Hot flushes: how to cope

Hot flushes are the most common symptom of the menopause but there are a range of medical treatments and self-help techniques to beat the heat.

Not all women experience hot flushes going through the menopause, but most do. Three out of every four menopausal women have hot flushes. They’re characterised by a sudden feeling of heat which seems to come from nowhere and spreads through your body. They can include sweating, palpitations, and a red flush (blushing), and vary in severity from woman to woman.

Some women only have occasional hot flushes which don’t really bother them at all, while others report 20 hot flushes a day, that are uncomfortable, disruptive and embarrassing.

Hot flushes usually continue for several years after your last period. But they can carry on for many, many years – even into your 70s or 80s. They’re probably caused by hormone changes affecting the body’s temperature control.

Causes of hot flushes

Most women going through a natural menopause experience hot flushes. But there are other causes of hot flushes, including:

• Breast cancer treatment – according to Cancer Research UK, seven out of 10 women who’ve had breast cancer treatment have hot flushes, and they tend to be more severe and frequent than those of women going through a natural menopause. This is because chemotherapy and tamoxifen tablets reduce oestrogen levels.
• Prostate cancer treatment – men having treatment for prostate cancer can also have hot flushes, sometimes for years. Hormone treatment causes hot flushes in men by lowering the amount of testosterone in their body. Read advice for men with prostate cancer on how to tackle hot flushes.

What does a hot flush feel like?

Women often describe a hot flush as a creeping feeling of intense warmth that quickly spreads across your whole body and face ‘right up to your brow’ and which lasts for several minutes. Others say the warmth is similar to the sensation of being under a sun bed, feeling hot ‘like a furnace’ or as if someone had 'opened a little trap door in my stomach and put a hot coal in’.

Watch these videos where women describe what a hot flush feels like.

Hot flush triggers

Hot flushes can happen without warning throughout the day and night, but there are well-known triggers, including woolly jumpers, especially polo necks; feeling stressed; drinking alcohol or coffee; or eating spicy foods.

Treatments for hot flushes

Many women learn to live with menopause-related hot flushes, but if they’re really bothering you and interfering with your day-to-day life, talk to your doctor about treatments that may help.

The most effective is HRT which usually completely gets rid of hot flushes. But other medicines have been shown to help, including vitamin E supplements, some antidepressants, and a drug called gabapentin, which is usually used to treat seizures.

Note that doctors recommend that you don’t take HRT if you've had a hormone dependent cancer such as breast or prostate cancer.

Here’s more information on help for hot flushes from your GP.

Complementary therapies for hot flushes

Women often turn to complementary therapies as a ‘natural’ way to treat their hot flushes.

There have been small studies indicating that acupuncture, soy, black cohosh, red clover, pine bark supplement, folic acid, and evening primrose oil may help reduce hot flushes.

However, the research is patchy, the quality of the products can vary considerably, and the long-term safety of these therapies isn't yet known.

It’s important to let your doctor know before you take a complementary therapy because it may have side effects (for example liver damage has been reported with black cohosh) or mix badly with prescription medicines (red clover is unsuitable for women taking anticoagulants).

Be aware, too, that soy and red clover contain plant oestrogens so may be unsafe for women who have had breast cancer.

Read more about complementary therapies and whether they work.

Self help remedies for hot flushes

Try these everyday tips to ease the overheating:

• cut out coffee, tea, and stop smoking
• keep the room cool, use a fan – electric or handheld – if necessary
• if you feel a flush coming on, spray your face with a cool water atomiser or use a cold gel pack (available from pharmacies)
• wear loose layers of light cotton or silk clothes so you can easily take some clothes off if you overheat
• have layers of sheets on the bed rather than a duvet so you can remove them as you need to and keep the bedroom cool
• cut down on alcohol
• sip cold or iced drinks
• have a lukewarm shower or bath instead of a hot one
• change the timing of your medicine. If tamoxifen is causing your hot flushes, Cancer Research UK suggests taking half your dose in the morning and half in the evening

Is a hot flush anything to worry about?

