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What Causes Hot Flashes: It’s More Than Just Estrogen

by | Feb 8, 2022 | Hormone Imbalances, Women's Health

What causes hot flashes? Contrary to popular belief, hot flashes and night sweats are not always due to low estrogen. There are many potential causes:

Gastroesophageal reflux disease (GERD)

Also known as acid reflux or heartburn, GERD is a painful condition where stomach acid is backed up into the esophagus. Along with pain and discomfort, this condition can also cause hot flashes. GERD is primarily a result of low stomach acid. To learn more about GERD, read my blog on this topic

Blood sugar imbalance

The body requires less energy at night, resulting in reduced glucose production. If a person’s blood sugar levels already running low, this increased drop may lead to hot flashes.  

Thyroid Imbalance

The thyroid hormones control body temperature by influencing how much the blood vessels dilate and therefore how much heat can escape.  Typically, an overactive thyroid (hyperthyroidism) will raise body temperature and an underactive thyroid (hypothyroidism) will lower body temperature. However, according to David Brownstein, M.D., author of Overcoming Thyroid Disorders, a low functioning thyroid can also cause hot flashes and night sweats.  

Elevated Cortisol

If you consistently wake up between 2-3am, high nighttime cortisol levels are likely to blame. Cortisol is a hormone that is made by your adrenals and is known as the stress hormone. Studies show that increase cortisol levels are often correlated with an increase in night sweats and hot flashes.

Sex hormone Imbalance

Estrogen, testosterone, and progesterone (aka, the sex hormones) must be properly balanced to achieve optimal health. While it is true that low estrogen can cause hot flashes, having excess estrogen and low progesterone can also be the cause. 

Low Serotonin

Estrogen supports production of the feel good neurotransmitter, serotonin. Therefore, declining hormones can lead to low serotonin. However, as the gut produces a large percentage of serotonin in the body, a leaky gut can also be the cause of low serotonin levels. 

While this may seem overwhelming there are some simple steps you can take to create balance.


If you are eating a mostly processed food diet, changing that to a mostly whole food diet can clear up many symptoms. 

Here is a guide that may help depending on what is out of balance. 

  • Incorporate protein into your meals and snacks. Good quality protein from meat, fish, fowl, eggs, dairy, and various plant sources  (legumes, nuts and seeds).   
  • Include 6-8 servings of a wide variety of vegetables in your meals, especially those that are bright in color.
  • Go lightly on fruits and avoid high glycemic fruits such as bananas, figs, raisins, dates, oranges, and grapefruits.  
  • To stabilize blood sugar throughout the day, eat breakfast before 10am, lunch before Noon, a snack between 2-3pm, with dinner between 5-6pm.  I know intermittent fasting is popular right now but 80% of patients that come in should not be fasting due to blood sugar or hormonal imbalances. 

If these changes don’t alleviate hot flash symptoms, then let me help!

Here are the steps I take when working with a patient:

Thorough Initial Intake

I spend an hour with my new patients discussing lifestyle, diet, and health history. I hear all the time that patients have been told that their labs are all normal and they just have to deal with the hot flashes and night sweats. This is not acceptable! 

During this consult, we may begin to work on dietary changes and  I typically will order labs based on their individual needs. 


I typically check the following labs when someone has hot flashes and/or night sweats: 

TSH, Free T3, Free T4, Reverse T3 (thyroid antibodies if they have not been checked), Estrogen, Testosterone, progesterone, Cortisol, DHEA, Insulin, Vitamin D3, B12, Folate, iron, Ferritin. Also, a Complete Metabolic Panel can help me assess if there is an issue with digesting proteins or fats. 

I also love to check the complete Micronutrient status. The test I use provides me with the serum and cellular values so I can assess if it is a true deficiency or an absorption issue. Check out my blog on micronutrient testing to learn more on this topic. 

Lab review

Lab reviews include a detailed explanation of each patient’s labs.  I may recommend some dietary changes such as eliminating gluten or making sure they eat some protein and good fats before bedtime. 

In addition, I use supplementation, homeopathy, and BHRT (Bioidentical hormone replacement therapy) to meet the needs of each patient. All protocols are individualized for the patient. 

I like to see at least a 10% improvement in my patient’s symptoms each week. 

Dr. Melanie Maclaren

Dr. Melanie MacLaren

Dr. Melanie MacLaren is a naturopathic doctor and registered yoga teacher who is passionate about natural health and the individualized needs of each of her clients.

Call 317-818-1800 to learn more about Dr. Melanie or request an appointment. 

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