Are Hot Flashes Keeping You Up?

February 20, 2023

Valerie Cacho MD

Learn why and what to do about it in a Q&A with menopause specialist, Dr. Yas 

Do you wake up at night feeling warm, sweaty, or so drenched you need to change your pajamas? If so, learn why you have hot flashes and what to do about them with Dr. Hajira Yasmin aka Dr. Yas. She is a certified ob-gyn and menopause specialist based in Raleigh, North Carolina whose mission is to empower, educate, and uplift women to live an enriched life of optimal gynecological health with graceful transitions through adolescence, childbirth, midlife again and more.

The following excerpt taken from my IG live with Dr. Yas.  For the full interview visit → 

Dr. Val: Let’s dive right in! What are hot flashes and night sweats? Why do we have them?

Dr. Yas: It’s such a big question, I wish we could talk about that for hours. Hot flashes are a feeling of warmth, it’s like a heat wave that comes on your chest and goes to your face and forehead. You end up sweating sometimes with flushing as well. You look like you’re really red and flushed. 

Why does that happen? The reason is because there’s a fluctuation in your hormone called estrogen. Every woman has this hormone called estrogen progesterone. The average age of menopause is 51, — and if you take a woman going into perimenopause at 40, which can happen — the estrogen starts fluctuating. Its consistency is not high in the first part of the cycle; it’s dropping down and going up. Those huge fluctuations alter the neurons in your hypothalamus, which is the temperature center. 

It comes with confusion, too. You get that flush and you go, “What’s happening to me?” Sometimes adrenaline increases and your heart rate goes a little fast. Anxiety and panic can come with hot flashes. That is a whole phenomenon that can last about seven years on average; but some people are lucky and it’ll last for about 18 months to two years. There are also super flashers. 

Dr. Val: Super flashers? What is that?

Dr. Yas: 80% of people do get hot flashes in some way or the other. 20 to 25% are called super flashers. These super flashers don’t just stop in two years; they continue to flash even into menopause. After the transition is over, I have patients that come to me and they’re like 58 or 60 or 61 and go, “I still get this flash. I still end up with sweat.”

Dr. Val:  What my folks want to know is why is it happening at night or does it happen more at night? Sometimes what can happen for women is that we don’t know when the next one is coming so that anticipation can create more anxiety. Do you think that plays a role in why hot flashes are so disruptive at night?

Dr. Yas: It’s both. It’s anxiety that triggers that cycle of anticipation. For someone who gets up in the middle of the night it’s, “What’s happening to me? Why am I sweating and my heart is racing? Is something going wrong with my heart? That anticipation and anxiety hits your adrenaline, too, and anxiety itself is a trigger for hot flashes. 

It’s a vicious cycle. The second thing is there are a few studies that have reported hormonal fluctuations happen more at night — the estrogen drops more at night and women sweat more at night. There is a UK study that about 28 hot flashes happen in a week, typically when you’re going through that transition from perimenopause to menopause. They put about 17 during the day and 11 or so at night. They relatively happen less at night, but why do they even happen at night when you’re sleeping? It’s probably both. Like there’s a trigger, like a very hot bedroom or your covers are too warm or you’ve eaten a spicy food or you’re dehydrated and not sleeping well or you drank before bed. There are some triggers you did during the evening hours or afternoon and that triggered you to be more awake and have one hot flash and that becomes a cycle. 

Dr. Val: How about caffeine? 

Dr. Yas: Caffeine can as well. People should stop drinking caffeine by two or three in the afternoon. I’m sure you know that as a sleep doctor too, there’s a huge half-life on caffeine and caffeine is both a play on sleep and hot flashes as well. Anything to do with caffeine, we try to cut that back by 2 or 3pm, if they’re going to bed by 9 or 10pm. 

Dr. Val: When do you decide to start treatment and what is your treatment approach for hot flashes?

Dr. Yas: This very much depends what practice you’re going to and whether it’s a menopause specialist provider because we dive deeper into menopausal symptoms, and my practice is totally geared towards menopause and perimenopause and sexual wellness. So, I devote all my time to educating and giving options and laying down a very personalized care plan for my patients. 

So, yes, women can wait [hot flashes] out because this is going to go away. Not everyone is going to suffer for seven years because 18 months to two years is the actual average for people who are active. They are going to go away. If you think you can alter your lifestyle and diet and by removing triggers, you can happily wait for about three to six months. If in six months, you think you’ve tried everything you can — you tried supplements and altered your diet because diet plays a big role as well. It’s all about the mind and gut reaction. 

Adding exercises is a great thing, even if it’s a 20 minute walk in the evening or during your lunch break. You get sunlight on your face and your circadian rhythm kicks in, you’re aligning your body for a good night’s sleep. Hot flashes have been known to be less in those people who exercise at least 20 minutes everyday. So, exercise, diet, and even some supplements. We have studied soy products and they help in hot flashes. Even taking a cup of edamame or tofu or miso soup or anything that has soy, and herbal supplements, too. 

We are finding more and more data that the hemp derived CBD is also helping some hot flashers, and we do give that. We have to find the right products and make sure the THC is less than 0.3%. That has helped quite a few patients. Even taking vitamins; you need to be on vitamin C and your B6 vitamin and magnesium. They all help with hot flashes and if nothing is helping you for about three to six months, there are many doctors like me who will go through the weeds of hormonal therapy. 

Dr. Val: Tell me about that! What do you mean by “go through the weeds”?

Dr. Yas: It is very individualized; hormonal therapy is very nuanced. It really has to go with what are your health risk factors, BMI, clotting risk factors. Do you have a family history of breast cancer? Do you have any autoimmune diseases? Do you have anything in your history that impacts using estrogen or even progesterone? Once we know what the indications are, I have to go into what the best preparations are for this woman sitting in front of me. What is her lifestyle and the work she does and how she manages pain? Can she take a pill? Can she take a gel? Can she take a patch? Can she take a vaginal product? Usually vagina products don’t help a lot with hot flashes, they’re more for gential symptoms like dryness and pain. 

It’s a very lengthy and long discussion. I think that’s where we are failing in busy health systems. We don’t have much time to go through the nuances or weeds of hormone therapy. 

A last note from Dr. Yas:

I want to talk a little bit about yoga, paced breathing, and acupuncture because I’m an integrative gynecologist. I’m not all about medications. I integrate all these other therapies like yoga and Pilates is a great thing. There was a study at Wake Forest University where they used acupuncture and acute pressure and found that doing that one episode of acupuncture actually gave a lot of relief to a lot of women. It doesn’t work for everybody, but it does give relief from hot flashes and the effect will stay for about three to six months. 

I encourage women to try all these other complimentary things — anything with paced breathing like meditation or anything that connects your mind to your body, before you jump on to any medications, herbals, or supplements. Clean up your diet, get some exercise, and take care of your mind and body and then come back to me and see what’s working and what’s not working. 

For more menopause tips follow Dr. Yas on IG @dryas.alraymd. If you live in NC and are looking for a certified menopause physician visit her website:   

This interview has been edited for length and clarity.

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