Hot flushes are generally a harmless symptom of the menopause. But very occasionally they may be a sign of a blood cancer or carcinoid (a type of neuroendocrine tumour).

See your doctor if, in addition to hot flushes, you've been unwell with, for example, fatigue, weakness, weight loss or diarrhoea.

Now read about the best foods to eat during the menopause.

Read other articles about the menopause.

'My PSA test found cancer'

Prostate cancer survivor Guy Williams talks about the PSA test, being diagnosed with cancer and why he decided to have surgery to remove his prostate.

Guy was 51 when he first considered having a prostate cancer test. Both his father and uncle had the disease. His age and a family history of prostate cancer put him in a higher risk group.

But his first attempt to have the PSA test, a blood test which looks for the early signs of cancer, showed just how divided the medical community is on the usefulness of the test.

PSA (prostate-specific antigen) is a protein made by the prostate gland. Some of it will leak into your blood, depending on your age and the health of your prostate. A raised PSA level in your blood may mean you have prostate cancer.

On the one hand, the PSA test could save your life if it detects the early signs of cancer.

On the other hand, a wrong diagnosis – which does happen occasionally – could lead to unnecessary anxiety and potentially life-changing treatment.

"My GP leant strongly towards me not having a test," says Guy, a secondary school drama teacher and a father of three. "He suggested the PSA test was not entirely reliable and talked me through its pros and cons.

"He was entirely professional and gave me material to read to help me make a decision." After mulling over his doctor's advice and reading more about the condition, Guy decided not to have the test.

Getting a second opinion

'I was worried about the side effects of having a prostatectomy, but at least you live.'

Guy Williams

"When I told my father, he hit the roof," he says. "He insisted that I go back to the surgery and have the test. A short while later I went back to see a different doctor at the surgery."

Because of Guy's family history, the second doctor felt he should have the PSA test. "I got the results back the next day," Guy says.

"The test showed that my PSA level was raised. The doctor said there could be several reasons for this so, to be on the safe side, he did another test."

When this came back again with a PSA reading higher than is probably normal in someone of his age, Guy was referred to a specialist for a physical examination. He was then referred for a biopsy, which involves analysing tissue samples taken from the prostate.

The biopsy confirmed that Guy had cancer. A surgeon advised him that the best treatment option would be to have his prostate gland completely removed, a procedure called a prostatectomy.

"I was trying to ask the right questions but I was overwhelmed by the whole situation," he says. "Although the diagnosis wasn't completely out of the blue, it still really knocked me."

Treatment for prostate cancer generally depends on how fast the cancer is growing, whether it has spread outside the prostate gland, and the person's age and general health.

But all treatments, whether it's a prostatectomy, radiotherapy or hormone therapy, carry the risk of significant side effects. These include loss of sexual desire, erectile dysfunction and urinary incontinence.

There's not always a clear medical reason for choosing one type of treatment over another. The decision may be based on a person's values, needs and preferences.

Prostate surgery

Guy read up on all his options, received help from Macmillan Cancer Support and Prostate Cancer UK.

"All my research was really helpful but by the end I felt I had too much information," says Guy. "The more I knew, the more difficult it was to make a decision. I wanted someone to tell me what to do."

Guy was advised by his surgeon that the best course of action would be to surgically remove his prostate gland. Concerned about the possible side effects of a prostatectomy, he asked for a second opinion.

"I put all of my questions, worries and concerns to the next consultant I saw," he says. "After considering my circumstances, he too recommended surgery. At the end of the day, you must put a certain amount of trust in the professionals. Ultimately, they're the experts.

"I was worried about the side effects of having a prostatectomy, but at least you live. On balance, that's what I wanted. In the end, it wasn't really a choice."

In May 2011, five months after having the PSA test, Guy went in for surgery at Brighton's Royal Sussex County Hospital.

"The surgery went well," says Guy. "The pain and the bladder control, the side effects of the operation, are now much better. Exhaustion is my main problem. After a day's teaching I'm totally knocked out."

Guy's prostate gland was analysed after it was removed and tests showed the cancer was more aggressive than previously thought.

"For me, surgery was the right thing to do," says Guy. "If it had not been for my dad encouraging me to get a second opinion on having the PSA test, I probably would never have known I had prostate cancer."

