Hot Flashes and Anxiety: What’s the Connection?

3 minute read

By: Barbara Brody|Last updated: May 11, 2022
Medically reviewed by: Sharon D. Malone

You’re going about your day when all of a sudden, an intense wave of heat crashes over you. You become flushed and start to sweat. Your heart is beating overtime. You might also feel weak, dizzy, or nauseated. Your head starts to pound.

Is it a hot flash? Severe anxiety? Both?

The answer isn’t always as clear-cut as you might expect, since hot flashes and anxiety each can manifest in similar ways. What’s more, research suggests that women who are prone to anxiety symptoms might be somewhat more apt to suffer hot flashes once they reach their perimenopausal years. And, of course, someone who’s caught off-guard by a run-of-the-mill hot flash might feel surprised and anxious, even if they don’t routinely struggle with anxiety issues.

To sort it out, it helps to understand a little more about what causes severe hot flashes as well as why anxiety can literally make you sweat.

How hot flashes happen

Hot flashes are the most common symptom reported by menopausal women. These brief surges in body temperature tend to occur most during perimenopause, which is the stage that precedes the total absence of your periods (menopause).

Although the exact mechanism that causes hot flashes is not fully understood, hormonal changes clearly play a starring role. Your estrogen level and progesterone level can be pretty erratic during perimenopause. In addition to controlling your monthly cycle while you’re still menstruating, these hormones also send signals to the hypothalamus, better known as your brain’s thermostat. The hormonal fluctuations associated with menopause can mess with the hypothalamus so that you end up thinking your body temperature is higher than it actually is. (Everyone else in the same room, of course, feels just fine.)

One theory is that transitioning to a menopausal status narrows your “thermoneutral zone”— the temperature range in which you aren’t sweating or shivering. As a result, it becomes a lot easier for you to go from feeling comfy to overheated in a snap.

Whenever your body thinks it’s too hot, it takes action to cool you down: Blood flow to your skin increases — hence, the hot flushes— and you sweat, cooling down as the moisture evaporates.

AW184 Hot Flashes and Anxiety: What’s the Connection? (photo of womans shadow on red pavement, arm reaching up in anguish)

Why anxiety makes you sweat

No matter your age or menopausal status, you probably know what it feels like to develop clammy hands before a date or an important client meeting. When you’re stressed, you might also perspire more under your arms.

When you get anxious, your body’s natural “fight-or-flight” response kicks in: Your adrenal glands, which happen to be controlled by the hypothalamus (also responsible for temperature regulation) release stress hormones, including adrenaline. Adrenaline makes your heart rate go up and prompts you to breathe more quickly. It also stimulates two types of sweat glands to kick into action.

Strange as it may sound, there’s actually more than one kind of sweat. Regular sweat — the kind that’s designed to cool you down on a hot day — comes from the eccrine glands. It’s made of mostly water, salt, and potassium and evaporates quickly. So-called stress sweat, however, comes from the apocrine glands and contains fatty acids and proteins. It tends to linger on your body. When your body goes into fight-or-flight mode, you produce both types of sweat.

Anxiety, panic attacks, and perspiration

Sometimes it’s easy to figure out why you’re perspiring. If you’re outside in the sun on a hot day and you start to sweat, it makes sense that your body would want to cool down. If you’re worried about a big presentation and your hands get clammy, that’s anxiety.

Where it starts to get tricky is when you go beyond run-of-the-mill nerves and shift into severe anxiety — a.k.a. panic attacks, or anxiety that’s so severe and sudden that it disrupts day-to-day life. Anxiety symptoms include feeling an overwhelming sense of doom. Many people also tremble or shake, get short of breath, or feel like they’re out of control. It’s not uncommon to feel out of control, have a strong sense of dread or doom, or imagine you’re having a heart attack or dying.

Sweating and a racing heart are also common, which explains why a panic attack might be confused with a menopausal hot flash.

AW185 Hot Flashes and Anxiety: What’s the Connection? (blurred photo of woman with her hand up to her chest)

Hot flashes or anxiety: what’s making you sweat?

If you’ve found yourself getting sweaty and flushed and the cause isn’t obvious, you might have to do a little detective work to sort it out. Some factors to consider:

Your age: Most women who develop hot flashes find that they start in their 40s, often as they get close to menopause. By comparison, panic attacks can start at any age, but usually start before age 25. In other words, if you’re in your mid-to late-40s and have never had a panic attack before, odds are your flashes are related to being perimenopausal.

Location on your body: Menopause-related hot flashes usually start in the face, neck or chest. While a panic attack can make your face flushed, it’s far more apt to make your palms or underarms sweat.

Triggers: Both panic attacks and menopausal hot flashes can come on seemingly without warning, at any time of day—or night. (Night sweats are hot flashes that happen while you’re snoozing; however, anxiety can cause nighttime sweating as well.) For people who get frequent panic attacks, there are often noticeable patterns: Someone who is claustrophobic, for instance, might find that they have panic attacks more often in crowded or tight spaces.  

