm environments
Wearing heavy clothing

A hot flash can strike anywhere from one to 10 times a day and typically lasts one to five minutes. In that short window, your body goes on a true roller coaster.

First comes the sudden wave of heat that makes you want to tear off your sweater, Superman‑style. Then, once your body releases all that heat, you can be left with the opposite problem — cold, sweaty chills.

Treating hot flashes

If you suffer from hot flashes, pay attention to when they tend to strike. Identifying those personal patterns can help you make small lifestyle adjustments that may ease your symptoms.

For example, rather than overdressing for cold weather, you might wear one less layer. Instead of ordering your favorite spicy dish, opt for a milder version. And if you have a hot flash while drinking a glass of wine, switch to a mocktail, or pour yourself a glass of alcohol-free wine at the end of the day.

Some women are fine with lifestyle adjustments, especially if their hot flashes are mild or they perceive them as not bothersome, Christmas says. For others, medication or other therapies might be needed.

The menu of hot flash treatments has grown in recent years. Here are several options:

Hormone therapy (HT): Provides your body with small amounts of estrogen (and progesterone if you still have a uterus). HT has been shown to reduce the frequency and intensity of hot flashes by up to 90 percent, and benefits are felt within a month.
Fezolinetant (Veozah): Loeb-Zeitlin says this nonhormonal prescription medication blocks nerves in the brain that trigger the hot flash, targeting those KNDy neurons. “We mostly use this for women who can’t use hormones. We see about a 50 percent reduction in vasomotor symptoms,” she says. Another nonhormonal medication, elinzanetant (Lynkuet), was recently approved for the treatment of hot flashes.
Paroxetine (Brisdelle): An SSRI (selective serotonin reuptake inhibitor) that is federally approved to treat moderate to severe vasomotor symptoms. This prescription has been shown to reduce hot flash frequency and severity within four weeks. Paroxetine falls into the category of antidepressants, though a lower dose is used for hot flashes. Other SSRIs/SNRIs that research shows are effective for reducing hot flashes are citalopram (Celexa), escitalopram (Lexapro) and venlafaxine (Effexor).
Gabapentin and pregabalin: These are anti-convulsant medications typically used for chronic pain. “There’s about a 45 to 60 percent reduction in vasomotor symptoms with these medications,” Christmas says. These drugs are believed to help calm the nervous system and target the brain to improve your body’s thermoregulatory zone.
Black cohosh: Although there is less research on supplements, black cohosh is one herb that is a phytoestrogen, meaning a plant that has estrogenic properties that may ease vasomotor symptoms, Loeb-Zeitlin says. Just remember to talk to your doctor before taking a supplement, as they can have side effects and interact with other medications you may be taking.
Cognitive behavioral therapy (CBT): When a hot flash happens, especially when you’re out in public, it’s stressful. “You start to think it’s happening again, so your heart races and you get worked up and upset. That state heightens the severity of the hot flash,” Christmas says. CBT is about reappraising your thoughts and responding in a more productive way that helps control your body’s response.

“You might take a deep breath, say to yourself ‘I know what this is,’ and choose to put ice on the back of your neck or think about jumping into ice-cold water. Ultimately, you’re talking to yourself to calm down your central nervous system,” she says.

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