Navigating perimenopausal hotflashes: Pathophysiology, risk factors and management

Perimenopausal hot flashes exhibit vasomotor symptoms that are driven by neuroendocrine changes, particularly fluctuations in estrogen levels, which disrupt hypothalamic thermoregulation. Treatment strategies range from lifestyle modifications and behavioral interventions to pharmacologic therapies, including hormone replacement therapy (HRT) and non-hormonal alternatives such as selective serotonin reuptake inhibitors (SSRIs), gabapentinoids, and newer neurokinin receptor antagonists. Complementary therapies, including acupuncture, cognitive-behavioral therapy, and phytoestrogens, also show promise in symptom relief. This article explores the symptoms, pathophysiology underlying perimenopausal hot flashes, identifying key risk factors, helping researchers and patients navigate this transitional phase effectively. Keywords: Estrogen, SSRI, SNRI, vasodilation, lifestyle