Simultaneous symptoms: No matter how much you sweat, how flushed your face is, or how sudden it comes on, the biggest clue has to do with your emotional state. While someone who’s having a panic attack might not understand what’s going on (especially if they haven’t had one before), they will still have a deep sense of fear or danger.

A panic attack is almost always accompanied by a sense of impending doom or danger, even if the person experiencing it can’t pinpoint exactly what’s so scary. You might feel like you’re having a heart attack, going crazy, or that you’re about to die. (Fortunately, panic attacks are usually short-lived and not physically dangerous.)  

Hot flashes, on the other hand, tend to primarily be about the physical sensation of heat and the discomfort that it can cause.

AW183 Hot Flashes and Anxiety: What’s the Connection? (photo of a woman inside an elevator)

What if it’s both menopause and anxiety?

While it would be nice to be able to keep menopausal hot flashes and anxiety in two totally separate boxes, the truth is that these problems sometimes overlap. Some research suggests that women who have pre-existing anxiety disorders (including but not limited to panic disorder) might be more likely to experience hot flashes when they approach menopause, though the reason why isn’t totally clear.

At the same time, many women find the menopausal transition stressful, even if they never meet the criteria for a full-blown anxiety disorder.

Whatever the root(s) of your problem, don’t ignore it — especially if it’s making you uncomfortable or interfering with the overall quality of your life. Even if your hot flashes are unrelated to a serious anxiety problem, studies suggest that cognitive behavioral therapy help some women better manage their perimenopausal symptoms.

Talk to your primary care doctor and consider seeing a mental health professional to discuss your anxiety and menopausal symptoms. And if you need help finding one, Alloy can point you in the right direction.

Sources:

  1. "Hot Flashes". Breastcancer.org. https://www.breastcancer.org/treatment/side_effects/hot_flashes

  2. Freeman, Ellen W, and Mary D Sammel. “Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn Ovarian Aging cohort.” Menopause (New York, N.Y.) vol. 23,9 (2016): 942-9. doi:10.1097/GME.0000000000000662

  3. "Introduction to Menopause". Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/introduction-to-menopause#:~:text=Hot%20flashes%20or%20flushes%20are,for%202%20years%20or%20less

  4. "What Causes Hot Flashes?". Breastcancer.org. https://www.breastcancer.org/tips/menopausal/treat/hot-flashes/causes

  5. Freedman, Robert R. “Menopausal hot flashes: mechanisms, endocrinology, treatment.” The Journal of steroid biochemistry and molecular biology vol. 142 (2014): 115-20. doi:10.1016/j.jsbmb.2013.08.010

  6. "Why do people sweat when they are nervous?". The Pennsylvania State University. https://sites.psu.edu/siowfa16/2016/10/20/why-do-people-sweat-when-they-are-nervous/

  7. "The Science of Anxiety (Infographic)". Northwester Medicine. Jun 2020. https://www.nm.org/healthbeat/healthy-tips/emotional-health/the-science-of-anxiety

  8. "The difference between regular sweat and stress sweat". Piedmont. https://www.piedmont.org/living-better/the-difference-between-regular-sweat-and-stress-sweat

  9. "Anxiety Disorders". National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders

  10. "Did I just have a hot flash? I'm 44!". Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/did-i-just-have-a-hot-flash-im-44#:~:text=Hot%20flashes%20%E2%80%94%20those%20sudden%20surges,menopause%20years)%20than%20during%20menopause

  11. "Panic disorder". Medline Plus. https://medlineplus.gov/ency/article/000924.htm#:~:text=Panic%20disorder%20is%20twice%20as,diagnosed%20until%20they%20are%20older

  12. "Hot flashes - symptoms and causes". Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hot-flashes/symptoms-causes/syc-20352790#:~:text=A%20hot%20flash%20is%20the,as%20if%20you're%20blushing

  13. Katie McCallum. "Night Sweats: 7 Reasons You May Be Sweating at Night". Houston Methodist. https://www.houstonmethodist.org/blog/articles/2020/feb/night-sweats-7-reasons-you-may-be-sweating-at-night/

  14. "Panic attacks and panic disorder". Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021

  15. " Self-Help CBT and the Management of Perimenopausal Symptoms in Working Women". MGH Center for Woman's Mental Health. https://womensmentalhealth.org/posts/cbt-management-perimenopausal-symptoms/

Written by:

Barbara Brody

Barbara Brody is a freelance writer who specializes in health and wellness. Her work has appeared in a variety of outlets including WebMD, Health, and Prevention.

Medically reviewed by:

Sharon D. Malone

Dr. Sharon Malone is among the nation’s leading obstetrician / gynecologists with a focus on the specific health challenges associated with menopause.