Physiology of hot flashes

Freedman, Robert R.

doi:10.1002/ajhb.1077

Cited by 369Menopause: Health Impacts and TreatmentsThermoregulation and physiological responsesEstrogen and related hormone effects

Physiology of hot flashes

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Freedman, Robert R.·2001·American Journal of Human Biology

DOI 10.1002/ajhb.1077

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Abstract

Hot flashes are the most common symptom of the climacteric, although prevalence estimates are lower in some rural and non-Western areas. The symptoms are characteristic of a heat-dissipation response and consist of sweating on the face, neck, and chest, as well as peripheral vasodilation. Although hot flashes clearly accompany the estrogen withdrawal at menopause, estrogen alone is not responsible since levels do not differ between symptomatic and asymptomatic women. Until recently it was thought that hot flashes were triggered by a sudden, downward resetting of the hypothalamic setpoint, since there was no evidence of increased core body temperature. Evidence obtained using a rapidly responding ingested telemetry pill indicates that the thermoneutral zone, within which sweating, peripheral vasodilation, and shivering do not occur, is virtually nonexistent in symptomatic women but normal (about 0.4 degrees C) in asymptomatic women. The results suggest that small temperature elevations preceding hot flashes acting within a reduced thermoneutral zone constitute the triggering mechanism. Central sympathetic activation is also elevated in symptomatic women which, in animal studies, reduces the thermoneutral zone. Clonidine reduces central sympathetic activation, widens the thermoneutral zone, and ameliorates hot flashes. Estrogen virtually eliminates hot flashes but its mechanism of action is not known.

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Physiological hot flashes were measured by sternal skin conductance using the Biolog ambulatory recorder, with hot flashes flagged by published norms and each skin conductance track evaluated by a trained expert verifying that events matched published norms for vasomotor events.
“Based on published norms,10–13 hot flashes were flagged if there was an increase in sternal skin conductance of at least 2 μmho within a 30 second period, with a 15-minute post-event lock-out. Each skin conductance track was evaluated by a trained expert, verifying that each skin conductance event matched published norms for vasomotor events.”
From Clinical hypnosis in the treatment of postmenopausal hot flashes (2013) · cites this paper as [13]
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Hot flushes are characterized by a transient and intense sensation of heat accompanied by activation of heat-loss effectors including skin vasodilatation, sweating, and cold-seeking behavior.
“Hot flushes are characterized by a transient and intense sensation of heat accompanied by the activation of heat-loss effectors including skin vasodilatation, sweating, and cold-seeking behavior (Fig. 3) (Freedman, 2001; Kronenberg, 2010).”
From Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: A novel hypothesis on the mechanism of hot flushes (2013) · cites this paper as Freedman, 2001
Hot flushes can be triggered by thermal, chemical, or other stimuli including increased ambient temperature, hot beverages, caffeine, spicy food, stress or anxiety.
“Hot flushes can be triggered by a variety of stimuli including thermal (increased ambient temperature or hot beverages), chemical (caffeine or spicy food) or other (stress or anxiety) (Archer et al., 2011; Freedman, 2001).”
From Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: A novel hypothesis on the mechanism of hot flushes (2013) · cites this paper as Freedman, 2001
After a hot flush is triggered, the core temperature drops, as expected with activation of heat dissipation effectors.
“After a hot flush is triggered, the core temperature drops (Fig. 3) (Freedman, 2001; Kronenberg, 1990; Molnar, 1975), as expected with the activation of heat dissipation effectors.”
From Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: A novel hypothesis on the mechanism of hot flushes (2013) · cites this paper as Freedman, 2001
Raising the ambient temperature increases the frequency of flushes in symptomatic postmenopausal women.
“Conversely, raising the ambient temperature increases the frequency of flushes in symptomatic postmenopausal women, and this feature has been used to stimulate flushes in a laboratory setting (Freedman, 2001).”
From Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: A novel hypothesis on the mechanism of hot flushes (2013) · cites this paper as Freedman, 2001

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Authors: Freedman, R. R.
Affiliations: Wayne State University (US)
Corresponding author: Freedman, Robert R.
Venue: American Journal of Human Biology
Publisher: Wiley
Published: 2001-05-31
Volume: 13
Issue: 4
Pages: 453-464
ISSN: 1042-0533 (ISSN-L)
1520-6300
DOI: 10.1002/ajhb.1077
OpenAlex: W2062202632
Cited by: 369
References: 66
Citations by year: 2026: 13 · 2025: 14 · 2024: 3 · 2023: 8 · 2022: 10 · 2021: 5 · 2020: 10 · 2019: 14 · 2018: 13 · 2017: 12 · 2016: 22 · 2015: 10 · 2014: 16 · 2013: 24 · 2012: 9
FWCI: 1.81
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: American Journal of Human Biology (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health
National Institute on Aging (AG-05233)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
Keywords: hot flashes, climacteric, menopause, thermoneutral zone, heat dissipation, sweating, peripheral vasodilation, clonidine, estrogen, core body temperature
MeSH terms: Body Temperature Regulation, Circadian Rhythm, Clonidine, Female, Humans, Menopause, Middle Aged, Risk Factors, Skin Temperature, Sweating, Sympatholytics, Time Factors, Estrogen Replacement Therapy, Hot Flashes

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