Semin Reprod Med 2005; 23(2): 117-125
DOI: 10.1055/s-2005-869479
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662.

Pathophysiology and Treatment of Menopausal Hot Flashes

Robert R. Freedman1
  • 1Professor, Obstetrics and Gynecology, and Psychiatry and Behavioral Neurosciences, and Director, Behavioral Medicine Division, Wayne State University School of Medicine, Detroit, Michigan
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25. April 2005 (online)


Hot flashes are the most common symptom of menopause. Although the appearance of hot flashes coincides with estrogen withdrawal, this does not entirely explain the phenomenon because estrogen levels do not differ between symptomatic and asymptomatic women. Luteinizing throughout? hormone pulses do not produce hot flashes nor do changes in endogenous opiates. Recent studies suggest that hot flashes are triggered by small elevations in core body temperature (Tc) acting within a reduced thermoneutral zone in symptomatic postmenopausal women. This narrowing may be due to elevated central noradrenergic activation, a contention supported by observations that clonidine and some relaxation procedures ameliorate hot flashes. Because hot flashes are triggered by Tc elevations, procedures to reduce Tc, such as lowering ambient temperature, are beneficial. Estrogen ameliorates hot flashes by increasing the Tc sweating threshold, although the underlying mechanism is not known. Recent studies of hot flashes during sleep call into question their role in producing sleep disturbance.


Robert R Freedman, Ph.D. 

Obstetrics and Gynecology, and Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine

C. S. Mott Center, 275 E. Hancock Avenue

Detroit, MI 48201

eMail: [email protected]