Menopausal Flushing

Key takeaways

• Hot flushes commonly last minutes and may disrupt sleep, concentration and quality of life without indicating dangerous fever.
• Menopausal hormone therapy is the most effective treatment for many suitable patients, but requires individual risk assessment.
• Non-hormonal medicines and behavioural approaches are options when hormones are unwanted or unsuitable.

The listings below are not appropriate for every flush; age, uterus status, bleeding, clot risk and cancer history affect selection.

Confirming the context

Cycle change and typical episodes often establish the menopausal link. Thyroid disease, infection, medicine effects and rare hormone-producing conditions are considered when flushing is atypical, persistent or accompanied by concerning symptoms. Any bleeding after menopause needs assessment.

Treatment choices

Systemic oestrogen, with endometrial protection when a uterus is present, reduces vasomotor symptoms. Route and dose affect risk. SSRIs, SNRIs, gabapentin and other non-hormonal options have different adverse effects and interactions. Cooling, layered clothing and reducing individual triggers can provide additional relief.

When to seek urgent care

Flushing alone is rarely urgent. Seek urgent care for flushing with chest pain, fainting, breathing difficulty, severe headache or neurological symptoms, or very high temperature with confusion.