Approach to Hot Flashes: A Narrative Review

More than 80% of women experience hot flashes (HFls) during menopause.These are defined by transient sensations of heat, sweating, flushing, anxiety, and chills lasting for 1-5 minutes.HFls can cause considerable distress, especially when severe and frequent, thus affecting a healthy menopause.This review discusses the epidemiology, pathophysiology, clinical features, and management of menopausal HFls.Epidemiological data indicate that HFls affect 85% of women globally, with varying prevalence across regions.The exact pathophysiology remains unclear but involves dysfunction of the hypothalamic thermoregulatory center, influenced by estrogen deficiency, serotonergic and noradrenergic mechanisms, neurokinin B (NKB) pathways, and calcitonin gene-related peptide (CGRP) activity.Clinical presentation typically includes transient heat sensations, predominantly affecting the face and upper body, with associated sweating, chills, and sleep disturbances.Management depends on severity, with lifestyle modifications and cognitive behavioral therapy recommended for mild symptoms.Hormone replacement therapy (HRT) remains the first-line treatment for moderate to severe HFls, with careful risk assessment.Nonhormonal options, such as selective serotonin (SRT)/norepinephrine (NE) reuptake inhibitors, gabapentin, and emerging therapies, such as neurokinin 3 receptor (NK3R) antagonists, offer alternatives for women unsuitable for HRT.In this review, we will discuss a structured approach to the diagnosis and management of HFls to alleviate symptoms and improve the quality of life in menopausal women.