Hot Flashes, Anxiety and Menopause: What’s the Connection?

You get a rush of heat. Then, you start to sweat. Out of nowhere, it feels like your body temperature has gone up 10 degrees. There’s no doubt about it, you’re having a hot flash.

Naturally, this could set off another alarm in your body: anxiety.

The real question is: Could these two be connected? Hot flashes are a common symptom of menopause and perimenopause. But could anxiety — the feeling of intense worry and nervousness — be a trigger for making them worse?

Gynecologist Ibrahim Sozen, MD, breaks down the connection between anxiety and hot flashes — and how you can manage both.

What are hot flashes?

If you’re approaching or in the midst of menopause, you’re likely no stranger to hot flashes.

A hot flash is a common vasomotor symptom that occurs during menopause and perimenopause. It usually feels like breaking out in a sweat and feeling suddenly very hot, like you just walked into a sauna. You may also start experiencing night sweats, which come hand-in-hand with hot flashes like a sneaky dynamic duo.

While the “why” behind hot flashes and night sweats aren’t exactly clear, they’re likely linked with decreasing estrogen levels.

“The ovaries gradually produce less and less estrogen when someone is in their mid-40s,” explains Dr. Sozen.

During this time, these hormone changes can affect your body’s ability to control its own temperature.

Does anxiety trigger hot flashes?

If you experience anxiety, you know it can feel like a fire drill going off in your head. Suddenly, even the smallest worries become the biggest catastrophes.

As your body is going through a period of stress and uneasiness, it’s common for anxiety to also trigger certain physical symptoms in the rest of your body.

A 2016 study suggests that anxiety may be a good predictor of a hot flash coming. This same study pointed out that people with somatic anxiety symptoms (somatic meaning you have physical reactions to anxiety, like stomach aches, headaches and dizziness) had a higher chance of experiencing hot flashes as well.

But more emotional-related anxiety or worry didn’t have as strong of a relation to hot flashes. In other words, simply feeling nervous over a job interview isn’t enough to trigger a hot flash.

“This connection to hot flashes is especially true for events like panic attacks, where your heart rate and breathing rate are likely to spike even more,” notes Dr. Sozen.

Some examples of physical anxiety symptoms are:

• Heart palpitations.
• Upset stomach or nausea.
• Muscle tension.
• Shortness of breath.
• Feeling light-headed or dizzy.

Is it menopause, anxiety or both?

What came first? The chicken or the egg? Anxiety or hot flashes? The answer is … it can go both ways.

“Anxiety can trigger a hot flash. And the opposite is also true — a hot flash can lead to feelings of anxiety,” explains Dr. Sozen. “The sudden rush of warmth and other physical symptoms of hot flashes can be really distressing.”

Hot flashes tend to hit you — well, in a flash. So, when you experience a rise in temperature, you may be caught off guard and, understandably, feel a twinge of anxiety or nervousness.

In one study published in 2005, researchers followed 436 premenopausal women for six years and found that people with anxiety were 3 to 5 times more likely to have hot flashes.

In other words, if something else causes a hot flash, it may cause a domino effect and trigger feelings of anxiety as well. And if you’ve been feeling hot flashes come and go for a long time, you may start anticipating these flashes to hit you at any moment.

Hot flashes can cause both physical and emotional anxiety, depending on the person. Here are some common signs of non-physical anxiety symptoms:

• Feelings of nervousness and restlessness.
• Having trouble sleeping due to racing thoughts.
• Obsessive and worrisome thoughts.

How to decrease anxiety and stress during menopause

One thing is for sure: It’s a good idea to keep your stress and anxiety levels in check during menopause. If you’re experiencing intense anxiety, it’s probably touching many parts of your life. Reducing hot flashes is another benefit to treating your anxiety.

Here are some ways to keep physical and emotional anxiety symptoms at bay.

Cognitive behavioral therapy (CBT)

One type of therapy that Dr. Sozen recommends is cognitive behavioral therapy (CBT), which is a structured form of talk therapy that can relieve both psychological and physical symptoms of anxiety.

