Are Hot Flashes Bad for Your Heart?

Hot flashes are one of the most common symptoms of menopause. While most people see them as an uncomfortable annoyance, research is starting to show that hot flashes may have health effects.

At the annual meeting of the North American Menopause Society (NAMS) in early October, an overview of how hot flashes could affect the heart and brain was presented by Rebecca Thurston, PhD, Pittsburgh Foundation Chair in Women’s Health and Dementia and Professor of Psychiatry, Clinical and Translational Science, Epidemiology and Psychology at the University of Pittsburgh and a past president of the North American Menopause Society.

According to Thurston, research shows that people who get more frequent hot flashes may also have worse cardiovascular risk profiles.

In other words, these people tend to have health risk factors like high blood pressure, insulin resistance, diabetes, and high cholesterol levels. These factors can also put them more at risk for the thickening of the arteries (atherosclerosis) that can be caused by high blood pressure.

Hot Flashes: More Than Annoying

Hot flashes, also called vasomotor symptoms, are caused by the changing levels of estrogen that take place during menopause. Decreasing estrogen levels cause the hypothalamus—which is basically the brain’s thermostat—to overreact to even slight changes in body temperature.

The result is a hot flash, which can be like a sudden feeling of heat that’s accompanied by a rapid heartbeat, sweating, flushing, and red skin. When hot flashes occur at night, they are often called night sweats because a person wakes up drenched in sweat.

About 75% of people going through menopause have hot flashes. For some, the symptom is frequent and severe. People may have several hot flashes a day with each lasting up to 10 minutes. On the other hand, some menopausal people never experience hot flashes, or only have very mild ones.

Thurston told Verywell that hot flashes may persist for seven to 10 years—and during that time, they might be more than an annoyance.

“We think about hot flashes as this bothersome symptom that you really should just kind of suffer through,” said Thurston. “What we’re seeing is that that’s probably not true. They are, at a very minimum, telling us something about women’s cardiovascular health and about brain health.”

Even though menopause is a key part of a person’s life, it can be overlooked even by gynecologists who specialize in caring for people’s reproductive health.

“Many gynecologists are not trained in menopause care at all,” said Thurston. “We’re overlooking this whole menopause transition.”

Thurston pointed out that many people stop seeing a gynecologist after their last pregnancy and use general practitioners for their healthcare, which is why she thinks that “primary care providers need to know more about menopause,” too.

Hot Flashes and Cardiovascular Risk

According to Thurston, studies have shown that having frequent, persistent hot flashes, as well as having them earlier in menopause, is associated with a higher risk of cardiovascular disease.

“I think there’s enough research [showing this link] that people are starting to pay attention to it,” Anne Ford, MD, a NAMS certified menopause practitioner, an associate professor of obstetrics and gynecology at Duke University School of Medicine, and division director of Duke Women’s Health Wake County North, told Verywell.

Why are hot flashes associated with a higher risk of cardiovascular disease? The short answer, according to Thurston, is that “we don’t know.”

Hormones, interruptions in sleep, obesity, or smoking—factors that Ford called the “usual suspects” in cardiovascular issues such as heart attack and stroke—don’t seem to be what’s at work with hot flashes and the heart.

After these factors were accounted for in research, the association between vasomotor symptoms and cardiovascular disease was still there, and Ford said that researchers “definitely feel confident in that association.”

Still, Thurston said we need more research to clarify how hot flashes and cardiovascular disease risk are connected because it’s not clear whether one causes the other or if they’re both caused by shared factors.

Untangling that relationship is important not just for helping people get relief from hot flashes, but figuring out how to help them reduce any possible health risks.

“We don’t yet know whether treating them will improve cardiovascular health and brain health, but hot flashes certainly have been demonstrated again and again to be more than just a bothersome symptom,” said Thurston.

While Ford noted that research is still ongoing, she added that “if people aren’t paying attention to it—they should be.”

Hot Flashes and the Brain

“Brain fog” is another common symptom of menopause. While hot flashes are certainly not all in a person’s head, they may have an effect on the brain.

In one of their studies, Thurston and colleagues looked at the brains of just over 200 middle-aged women. They specifically looked for spots in the white matter of the brain that showed up brighter on MRI scans (called white matter hyperintensities), which can give insight into the health of the brain’s small blood vessels.

The researchers saw a relationship between hot flashes and increased white matter hyperintensities in the brain—especially when the hot flashes occurred during sleep.

Based on the findings, the researchers purposed that hot flashes could be a midlife marker of brain health.

Should You Worry About Your Hot Flashes?

If you get hot flashes—even frequent or severe ones—you don’t necessarily need to panic.

“I don’t want this information to scare women—women are stressed out enough at midlife,” said Thurston. “But just use it as a signal to take care of yourself.”

Bottom line? Ford said that a person who is having severe or frequent hot flashes should see their healthcare provider as a starting point—even if it’s just to find relief from the symptom. Whether they also need to see a cardiologist to have their heart health looked at will depend on other factors like their overall health and whether they have a family history of heart disease.

Ford said that as a provider, “if somebody comes to me and says ‘I want to take hormone therapy because I read this article where my vasomotor symptoms are associated with worsening cardiovascular disease,’ and they’re 50 pounds overweight and they’re on a lipid-lowering medication and have diabetes, diabetes, I’m going to say ‘you’ll get more bang for your buck if you work on these other factors.’”

Hot flashes or not, Thurston added that there are proactive steps menopausal people can take to protect their health throughout the menopause transition.

“If you’re a smoker, stop smoking,” said Thurston. “Now’s the time to start that exercise program. Take your anti-hypertensive medications if you need them and get your diabetes treated.”