Find out more about whether you should have a PSA test.

Should I have a PSA test?

The PSA test is a blood test that can detect the early signs of an enlarged prostate. It is the most common initial test for men who are worried about prostate cancer.

The test, which can be done at a GP surgery, measures the level of prostate-specific antigen (PSA) in your blood.

PSA is a protein made only by the prostate gland. Some of it will leak into your blood, and the amount depends on your age and the health of your prostate.

Raised PSA levels

The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml). PSA levels can range from less than 1ng/ml to hundreds of ng/ml.

• If you're aged 50 to 69, your PSA level is considered raised if it's 3ng/ml or higher.

A raised PSA level in your blood may be a sign of prostate cancer. However, other conditions, such as an enlarged prostate, prostatitis, or a urinary infection, can also cause a raised PSA level.

There are well-known issues with the accuracy of the PSA test and potential harmful consequences, which is why there is currently no national screening programme for prostate cancer in the UK.

Instead, all men over the age of 50 can access quality information about the PSA test and discuss the option of having a free test with their GP as part of a scheme called the prostate cancer risk management programme (PCRMP).

Under PCRMP, your GP will be expected to discuss with you the benefits, limitations, and risks of the PSA test to help you decide whether or not to have it.

You should also be given a leaflet about PSA testing for prostate cancer. The leaflet provides similar, but more detailed, information to what you'll find on this page.

Men are at higher risk of prostate cancer if they have a family history of prostate cancer, are of black ethnic origin, or are overweight or obese.

If you are worried about prostate cancer, you should talk to your GP. Read more about prostate cancer, including the symptoms of prostate cancer and treatments for prostate cancer, in our Health A-Z section.

Pros and cons of the PSA test

Pros

• It may reassure you if the test result is normal.
• It may give you an indication of cancer before symptoms develop.
• It may find cancer at an early stage, when treatment could prevent the cancer becoming more advanced.
• PSA testing may reduce your risk of dying from prostate cancer by 21%.
• If treatment is successful, you may avoid the risks of advanced cancer.
• In cases of advanced cancer, treatment will usually extend life.

Cons

• It can miss cancer and provide false reassurance.
• It may lead to unnecessary worry and medical tests when there is no cancer.
• It cannot tell the difference between slow-growing and fast-growing cancer.
• It may make you worry by finding slow-growing cancer that may never cause any symptoms or shorten your life.
• To save one life from prostate cancer, 27 men would have to be diagnosed with it.

Before having the test

If you're having a PSA test, you should not have:

• an active urinary infection
• ejaculated in the last 48 hours
• exercised heavily in the last 48 hours
• had a prostate biopsy in the last six weeks

Each of these may give an inaccurate PSA reading.

What happens after the test?

There are usually three main options after a PSA test.

A normal PSA level
If your PSA level is not raised, you are unlikely to have cancer. No immediate action is needed, although you may have further PSA tests in the future. However, the PSA test doesn't always pick up prostate cancer.

A slightly raised PSA level
Three out of four men with a raised PSA level will not have prostate cancer. If your PSA level is slightly higher than normal, you probably don't have cancer, but you might need more PSA tests.

A raised PSA level
One in four men with a raised PSA level will have cancer. The higher the level of PSA, the more likely it is to be a sign of cancer. If your PSA level is definitely raised, your GP will arrange for you to see a specialist for further tests to find out if you have prostate cancer.

A PSA test alone cannot tell you whether you have prostate cancer. Your doctor may also perform a digital rectal examination (DRE). This is an examination of the prostate gland, during which the doctor will insert a gloved finger into your rectum.

The DRE checks for signs of prostate cancer, such as the prostate gland feeling hard. However, a gland that feels normal does not necessarily mean you don't have cancer.

Many early cancers may not be detected by a DRE, so a DRE is not recommended as a substitute for the PSA test.

Your doctor will also consider your age, any family history of prostate cancer, your ethnic background, and any previous PSA test results.

In some cases, extra PSA tests may help make the situation clearer or show any changes.

