From the Guidelines
There is no specific lab workup required for diagnosing hot flashes, as the diagnosis is primarily clinical based on patient symptoms. However, if menopause is suspected as the cause, FSH (follicle-stimulating hormone) and estradiol levels may be checked, with FSH typically elevated (>30 mIU/mL) and estradiol decreased (<30 pg/mL) in menopause 1.
Key Laboratory Tests
- TSH should be measured to rule out thyroid disorders that can mimic hot flashes.
- Complete blood count may be useful to exclude conditions like lymphoma that can cause night sweats.
- If hot flashes occur outside the typical menopausal age range or are accompanied by unusual symptoms, additional testing might include:
- Comprehensive metabolic panel
- Inflammatory markers like ESR or CRP
- 24-hour urinary metanephrines to rule out pheochromocytoma For most perimenopausal or menopausal women with typical hot flashes, extensive laboratory evaluation is unnecessary, and treatment can be initiated based on clinical presentation alone 1. The pathophysiology of hot flashes involves dysfunction of the hypothalamic thermoregulatory center due to estrogen withdrawal, leading to inappropriate peripheral vasodilation and the sensation of heat. According to the most recent guidelines, lifestyle modifications, and/or environmental modifications can be offered to help mitigate vasomotor symptoms of premature menopausal symptoms 1.
From the Research
Laboratory Workup for Hot Flashes
There is no specific laboratory workup mentioned in the provided studies for diagnosing hot flashes (vasomotor symptoms) [ 2, 3, 4, 5, 6 ].
Diagnosis and Treatment Approach
- The diagnosis of hot flashes is typically based on a careful patient history, with specific attention to the frequency and severity of hot flashes and their effect on the individual's function [ 2 ].
- Treatment options include:
- Hormone replacement therapy, which is the most effective treatment for menopausal symptoms such as hot flashes [ 3, 4, 5, 6 ].
- Selective serotonin and norepinephrine reuptake inhibitors [ 5 ].
- Lifestyle modification [ 5 ].
- Other medications such as venlafaxine, gabapentin, and megesterol acetate [ 2 ].
Pathophysiology of Hot Flashes
- Hot flashes are thought to be related to an alteration in the set point of the hypothalamic thermoregulatory center [ 4, 6 ].
- The exact pathophysiology of hot flashes remains unknown, but it appears to be related to estrogen deficiency and abnormal hypothalamic thermoregulatory control [ 5, 6 ].
- Recent data suggest an important role for calcitonin gene-related peptide, hypothalamic kisspeptin, neurokinin B and dynorphin signal system, serotonin, and norepinephrine in the causation of hot flashes [ 5 ].