Are hot flashes a “biomarker” for future cardiovascular health?

Once you’ve made it to the other side of perimenopause, you probably don’t miss the symptoms that came with the hormonal rollercoaster—certainly not the most classic one: hot flashes. Not only can these fiery spells derail your sleep, work meetings, and social plans, but it turns out they may also affect your future heart health. Researchers are now exploring whether hot flashes can act as an early warning sign of cardiovascular disease and other heart-health complications later down the line. 

The scientific research evaluating the possible connection between hot flashes and heart disease is emerging.  There is still quite a bit we do not know.  But when it comes to the treatment of hot flashes, the science is clear.  We know that these can be effectively managed through treatments like MHT. 

Understanding Hot Flashes: More Than a Menopause Symptom

Hot flashes, also referred to as vasomotor symptoms, affect roughly 75-80% of women during the menopause transition. In perimenopause, which can span up to 10 years before menopause, your estrogen levels rise and fall unpredictably throughout the day. When estrogen dips, it affects the hormones that control your hypothalamus, which is a small region in your brain that acts as your body’s thermostat.

A hot flash is exactly what it sounds like: a sudden surge of full-body heat. But it can also be accompanied by:

• Flushing

• Sweating

• Rapid heartbeat

• Feeling anxious 

• Chills afterwardThey can last seconds to minutes. They can pop up a few times a week or dozens of times a day! For some women, hot flashes can come and go for years. Hot flashes can certainly affect your quality of life, and maybe even your long-term heart health.

The Link Between Hot Flashes and Cardiovascular Health

Recent research suggests that women who experience frequent or severe hot flashes, especially during perimenopause, may face a higher risk of future cardiovascular events, including heart disease and stroke.

In one 2025 study, women with frequent hot flashes and night sweats had roughly double the odds of ischemic stroke compared with those without them, even after accounting for traditional risk factors like high blood pressure and cholesterol. 

Other research has also linked hot flashes to sleep disruption, which in turn can affect heart health. The study, published by the Menopause Society, found that about 59% of nighttime hot flashes happen in the second half of the night, when REM sleep (one of the most restorative sleep stages) usually occurs the most. Not getting enough quality sleep has been tied to higher cardiovascular risk.

These studies suggest that we need to pay attention to how often hot flashes occur during the day and the timing of nighttime hot flashes.  These could be signals of underlying subclinical cardiovascular disease.  It may be that we need to think of frequent hot flashes during the menopause transition like a warning light in our car dashboard: not a definitive diagnosis of cardiovascular disease, but a nudge to schedule an assessment.

How Do Hot Flashes and Heart Health Intersect?

Estrogen doesn’t just help keep your body temperature regulated and your vagina lubricated—it can also protect your cardiovascular system. It helps keep blood vessels flexible and open, supports healthy cholesterol levels, and slows plaque buildup in your arteries. As estrogen declines during perimenopause, your blood vessels may become more prone to stiffness and plaque buildup, raising the risk of heart disease and stroke over time.

At the same time, metabolism often shifts during perimenopause in ways that also affect heart health. Many women notice changes like:

• Increase in abdominal fat (sometimes referred to as “menopause belly”)

• Reduced insulin sensitivity 

• Elevated cholesterol levels

• Higher blood pressure

Patterns and Severity: Who Is Most at Risk?

Not all hot flashes feel or mean the same thing. Research suggests it’s not just whether you have them, but how often, how intense, and how long they last that may matter most for future heart risk. Consider talking to your healthcare provider if your hot flashes:

• Happen often

• Routinely disrupt your sleep

• Are often paired with night sweats

• Started early in perimenopause and have stuck around for years

Some women are also more likely to experience both more severe hot flashes and higher cardiovascular risk overall, including those with higher body weight, smokers, women with metabolic syndrome, and Black women, who on average report more frequent and longer-lasting vasomotor symptoms.

How This Compares to Other Menopause Symptoms

A lot changes during perimenopause—from mood swings and brain fog to vaginal dryness and joint pain. But not every symptom carries the same weight for long-term heart health.

Hot flashes and night sweats stand out because they’re directly tied to how your blood vessels and temperature-control systems respond to these hormonal shifts. These systems are closely connected to your cardiovascular health. Other menopause symptoms, such as frozen shoulder, can absolutely affect your quality of life, but so far they don’t show the same link to heart risk.