Key PSA facts

• The PSA test result may not be elevated and provide false reassurance. About 15% of all men with a normal PSA level have prostate cancer.
• Three out of four men with a raised PSA level don't have prostate cancer.
• One out of four men with a raised PSA level will have cancer.
• Biopsies miss one in five prostate cancers.

Biopsies and further testing

If your PSA level is raised, a biopsy, which involves taking tissue samples from the prostate gland, may be needed to check if you have cancer.

Prostate biopsies can miss some cancers. One in five cancers are missed at prostate biopsy. You may not know for sure that you don't have cancer after a clear result, and biopsies sometimes have to be repeated.

Biopsies can sometimes cause complications. The most common is bleeding followed by infection. Most men experience blood in the urine and blood in the sperm after a biopsy. Antibiotics will be given to prevent infections.

Prostate cancer treatment

If early prostate cancer is found, the treatment you receive will depend on your individual circumstances. The type and size of the cancer and your general health are among factors that will be considered when deciding on the right type of treatment.

Most types of treatment, such as surgery and radiotherapy, come with serious side effects, including erection, fertility, and bladder problems.

Read more about treating prostate cancer.

You should talk to your consultant about the benefits and risks of any treatment before you begin.

Prostate cancer treatment stories

Treatment for prostate cancer can have serious side effects. Here, male patients describe how it affected them.

• prostatectomy involves the surgical removal of the prostate gland
• brachytherapy is a form of radiotherapy where a number of tiny radioactive seeds are surgically implanted into the tumour

While the side effects from the prostate cancer treatments below are the most common ones, not all men will experience them.

Some men will have short-term discomfort and make a good recovery, while others may experience longer-term symptoms which may require lifestyle changes.

The men's names have been changed to protect their privacy.

Incontinence

If your urinary incontinence is mild, you may be able to control it by learning some simple exercises. Pelvic floor exercises can strengthen your control over your bladder. For more severe cases, surgery may be necessary.

Bill had radical prostatectomy (prostate removal) after he was diagnosed with prostate cancer aged 66

Bill was incontinent for six months after the surgery and says during that time his life had to be divided into 40-minute slots. "The sort of nappy-type pads that I wore had a 40-minute lifespan," he says. "If I was going to go to the cinema or anything of that sort, everything had to be worked out in 40 minutes.

"I was still very pleased I'd had the surgery. I would never have not had the surgery because of it." Bill was considering changing his lifestyle as a result, but then he started getting better.

Anthony had brachytherapy (a form of radiotherapy) after he was diagnosed aged 59

After the treatment, Anthony experienced bladder pain and had trouble passing water. He says: "[I was also] passing water far too often to get involved in doing anything else. This obviously leads to a lack of confidence and you don't feel like leaving the house." He says his condition has gradually improved and as a result so has his confidence. "I can go out of the house and travel about now and it's getting back to normal," he says.

Simon was 54 when he was diagnosed and had a radical prostatectomy

Simon was given male incontinence pads after his treatment to deal with what he calls "dripping". He says not many chemists stocked them and he would often run out. He says: "I'd advise anybody to make sure their local chemist has got them in for you, as our local chemist only had one pack."

He says the pads are not uncomfortable but he found the drip sensation annoying. He has since been able to return to work as a builder. "I haven't worn pads now for the last four or five months," he says. "I get a drip now and again but it's mostly if I put my legs wide apart."

Impotence

There are a number of treatments available for erectile dysfunction, including drugs to increase blood flow, such as Viagra, injections to produce an erection, vacuum pumps and surgical implants.

Nigel had radical prostatectomy after he was diagnosed aged 56

Nigel says his sex drive has gradually diminished since his treatment. "It became very limited," he says. He is unable to have or maintain an erection. "That isn't a huge problem to me and my wife," he says. "We've learnt to come to terms with it. It was something we didn't want and we would've preferred not to have had, but it's secondary to everything else. Both of us are here and we get on with our life."

