Hot flashes: a review.

Hot flashes are the most common vasomotor symptom of menopause, affecting over 75% of women and significantly impairing quality of life. These symptoms are a frequent reason women seek medical care, often from primary care physicians. This review summarizes the clinical presentation, underlying pathophysiology, and current management of hot flashes. Clinically, symptoms include episodic heat sensation, flushing, and sweating, often associated with sleep disturbance. Pathophysiology involves estrogen withdrawal and thermoregulatory dysfunction, including a narrowed thermoneutral zone and increased neurokinin B signaling. Management includes lifestyle modifications and complementary therapies with variable evidence. Hormone replacement therapy remains the most effective treatment for appropriate candidates, while nonhormonal pharmacologic and non-pharmacologic approaches are commonly used when estrogen is contraindicated. Emerging targeted therapies offer additional treatment options. Treatment should be individualized based on symptom severity, patient preferences, and risk profile.