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Physiology of hot flashes
Open accessAbstract
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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In the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“Using an ingestible thermometer (radio-telemetry pill), a very small increase in core temperature was detected before the onset of 65% to 76% of flushes (Fig. 3) (Freedman, 1998, 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
In the citing paper
“In symptomatic postmenopausal women, exposure to a warm environment provokes hot flushes (Freedman, 2001; Freedman and Roehrs, 2006; Kronenberg and Barnard, 1992; Molnar, 1981).”
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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Metadata
- 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
- 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
- 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 (medical) › Thermoregulation and physiological responses
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › 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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