Above all, the basics still matter the most. Keeping blood pressure and cholesterol in a healthy range, managing blood sugar, avoiding smoking, and staying on top of routine checkups, especially if you have a family history of heart disease, are the most important ways to protect your heart.

Proactive Steps: Protecting Your Heart if You Have Hot Flashes

If you’re having frequent or intense hot flashes, don’t panic. Flip the script and get proactive. Many lifestyle habits that support heart health and help dial down hot flash severity. Consider these strategies:

• Get moving. A mix of cardio and bone-strengthening resistance training each week supports healthy blood flow and cardiovascular fitness. Regular exercise may also help decrease hot flash frequency or intensity for some women. Not to mention, it’s one of the most reliable ways to lower long-term heart risk.

• Eat a balanced diet. Stack your plate with omega-3 fatty acids and fiber-rich foods to help kick bad cholesterol (known as LDL) to the curb and ease hot flash burden. 

• Cut back on alcohol. Not only does alcohol interfere with body temperature regulation, but drinking more than three drinks daily can also elevate your blood pressure and increase your risk of cardiovascular disease.

• Prioritize good sleep habits. Restorative sleep helps keep your body’s systems running smoothly and supports heart health over time. Try cooling your bedroom and powering down screens before bed to make it easier to fall asleep.

• Manage your stress levels. We know that’s easier said than done, but relaxation techniques, including practicing mindfulness, meditation, and yoga can help calm your nervous system. They may also take the edge off hot flashes and support overall heart health.

• Keep your weight in check. Extra body fat, especially around your belly, is linked to more frequent and intense hot flashes, likely because it affects hormone balance and how your body regulates temperature. Weight management also supports heart health by helping improve blood pressure, cholesterol, and blood sugar levels.

When to Talk to Your Healthcare Provider

PSA: you don’t have to tough out severe hot flashes! You also shouldn’t ignore them either. If your symptoms are frequent, intense, disrupting your sleep, or dragging on for years, it’s imperative that you talk with a healthcare provider. A menopause-informed clinician can connect the dots between your symptoms and your overall risk profile. Together, you can choose a plan that helps relieve menopausal symptoms now while also supporting your heart health long term.

How hormone therapy can help

Menopause hormone therapy (MHT) is one of the most effective ways to treat hot flashes. For many women who are younger and closer to the menopause transition, and who don’t have major cardiovascular risk factors, research suggests it can bring relief without raising heart risk when it’s started at the right time and tailored to the person. That said, MHT isn’t one-size-fits-all. If you’re not a good candidate (or you’d just rather not use hormones), there are effective non-hormonal options, too.

For some women, hot flashes may be more than just a menopausal symptom. Don’t ignore your body’s signals and act early to keep your heart healthy.

Frequently Asked Questions

Why are hot flashes being linked to heart disease and stroke?

Hot flashes, or vasomotor symptoms, are tied to how our blood vessels and the hypothalamus (the brain's thermostat) react to declining estrogen. Because estrogen plays a vital role in keeping blood vessels flexible and maintaining healthy cholesterol levels, frequent or severe hot flashes may signal that the cardiovascular system is becoming more prone to stiffness and plaque buildup. A 2025 study even suggests that frequent hot flashes and night sweats could double the risk of ischemic stroke.

Does the timing of hot flashes matter for my health risk?

Yes. Research indicates that the frequency, intensity, and timing of these symptoms are key. Specifically, night sweats that occur during the second half of the night can disrupt REM sleep, which is essential for cardiovascular restoration. If your hot flashes started early in perimenopause and have persisted for years, or if they routinely interrupt your sleep, they may be a stronger "warning light" for underlying heart health issues.

Are all menopause symptoms equally linked to cardiovascular risk?

No. While many symptoms like "menopause belly," mood swings, or joint pain affect your quality of life, hot flashes and night sweats are unique because they are directly connected to the vascular system's response to hormonal shifts. Other symptoms, such as "frozen shoulder," do not currently show the same scientific link to long-term heart disease or stroke risk.

Can Menopause Hormone Therapy (MHT) help with both symptoms and heart health?

MHT is considered one of the most effective treatments for managing hot flashes. For many women who are younger, closer to the menopause transition, and do not have major pre-existing risk factors, MHT can provide relief without increasing heart risk. However, it is not a one-size-fits-all solution; it’s important to work with a menopause-informed clinician to determine if MHT or a non-hormonal alternative is right for your specific health profile.