Figuring out what’s causing your hot flashes can be tricky business. Is it anxiety, menopause, or both?

If you’re in the midst of perimenopause, aka menopausal transition, you’re likely all too familiar with hot flashes.

You’re no stranger to the random forehead sweats, the sudden feeling of warmth all over, and the night sweats that have you waking up drenched in sweat.

But could there be another reason for those moments of seemingly inexplicable burning skin and excessive sweating?

It may be anxiety, which is often a trigger for elevated heart rate, quickened breathing, and rising body temperatures.

Whether you’re experiencing hot flashes because of anxiety or menopause, there are ways you can successfully manage them.

Hot flashes, also known as vasomotor symptoms, are a common symptom of the menopausal transition, or perimenopause. A person is said to be in menopause 12 months after their last period (menstruation).

The menopausal transition can happen anywhere between the ages of 45 and 55 and can last from 7 years up to 14 years for some.

A 2019 review shows that more than 80% of women in menopause get hot flashes. However, this research doesn’t take into account transgender or gender-nonconforming persons who also experience menopause and hot flashes.

The length of time a person will experience them varies significantly, ranging from 3 to 11 years.

Hot flashes typically feel like a wave of intense heat in your chest, neck, and face. They can lead to sweating, red skin, and an elevated or irregular heartbeat.

They generally last between 30 seconds and 10 minutes and end with the chills as the heat leaves your body.

Many people who get hot flashes experience them at night, often referred to as night sweats. You might wake up flushed, drenched in sweat, and understandably uncomfortable.

There’s still some confusion among scientists about what exactly causes hot flashes.

During perimenopause and after, it’s believed that hot flashes are the result of decreased levels of estrogen and progesterone production.

The lack of estrogen misleads your hypothalamus, which is often considered the body’s “thermostat,” into believing that your body temperature is far too hot.

Hot flashes are the body’s way of getting rid of that imagined heat. Your heart rate increases, blood vessels widen, and sweat glands perspire to bring your body temperature down.

Anxiety can lead to hot flashes through a somewhat different mechanism, by exciting the sympathetic nervous system and releasing stress hormones like cortisol, increasing your body temperature.

It’s part of the body’s fight or flight response, artificially brought on by anxiety, even when you’re in no immediate danger.

Of course, the most prominent symptom of a hot flash is that sudden feeling of boiling up. The temperature of some people’s skin rises a whole 6°C during a hot flash.

But for some people, hot flashes include more than just that. Additional symptoms can include:

  • sweating
  • flushing
  • increased heart rate
  • heart palpitations
  • dizziness
  • insomnia

It’s no wonder that many people find hot flashes to be incredibly uncomfortable and distressing. Nobody likes waking up to a soaked pair of pajamas or sitting at work with a tomato-red face.

Anxiety disorders are among the most common mental health conditions. Around 31% of people in the United States will experience an anxiety disorder at some point in their life.

Women are nearly twice as likely as men are to develop an anxiety disorder.

Everyone knows what it feels like to experience anxiety, even if it isn’t severe enough to be considered a disorder.

Symptoms of anxiety can be both mental and physical, including:

  • excessive worrying
  • restlessness
  • muscle tension
  • elevated heart rate
  • upset stomach

The confusing thing about hot flashes and anxiety is trying to determine which caused which.

As we’ve already discussed, the physiological response to anxiety can certainly bring about the sensation of a hot flash. This is especially true for events like panic attacks, where your heart rate and breathing rate are likely to spike even more.

But the opposite is also true — a hot flash can lead to feelings of anxiety. The sudden rush of warmth and other physical symptoms of hot flashes can be distressing.

Ironically, the fear and anticipation of experiencing a hot flash can bring on those exact physical symptoms.

Let’s add one more piece to an already tricky puzzle — menopause.

Both anxiety and perimenopause can cause hot flashes on their own, but it’s also true that people with anxiety during perimenopause are more likely to experience vasomotor symptoms.

One long-term study that followed hundreds of women through mid-life found that those with the highest levels of physical anxiety symptoms during menopause also had the greatest chance of experiencing hot flashes.

The study also found that the influence of anxiety on hot flash frequency stayed the same throughout each stage of menopause.

These 2016 findings were consistent with the researchers’ earlier study, which found that women with high anxiety were nearly five times more likely to report hot flashes than women with “normal” levels of anxiety.

It’s difficult to prevent your body’s natural responses to menopause, but research like this tells us that treating underlying mental health concerns can be a critical way of reducing the frequency and intensity of hot flashes, even if they occur during menopause.

Still, it can be a challenge to determine whether your hot flashes are the result of anxiety, menopause, or both. However, they’re more likely to be a symptom of anxiety and not reproductive changes if:

  • you aren’t experiencing other symptoms of menopause, such as mood changes or menstrual irregularities
  • you’re younger than 40
  • you have a history of anxiety disorders

The good thing about anxiety is that there are plenty of effective ways to treat its symptoms, including hot flashes.

Some of the tried and true techniques for managing anxiety are:

  • Cognitive behavioral therapy (CBT). This type of therapy helps to correct illogical and harmful patterns of thinking, reducing stress and anxiety and calming the nervous system.
  • Medication. Some medications — such as antidepressants, benzodiazepines, and beta-blockers — are effective at reducing anxiety, but should be used with caution.
  • Meditation and mindfulness. Relaxation techniques like yoga, breathing, meditation, or journaling help calm the mind and reduce an elevated heart rate.

If menopause is the main culprit for your hot flashes, there are medical treatments that may help. These include:

  • Hormone therapy. Hormone replacement therapy entails taking an estrogen and progesterone supplement, which can come in many different forms. It’s incredibly effective in reducing symptoms of menopause, but it comes with some significant side effects.
  • Estrogen therapy. Women who’ve had a hysterectomy receive estrogen-only hormone therapy. The goal is to replace the supply of estrogen your ovaries no longer produce.
  • Antidepressants. Taking antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) — has shown to be effective for treating hot flashes.

Popular natural remedies for hot flashes have varying levels of scientific support, but some find these helpful:

Consider talking with your healthcare or mental health professional before starting any treatments or medications to make sure they’re safe for you and fit your needs.

Even though hot flashes can be a normal, albeit annoying, part of life for most, that doesn’t mean there’s never cause for concern.

Consider seeing a doctor if your hot flashes are persistent and disruptive to your life.

Hot flashes may also be the result of a more serious medical issue, such as:

They may also be a side effect of certain medications, so consider talking with your doctor about any drugs you currently take or plan to take.

Trying to figure out the causes of your hot flashes and how best to manage them can be frustrating, but you’re far from alone in your quest for answers.

The vast majority of people will experience hot flashes during their middle-age years, many of them managing anxiety at the same time.

With small changes you can make yourself and help from your healthcare or mental health professional, hot flashes and the anxiety that comes along with them can be manageable.

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