Hot Flushes, why they happen and how to find relief.
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Hot flushes are the body’s attempt to regulate temperature, a natural response when it senses an imbalance. The skin, being the body’s main defence against overheating, responds with flushing and sweating. Yet the precise mechanism remains incompletely understood, which is why so many approaches fail to bring lasting relief.
They are often blamed on a deficiency of oestrogen, but this does not fully explain the phenomenon. Young girls, women with very low oestrogen, and even some postmenopausal women do not experience hot flushes at all. Conversely, symptoms frequently begin during peri-menopause, when oestrogen levels can still be relatively high. This suggests the cause lies not in oestrogen alone, but in a far more complex neuroendocrine interaction.
The hypothalamus, the body’s temperature regulator, plays a central role. It responds to a host of signals—stress hormones, neurotransmitters, and metabolic cues—all of which influence heat production and dissipation. Substances such as noradrenaline, serotonin, prolactin and CGRP are all involved, many of them inflammatory in nature. When these rise, the delicate balance controlling temperature can be disrupted, resulting in the sudden surge of heat known as a hot flush.
Stress is a key driver. Through the release of corticotropin-releasing hormone (CRH), the body increases cortisol and adrenaline, heightening both anxiety and internal heat. Blood glucose fluctuations can trigger a similar response, provoking the same sudden overcorrection by the body.
But one factor is often overlooked—the decline in progesterone. As levels fall, its calming and regulatory influence diminishes. Progesterone normally stimulates nitric oxide, a potent vasodilator, and suppresses noradrenaline and inflammatory signals. Without it, vascular tone becomes unstable, stress responses intensify, and temperature control is easily disrupted.
It is the ratio that appears critical. When oestrogen is high relative to progesterone, the system becomes overstimulated. The body may perceive a drop in temperature and respond too aggressively, overshooting into a hot flush. This helps explain why symptoms often occur when hormones fluctuate, rather than when they are consistently low.
A rational approach therefore is to restore balance. Supporting progesterone levels, reducing stress, and stabilising blood glucose can all help bring the system back into equilibrium. In doing so, the body regains its ability to regulate temperature naturally, and the intensity and frequency of hot flushes can diminish.
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