Research & Education

The Association Between Stress and Hot Flashes

Hot flashes are one of the most common vasomotor complaints experienced by menopausal women. They are accompanied by sweating, heart palpitations, headaches, weakness, and fatigue, and can be triggered by various factors, including warm environments and hot beverages. Notably, stress (both perceived stress and stressful experiences) is documented to worsen the frequency and severity of menopausal symptoms such as hot flashes.

While still under investigation, the primary cause of hot flashes is believed to be a dysfunction of the central thermoregulatory centers due to menopausal estrogen withdrawal. Estrogen stimulates the production of serotonin, and the resulting decrease in serotonin during menopause may lead to an increase in norepinephrine levels, which can disrupt the hypothalamic “thermostat.” Therefore, serotonin and norepinephrine may play a role in the generation of hot flashes and support the association of hot flashes during times of stress.

In a study by Freeman and Sammel (n = 232), anxiety was significantly associated with the occurrence, severity, and frequency of hot flashes. Those with moderate anxiety had threefold higher odds of reporting hot flashes, while those with high anxiety exhibited fivefold higher odds compared to women in the normal anxiety range.

Nine years of data analysis from the Study of Women’s Health Across the Nation (n = 2,718) observed that “perceived stress,” or the degree to which the woman was upset by a life stressor, had the largest effect on menopausal symptoms. Women who said they were currently upset by a stressful event experienced 21% more vasomotor symptoms than women who had experienced no life stressors. 

Unfortunately, the typical age of menopausal onset (around 50) coincides with numerous life events that may trigger perceived stress — parental loss, empty nest syndrome, retirement, and divorce, to name a few. Additionally, the transitional phase of menopause itself can be stressful as it signifies the cessation of reproductive capabilities. 

A cross-sectional study (n = 315) among postmenopausal women aged 40 to 59 suggests an association between hot flash severity and oxidative stress – another form of stress. The authors propose it is due to the withdrawal of estrogen during menopause. Estrogen possesses antioxidant properties such as free-radical scavenging, neutralizing excess reactive oxygen species, and increasing antioxidant molecules like superoxide dismutase. 

Certain compounds may promote healthy stress responses and antioxidant status during the menopausal transition to help diminish mild hot flashes. Gamma-oryzanol, derived from rice bran oil, may support neurotransmitter balance in menopausal women by balancing luteinizing hormone secretion and endorphin release, resulting in a calming effect. Taurine, an amino acid found exclusively in animal-based products in nature, may also exert a calming effect by being a GABA-receptor agonist. Rodent models suggest that taurine may help attenuate norepinephrine's adverse effects. Furthermore, gamma-oryzanol and taurine both demonstrate antioxidant properties in the body. 

Hot flashes can significantly impact a woman’s quality of life for months or even years. Supporting neurotransmitter balance, antioxidant status, and healthy stress responses through dietary and lifestyle factors may help diminish mild hot flashes.

By Danielle Moyer, MS, CNS, LDN