You’re standing in line at the supermarket, and suddenly feel a whoosh of heat rise to the top of your head, leaving you flushed and sweaty and desperately fanning yourself. Yes—it’s another hot flash.
This misery is a cliché of menopause, and these sweat-inducing menopausal heat surges can strike day or night—or both.
But what if those temperature spikes aren’t menopause after all? As a gynecologist and menopause expert, I know that I have to check for other causes for these debilitating symptoms in my patients even if they’re already going through menopause. Read on for the some of the other reasons you may be having hot flashes—and what actions to take.
The thyroid gland pumps out the hormones that control metabolism and body temperature, among other things. So it’s no surprise that thyroid conditions can produce many of the temperature-related symptoms associated with menopause, including hot flashes, night sweats and a low tolerance for heat. Abnormal thyroid hormone levels can also mimic other common menopausal symptoms including brain fog, insomnia and irritability.
What to do: Since women are eight times more likely to develop a thyroid condition than men are, it makes sense to get your thyroid tested if you’re experiencing hot flashes. One key reason: Thyroid conditions require treatment to avoid potentially serious complications.
A simple blood test can measure your level of thyroid stimulating hormone (TSH), and if the level is abnormal, often the lab automatically will run extra tests to see whether you’ve developed a thyroid condition. Whether the thyroid gland is overactive (hyperthyroidism) or underactive (hypothyroidism), there are medications to correct the imbalance.
It takes time to ease thyroid-related hot flashes and night sweats, though. A doctor may have to adjust your medication several times, and even then it may take weeks or months to get complete relief. Just be warned: If you’re also going through menopause, you’ll still suffer menopause-related hot flashes.
Low blood sugar can trigger hot flashes in people with diabetes. How can you tell? Your hot flashes not only leave you sweaty but shaky and weak.
What to do: Rule out diabetes by asking your doctor to check your blood glucose levels, especially if you have other signs such as extreme fatigue, blurred vision and tingling feet or hands. If you know you have diabetes, and your blood sugar hot flashes occur frequently, talk to your health-care provider about changing the dosage of your medication or switching medications.
Certain cancers (and their treatments, see below) can produce hot flashes and night sweats. Those cancers include leukemia and lymphomas as well as breast cancer.
What to do: Doctors will rule out cancer by checking for swollen glands, ordering a complete blood count or doing a biopsy (in the case of some lymphomas and breast cancer). If you do have cancer and debilitating hot flashes, check with your health-care provider to see whether hot-flash remedies such as creams, pills or patches delivering a low dose of hormones are safe for you to use. If they aren’t, try nonhormonal medications.
The adrenal glands, located above each kidney, produce more than 50 hormones, including estrogen and the stress hormone cortisol. If you have an adrenal gland disorder, you may experience not only extreme hot flashes and night sweats but also other symptoms including fatigue, insomnia, moodiness and even depression. These are common menopausal symptoms, too, so it’s easy to miss the adrenal gland diagnosis.
What to do: A blood test can rule out most adrenal gland disorders. If it turns out you do have an adrenal disorder, once it’s treated, the hot flashes will stop—though you still could have menopause-related heat surges.
Some researchers think bacteria causes sarcoidosis, which leads to inflammation in the lungs, eyes and lymph nodes. It’s more common in women than in men, and one of the hallmark symptoms is night sweats.
What to do: Sarcoidosis usually begins in the lungs, so if in addition to night sweats, you feel short of breath and have a persistent cough or wheeze, ask your doctor about the possibility that it could be sarcoidosis. Doctors can diagnose the disease with an x-ray or a lung function test. If the X-ray catches a visible mass on the lungs, a doctor will perform a biopsy. Treatment with steroids or other medications will end night sweats caused by sarcoidosis.
This bacterial infection usually attacks the lungs, but night sweats are a common symptom. Tuberculosis (TB) is rare in the US, but it does exist here, and you can more easily get it if you travel to many other countries.
What to do: If you work in a high-risk setting (such as a hospital, nursing home or prison) or have been traveling in an area where TB is common (such as South America, Eastern Europe or the Western Pacific region) and you have night sweats, ask for a skin test to rule out the disease. If you have TB, you’ll need to take several drugs for six to nine months before you’re cured. That should eliminate your TB-related night sweats.
Niacin is a dietary supplement sometimes used to reduce LDL cholesterol levels. It can cause a flush that spreads from the neck to the face, though some women experience these surges as hot flashes.
What to do: If you take niacin, aren’t perimenopausal and are having what feels like hot flashes, talk to your doctor about trying a time-release niacin capsule (less likely to cause flushing than other types) or switching to a lower dose of niacin and then increasing the dose to its desired level slowly.
Doctors prescribe steroids to treat inflammation from a variety of conditions. Hot flashes can be a side effect of steroids—as can mood swings. If you are experiencing either of these potential steroid side effects, talk to your doctor about the possibility of lowering the dose.
The drugs tamoxifen and raloxifene are selective estrogen receptor modulators (SERMS) that mimic the effects of estrogen. Women who’ve had breast cancer take tamoxifen to reduce the risk of developing it again (or developing it in the other breast). Doctors prescribe raloxifene to strengthen bones for women with osteoporosis. Both can cause debilitating hot flashes and night sweats.
What to do: If night sweats are a problem, taking tamoxifen in the morning instead of at night may help. Medications such as venlafaxine (an antidepressant sold under the name Effexor) or gabapentin (an anticonvulsant) can ease hot flashes for women taking tamoxifen or raloxifene.
Chemotherapy can stop the body’s production of estrogen and cause many side effects that mimic menopause, including trouble concentrating, mood changes, hot flashes and night sweats.
What to do: Hormone replacement therapy can help ease hot flashes and night sweats. But if you have breast cancer, you’ll need to try a nonestrogen-based therapy. Some types of antidepressants as well as clonidine (Catapres), a drug typically used to treat high blood pressure, may help—as may hormone-free therapies generally recommended for menopausal heat surges such as breathing techniques that cool down the body.
If you’re middle-aged and are starting to experience hot flashes or night sweats, the mostly likely explanation is that you’re in perimenopause. But make an appointment with your health-care provider to see whether something else might be causing your symptoms or making them worse.
