While experiencing menopause, women often ask “why are my hot flashes getting worse?” and “how long will they last?”. Those seeking answers to these questions are not alone. So to address these and other questions on menopause symptoms, first look at what is happening in the body as well as potential risk factors to learn ways to cope and improve mental and physical health. 

When does menopause and the corresponding symptoms begin?

Women often enter the natural perimenopause phase or the menopausal transition period in their mid-to-late 40s’. This period typically lasts approximately four years and is set in motion by fluctuating hormone levels (2). During this time, women begin to sporadically experience hot flashes and night sweats. If the ovaries have been removed prior to the menopausal years, this is known as surgical menopause. 

What causes hot flashes and night sweats?

Issues such as hot flashes and night sweats are the most overwhelmingly common menopause symptoms and affect approximately 80 percent of women during their menopause transition (13). Hot flashes and night sweats are just two of many side effects women experience during menopause, and they are linked to changes in blood vessels. Because of the resulting increase in body temperature, they can cause flushed and heated feelings.

Since hot flashes and night sweats are closely tied to dilation or constriction of blood vessels and vasculature, they are known as Vasomotor Menopausal Symptoms (VMS). While much is still not understood about VMS, many believe that the menopausal drop in estrogen signals the hypothalamus region of the brain to react with the blood vessels. This, in turn, results in changes to the body’s temperature which cause hot flashes and night sweats. (5) VMS are also associated with fluctuations in serotonin and norepinephrine, which could potentially signal other menopause symptoms such as depression (7).

So these fluctuations aren’t just linked to an uncomfortable body temperature, but also to mental health issues. Since low levels of serotonin are linked to depression, estrogen fluctuation could also be part of the reason women may experience anxiety during menopause. At the same time, the norepinephrine variations can prove to be problematic to cardiovascular state. Just like the hormones serotonin and estrogen, norepinephrine can affect a body’s blood vessels and stress levels and possibly even a woman’s heart. 

Mature Woman Experiencing Hot Flash From Menopause

Why are hot flashes getting worse and lasting longer?

If one experiences more hot flashes and sense they are increasing in intensity, this is common during menopause. Frequent hot flashes and night sweats have been shown to last for approximately 7.4 years and can continue for up to 4.5 years following the final menstrual period (FMP) (2). These may last even longer for African American women. 

If a woman is experiencing hot flashes and night sweats in the premenopausal or perimenopausal years, this early onset may lead to dealing with VMS for a longer period of time as well as potentially indicate increased intensity of VMS (2). Additionally, women’s total VMS duration (in years) could last well into post-menopause compared to those who entered it at a later age (2).

What are the risk factors of VMS?

Studies have shown that there are a number of risk factors of VMS and may include the following (5) (6):

  • Obesity
  • Race and ethnic variations
  • Smoking
  • Lack of exercise

These may also indicate if a woman is more likely to experience a greater frequency and intensity or worsening of hot flashes and night sweats (VMS). 

Treatments for VMS and hot flashes

  • Avoid sleeping in hot environments
  • Use cotton sheets and clothing
  • Carry a portable fan to the office
  • Limit or avoid alcohol, spicy foods and caffeine
  • Maintain a healthy weight and lower your BMI
  • Practice mind-body relaxation techniques  
  • Undergo hormone replacement therapy

If the uterus is still intact, a doctor may recommend taking estrogen combined with progesterone, which in combination, helps protect the uterus against cancer. 

Hormone replacement therapy

Hormone replacement therapy is reported to be one of the most effective treatments for VMS. Recent studies have cited the latest Cochrane review referencing that “hormone therapy reduces the frequency and severity of hot flashes by 75-79 percent.” (2).

Hormone replacement pellet therapy, BioTe®

Practice-Happiness recommends BioTe® hormone replacement pellets to treat VMS. BioTe® has not only been shown to reduce hot flash duration and intensity, but has also proven to improve women’s moods, depression as well as decrease bone loss and vaginal dryness. This product delivers a natural non-synthetic form of hormone therapy to provide continuous relief.

During BioTe® treatment the doctor places a tiny pellet just underneath the skin. Afterwards, hormone therapy begins to deliver relief over a period of weeks. 

Why Choose Dr. Natalie Drake 

As a certified medical provider of this medication, Dr. Natalie Drake treats many women with bioTe® for the symptoms of menopause. Many people trust Dr. Natalie Drake to offer treatment for menopause symptoms as well as provide options for sexual dysfunction and urinary incontinence. She is a recognized OBGYN and leader for women’s health issues in the U.S. and Houston, Texas. Both Dr. Drake and her husband, gynecologic oncologist, Dr. Rich Drake, were associated with the Cleveland Clinic for years prior to relocating their practices to The Woodlands, Texas. 

If you are experiencing hot flashes, night sweats and other menopause symptoms, we are here to help restore a more normal quality of life and get you back to a healthier lifestyle. 

Contact our office at 281-203-5119 to schedule your appointment to get your hot flashes under control. 


  1. Maclennan AH. Evidence-based review of therapies at the menopause. Int J of Evidence Based Health. 2009:7(2):112-123
  2. Avis NE, Crawford SL, Greendale G,et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015; 175 (4): 531-539
  3. Nonhormonal management of menopause-associated vasomotor :symptoms: 2015 position state of the North American Menopause Society. Menopause N Y N. 2015;22 (11); 115-1172; quiz 117-1174
  4. Treatment options for vasomotor symptoms in menopause: focus on desvenlafaxine. International Journal of Women’s Health 2012:4 305-319, Umland and Falconieri
  5. Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women’s Health across the Nation. Obstet Gynecol. 2011; 38:489-501
  6. Rossmanith WG, Ruebberdt W. What causes hot flashes? The neuroendocrine origin of vasomotor symptoms in the menopause. Gynecol Endocrinol. 2009; 25 (5): 303-314
  7. Int J Cardiol Heart Vasc. 2019 Mar; 22: 123–131. Published online 2019 Jan 18. doi: 10.1016/j.ijcha.2019.01.001 PMCID: PMC6349559 PMID: 30705938. A systematic review and meta-regression analysis to examine the ‘timing hypothesis’ of hormone replacement therapy on mortality, coronary heart disease, and stroke Matthew Nudy,a,⁎ Vernon M. Chinchilli,b and  Andrew J. Foyb,c
  8. Gold EB, Colvin, Avis N.et al. Longitudinal analysis of the association between vasomort symptoms and race/ethnicity across the menopausal transition; study of women’s health across the nation. Am J Public Health 2006;96(7): 1226-1235