Angus was diagnosed aged 68 and had surgery and hormone therapy

Angus didn't find it too hard to come to terms with impotency. "At 70 I'm not that worried," he says. "It hasn't altered my relationship with my wife. By the time we reached 70, it wasn't the end of the world. It just doesn't happen any more. I think our relationship is fine, we're as affectionate as we always were but there isn't any sexual activity."

Charles had hormone treatment after he was diagnosed aged 66

Charles says he and his wife are not that bothered about his impotence. "In a younger man I think the impotence would worry them because it might affect their married life. It depends how the relationship between the husband and wife is. In my case, we've got three grown-up daughters now and my wife isn't bothered in any way. It doesn't interest her any more so we get along well together."

In fact, Charles' wife tells him that the hormone therapy has made him more even-tempered. "She says I'm more relaxed now than I've been in all the years she's known me," says Charles.

Bowel and bladder problems

Bowel dysfunction is mainly a side effect of radiotherapy. Short of treating individual symptoms as needed, there are few, if any, treatment options for bowel dysfunction after radiotherapy.

Frank was diagnosed aged 66 and had radical prostatectomy

On top of urinary incontinence and impotence, Frank developed symptoms of a dilated colon, called a mega-colon. "It becomes almost like a reservoir, so instead of being a muscular tube which is going to propel the faeces along, it becomes a collecting tank for faeces," he says. It was a condition Frank found particularly difficult, especially as he had a weak pelvic floor that weakened his bowel control even further.

Tim had radiotherapy after he was diagnosed at the age of 67

Following treatment, Tim had severe diarrhoea which lasted for about three weeks. He was warned beforehand that his rectum would probably be injured as a consequence of the radiotherapy. He says: "That was all explained to me, but you don't know what it means until you get it. We were all prepared for it so coped with the consequences, which lasted about three weeks after the treatment. It's gradually got better since."

George had radiotherapy after he was diagnosed aged 66

The radiotherapy caused damage to George's rectum, called proctitis, an inflammation of the anus. He says: "The result is that you have to keep your bowels as regular as you possibly can, because if you don't you'll just aggravate it and make it worse. And also the frequency is increased. Instead of possibly just going once or twice a day, you know at the extreme you might have to go three times a day, but the plus side is you do go as soon as you wake up."

Know your prostate

Every man has one, it's important for their sex life, yet few men know anything about their prostate or what can go wrong with it.

Better knowledge about this walnut-sized gland will help men to make better choices about testing and treatment.

The prostate is located below the bladder. It produces some of the fluid in semen and is crucial to a man's sex life.

The prostate often enlarges as men get older, but for two-thirds of men aged 50 or over this doesn't cause any problems.

In some cases, an enlarged prostate can press on the tube carrying urine from the bladder and cause urinary problems. This is known as benign prostate enlargement.

Other prostate conditions include swelling, known as prostatitis, which is sometimes caused by an infection. This can make urinating painful. Sometimes a single cell in the prostate starts to multiply out of control and cancer can develop.

Prostate cancer

Prostate cancer is the most common cancer in men in the UK, with more than 47,000 men diagnosed annually.

More than 11,000 men die from it every year, making it the second most common cause of cancer deaths in men after lung cancer.

However, if prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

About 90% of men diagnosed early will live at least five more years and 65-90% will live for at least 10 more years.

Most men with early prostate cancer have no symptoms at all. Some of the symptoms of prostate cancer below can also be caused by other prostate problems.

Symptoms of all prostate problems include:

• needing to urinate often, especially at night
• difficulty starting to urinate
• straining to urinate or taking a long time to finish
• pain when urinating or during sex

If you have any of these symptoms, you should talk to your GP.

High-risk group

Many men over 70 have prostate cancer, even though most of them will never have it diagnosed or have any symptoms.

In the majority of cases, this is a slow-growing cancer and it may stay undiagnosed because it never causes any symptoms or problems.

In some cases, the prostate cancer cells can grow quickly and move outside the prostate, spreading the cancer to other parts of the body, such as the bones.

Who's at risk of prostate cancer?

The risk of getting prostate cancer gets higher as you get older. Most men diagnosed with the condition are over 50.

If you have a father or brother diagnosed with prostate cancer, your risk of getting the disease is two-and-a-half times higher compared to the average man. The risk increases to 4.3 if the relative was diagnosed before the age of 60.