“This type of therapy helps to correct illogical and harmful patterns of thinking,” explains Dr. Sozen. “It helps stress and anxiety and calms the nervous system.”

Medications

If your anxiety-induced hot flashes are getting especially severe, your healthcare provider may recommend certain medications to help tackle them. But Dr. Sozen warns that these options should be discussed with your healthcare provider first.

“Some medications such as antidepressants, benzodiazepines and beta-blockers are effective at reducing anxiety, but should be used with caution,” says Dr. Sozen.

Meditation and mindfulness

Emptying your mind of worries is easier said than done. But there are certain mindfulness and breathing exercises you can do to help tackle anxiety symptoms.

“Relaxation techniques like yoga, breathing, meditation or journaling help calm the mind and reduce an elevated heart rate,” Dr. Sozen suggests.

There’s a variety of things to try, but the key is to ground your body.

Get plenty of rest

If you’re struggling to stay cool throughout the day, chances are your hot flashes are also invading your bedtime. This sudden rise in heat can affect your sleep schedule, so it’s important to find strategies to get the rest you need.

“Forty to 50% of people experience sleep disturbances or insomnia during the menopausal transition,” Dr. Sozen adds. “Sleep disorders can cause anxiety, and anxiety can cause a person to sleep poorly.”

If you’re not able to get seven to eight hours of sleep, try these strategies to find relief for your night sweats, and take naps as needed to help with any lost nighttime sleep.

Exercise if you can

It may seem counterintuitive, but getting your body moving can help with hot flashes. According to various research studies, exercise helps train your thermoregulatory system (the part of your body that controls and adjusts to different temperatures).

Basically, moving your body helps these systems practice regulating your body’s temperature — so when you do get a hot flash, they’re more prepared to adapt to it.

But it’s also important to be careful to not overextend yourself during workout sessions, or it could cause the opposite effect. Try doing easy cardio exercises as a way to get your blood flowing and put your mind at ease.

Talk about it

Having anxiety about your anxiety? Try not to keep it bottled up. Find someone you can talk to about any anxious feelings you may be having. This could be a close friend who understands your situation or a licensed therapist (or both!). The goal is to find a way to make sense of any anxious feelings and how they’re affecting you emotionally and physically.

How to manage hot flashes

There are also steps you can take to address hot flashes directly, including:

• Hormone therapy (HT). “I usually suggest a low-dose hormone replacement therapy for up to five years,” recommends Dr. Sozen. “This is safe for people in their 40s and 50s for a limited time.”
• Non-hormonal medications. Dr. Sozen also recommends an option for people who have moderate to severe hot flashes and aren’t good candidates for hormone therapy. “Those with the best results include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), anti-epileptics, clonidine and oxybutynin.” Talk with your healthcare provider about which may be most appropriate for you.
• Natural remedies. Some people experiencing hot flashes also find relief from treatments like Chinese herbal remedies.Black cohosh has been explored as an option for hot flashes and, while there isn’t enough research to support it, doctors have recommended it as a way to relieve fatigue or improve mood during menopause.

You can also make small changes in your day-to-day life, like:

• Adjusting your diet. Incorporating certain foods into your meals may help extinguish those rushes of heat. Plus, what you don’t eat is just as important; cutting out spicy foods, sauces and spices is a good way to avoid triggering a hot flash.
• Lowering room temperature. Bring that thermostat down! If your house is feeling too warm, adjust the temperature to help avoid hot flashes or lessen their fiery blow. A cooling fan by your desk, couch or bed can also help.
• Avoiding exercising in the heat. You might want to table that hot yoga class. If you’re experiencing repeated hot flashes, you don’t want to do exercise in a hot room or outdoors when the sun is beating down.

Whether your anxiety is causing your menopausal hot flashes to flare up or it’s the other way around, there are ways to cope with both. Use tactics to manage your hot flashes while also addressing your anxiety to see the best results.