From the Guidelines
Black individuals, particularly Black women, are more prone to hot flashes due to a combination of biological and social factors, including higher rates of obesity, genetic variations in estrogen metabolism, and social determinants of health such as chronic stress from racism and discrimination. These factors can contribute to hot flashes, as excess body fat affects estrogen metabolism and thermoregulation, and Black individuals often have higher baseline body temperatures and different sweat gland activity patterns, which may influence how hot flashes are experienced 1. Additionally, Black women typically enter menopause earlier than white women, extending the duration of vasomotor symptoms, and limited access to healthcare and lower rates of hormone therapy use among Black women may also contribute to increased reporting of hot flash symptoms 1. Some studies suggest that lifestyle modifications, such as weight loss and smoking cessation, may help alleviate hot flashes in this population, and cognitive behavioral therapy (CBT) may also be effective in reducing vasomotor symptoms 1. However, more research is needed to fully understand the racial differences in hot flash experiences and to develop effective treatment strategies for Black women. Key factors to consider in the management of hot flashes in Black women include:
- Genetic variations in estrogen metabolism and receptor function
- Social determinants of health, such as chronic stress from racism and discrimination
- Lifestyle modifications, such as weight loss and smoking cessation
- Access to healthcare and hormone therapy use
- Cognitive behavioral therapy (CBT) as a potential treatment strategy.
From the Research
Racial Differences in Hot Flashes
- African American women may have a greater risk of hot flashes compared to Caucasian women, but the reasons for this are unknown 2.
- A study found that African American women were more likely than Caucasian women to report any hot flashes, severe hot flashes, and hot flashes for more than 5 years 2.
- The risk ratios for the associations between race and the hot flash outcomes were attenuated after controlling for other important hot flash risk factors, such as obesity and low estrogen levels 2.
Risk Factors for Hot Flashes
- Advanced age, obesity, current smoking, less than 12 drinks in the past year, and lower estrogen levels are risk factors for hot flashes in African American women 2.
- Higher follicle-stimulating hormone (FSH) levels, anxiety, baseline menopausal symptoms, alcohol use, body mass index (BMI), and parity are also significant predictors of hot flashes 3.
- The association of hot flashes with increased body mass (BMI) challenges the current "thin" hypothesis and raises important questions about the role of BMI in hormone dynamics in the late reproductive years 3.
Hormone Therapy and Hot Flashes
- Estrogen is the most effective treatment for hot flashes, but nonhormonal alternatives such as low-dose paroxetine, venlafaxine, and gabapentin are effective alternatives 4.
- Combined estrogen/progestogen therapy increases the risk of breast cancer when used for more than three to five years, and should only be used to treat menopausal symptoms such as vasomotor symptoms (hot flashes) and vaginal atrophy, using the smallest effective dosage for the shortest possible duration 4.
- Selective estrogen receptor modulators (SERMs) such as raloxifene and bazedoxifene have been developed for the prevention and treatment of postmenopausal osteoporosis, but they are not associated with reductions in climacteric symptoms, particularly hot flashes 5, 6.