Black men are three times more likely to develop prostate cancer than white men. Researchers are looking at what may be the cause of this increased risk, but genes probably play an important role.

Researchers believe a diet high in saturated animal fats and red meat may be responsible for the high incidence of prostate cancer in Western countries.

Reducing your intake of animal fat and eating more fruit and vegetables may lower the risk of prostate cancer developing or spreading.

Tests for prostate cancer

There is currently no national screening programme for prostate cancer in the UK. If you are worried about prostate cancer, you should talk to your GP.

You may want to discuss the PSA test, the most common initial test for men who are worried about prostate cancer.

Find out more about the PSA test.

Darcus Howe: 'My battle with prostate cancer'

Darcus Howe, the racial equality campaigner, talks about raising awareness of prostate cancer, which affects three times more black men than white men.

'The news came as a complete shock. I was feeling great ... I didn’t have any symptoms'

Darcus Howe

Howe, who died in 2017, is best known as the "Devil's Advocate", the name of the current affairs television programme he presented in the 1990s.

"There's ignorance of prostate cancer among black men," he says. "Lives could be saved if they were more aware of this silent killer and got themselves tested."

Howe was diagnosed with an aggressive form of prostate cancer in April 2007.

He had been receiving treatment for type 2 diabetes, which he developed five years earlier, when routine tests showed the presence of protein in his urine.

He then had a blood test that revealed high levels of prostate specific antigen (PSA). This is a protein that healthy prostates produce in small amounts. The results of his blood test suggested that Howe could have prostate cancer.

Howe, who has five children and seven grandchildren, remembers vividly the day the consultant told him he probably had cancer.

"Beads of perspiration dripped from my face," he says. "My entire body shook uncontrollably. Cancer to me meant death.

"I thought of my children and grandchildren. I felt guilty that I had given them so much worry."

Until then, Howe had little knowledge of the condition. He didn't realise at the time that prostate cancer may have killed both his father and his grandfather.

"I had heard of the prostate," he says. "I knew it was a type of gland, but I didn't know what it was or what it did.

"The news came as a complete shock. I was feeling great at the time. I was eating healthily. I exercised. I had played cricket all my life. I didn't have any symptoms."

His cancer was aggressive. The malignant cells had appeared at the edge of his prostate and, if left untreated, would enter his bones and eventually kill him.

He had his prostate gland removed in June 2007 and after a course of radiotherapy and hormone injections, he has been given the all clear.

Diet and genes link

'I feel sad that a lot of my friends have died from it. We used to talk about what we’d do when we retired'

Darcus Howe

Prostate cancer is the most common cancer in men in the UK, with more than 47,000 men diagnosed annually. Around 11,000 men die from it every year, making it the second most common cause of cancer deaths in men, after lung cancer.

If caught early, prostate cancer can be cured. If it has spread to the bones it can't be cured, and treatment focuses on prolonging life and relieving symptoms.

The main test for prostate cancer is the PSA test, but research is being done to find a more reliable testing method.

Black men are three times more likely to develop prostate cancer than white men. Researchers are looking at what may be the cause of this increased risk, but diet and genes are thought to play an important role.

Howe learned that prostate cancer is hereditary in some cases. Having one or more close relatives with the disease increases your risk of developing prostate cancer yourself.

He now believes both his father and his grandfather probably died from the disease, even though it had not been clinically diagnosed in either of them.

"My father's death certificate said he died from a urinary infection. As for my grandfather, ever since I was a child I have been told he died from 'stoppage of water'.

"As a five-year-old, I had imagined that my grandfather had a tap fitted to his body which stopped working and killed him."

Around a dozen of Howe's friends have died from prostate cancer in the last few years. Most of them were in their early 60s.

"I feel sad that a lot of my friends have died from it," he says. "We used to talk about what we'd do when we retired. They worked hard all their lives after coming over from the Caribbean only to die soon after reaching retirement.

"It's a miserable death. I have seen how it affects people. For me, the campaign to persuade black men to think about getting tested for prostate cancer starts here."