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Menopause · Updated 2026-05-15

Hot flashes: what causes them and how to manage

Written byEditorial Team, HormonalHealth PortalReviewed byEditorial Medical Review, MD, NAMS-CMP· Updated May 15, 2026

Short answer: Hot flashes result from estrogen-driven dysfunction in the hypothalamus, your body's thermostat. Triggers include caffeine, alcohol, spicy food, and stress.

1 min read

Key takeaways

  • ~80% of women experience hot flashes during peri/menopause
  • Triggers vary — track yours for 2 weeks to identify
  • HRT, SSRIs (paroxetine, escitalopram), and gabapentin are evidence-based options

The mechanism

Estrogen modulates serotonin and norepinephrine, both involved in thermoregulation. When estrogen drops, the hypothalamus mis-reads body temperature, triggering "cool down" cascades — flushing, sweating, palpitations.

Common triggers

Caffeine, alcohol, spicy foods, hot beverages, stress, hot environments. Most women have 2-3 personal triggers. Track for 2 weeks to identify yours.

Evidence-based treatments

HRT (most effective, 75-90% reduction). Paroxetine 7.5mg (only FDA-approved non-hormonal). Off-label: SSRIs, gabapentin, clonidine, fezolinetant (Veozah, newer NK3 receptor antagonist).

SC
Reviewed by Editorial Medical ReviewBoard-certified OB/GYN · NAMS-certified · Updated 2026-05-15

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