17-07-2025
Hot Flashes Impact Heart And Brain Health. Why Aren't More Women Seeking Treatment For Them?
Welcome to the Perimenopause Playbook—your guide to navigating the most overlooked and misunderstood phase of the menopausal transition. Read the rest of the stories, from how to get a diagnosis to treatment options to where to actually find good care, here.
Up to 80 percent of women experience hot flashes, otherwise known as vasomotor symptoms, at some point in the menopausal transition. Yet only about a quarter of women receive treatment for them. And, no, they're not just inconvenient—they can actually have a lasting impact on your health.
Hot flashes are correlated with increased memory problems and Alzheimer's disease biomarkers in the blood. They're also associated with increased cardiovascular disease (CVD) risk, particularly in perimenopausal women. Hot flashes that occur during REM sleep have greater ties to CVD.
'I envision that hot flashes are going to be [treated] like blood pressure changes,' says Pauline Maki, PhD, a professor of psychiatry, psychology, and ob-gyn at the University of Illinois at Chicago. 'Once you reach a certain threshold of hot flashes, I think we're going to find that you need to treat them to optimize your heart and brain health.'
What Triggers a Hot Flash: There are neurons in an area of the brain called the hypothalamus. These neurons are responsible for regulating body temperature and are influenced by estrogen. When estrogen declines in perimenopause, menopause, and postmenopause, the neurons become overactive, dysregulating body temperature and triggering the hot flashes.
The Threshold: NIH-funded clinical trials are underway to determine what frequency and intensity of hot flashes negatively impact the brain and heart. Dr. Maki notes that surges in stress hormones like cortisol could be a factor—especially if a woman is more exposed to this stress hormone than a woman with fewer symptoms—but more research is needed to determine the cause. We do know that Black and Native women experience more frequent and intense hot flashes than their white counterparts.
The Role of Estrogen: It's the hot flashes that are affecting the brain and heart—not the estrogen. 'The idea is you treat the symptoms, you don't treat the loss of estrogen,' explains Dr. Maki. 'There's too much messaging about 'Oh, the loss of estrogen leads to dementia.' Well, we'd all be demented if that's the case, because all of us lose estrogen.'
Hot Flash Relief
Hormone therapy is the most effective treatment for hot flashes, but there are nonhormonal treatments available as well.
The first NK3 receptor antagonist that's FDA-approved to treat moderate to severe hot flashes.
A selective serotonin reuptake inhibitor (SSRI) that's also FDA-approved to treat hot flashes.
This medication used to treat epilepsy and chronic nerve pain is sometimes prescribed off-label.
CBT is found to reduce the impact of hot flashes and improve quality of life.
A small study shows acupuncture improves hot flashes, though researchers believe this is due to placebo effect rather than the treatment itself.
This story appears in the Summer 2025 issue of Women's Health.
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