There are many causes of flushing, with reddening of the face and a sensation of heat in the upper body, besides perimenopause and menopause. These symptoms are similar to those of hot flashes, but have different causes. Most of the time, these other conditions cause symptoms other than flushing, and a physician can assess whether to investigate possible other causes based on a patient’s medical history. If the prescribed therapy for hot flashes proves ineffective after 1 month, other possible causes should be investigated by seeing a physician in person. Some examples include:
- Hyperthyroidism: This is the most common cause of hot flashes aside from menopause, and Rory-affiliated providers recommend that all women talk to their primary provider about getting a blood test to check their thyroid function before being treated for hot flashes, although a blood test is not required prior to obtaining care over the Rory platform.
- Systemic mastocytosis: This is a group of diseases where too many mast cells (a certain type of white blood cell) are being made and deposited in different tissues. These cells are involved in allergic reactions and secrete histamine and other chemicals. Generally people with systemic mastocytosis have other symptoms besides hot flashes. The most common symptoms involve the digestive system (abdominal pain, nausea, vomiting, and diarrhea) and the skin (rash, itching).
- Carcinoid syndrome: This is a rare disease caused by a tumor that can occur in various organs that secretes many chemicals, among them histamine. Other symptoms that those with carcinoid syndrome typically experience are palpitations, wheezing, and diarrhea.
- Pheochromocytoma: This is a rare tumor of the adrenal gland causing large amounts of epinephrine and norepinephrine to be released either continuously or intermittently. These hormones normally function to get us ready to fight or run away from a dangerous situation–the so-called fight or flight response. Among other things, they cause blood to be diverted from our digestive organs to our muscles, dilate our airways, cause our hearts to beat faster and harder, and dilate our pupils. Other common symptoms of pheochromocytoma include headaches, palpitations, extreme sweating, and anxiety. Some people will also develop digestive symptoms like nausea, constipation, and abdominal pain.
- Severe allergic reactions (anaphylaxis): Other symptoms are wheezing, hives, swelling, palpitation, nausea, vomiting, and loss of consciousness. This is a life-threatening emergency, and if you think you are having a severe allergic reaction, you should call 911 and seek immediate medical attention.
- Rosacea: This is a common skin disease with a few different subtypes that causes flushing. Other symptoms include small dilated blood vessels on the face, facial redness, eye symptoms (redness, inflammation, increased tear production), roughened skin that can become very thick, and an acne like rash. It often occurs at younger ages, and most types of rosacea are more common in women. Usually the facial redness is persistent even when the person is not having a flushing episode.
- Benign cutaneous flushing: This is one of the most common types of flushing. It is brought on by triggers, including exercise, spicy foods, and emotions (embarrassment, anger, etc.). This type of flushing only occurs in combination with a trigger.
- Rare tumors: including medullary carcinoma of the thyroid, pancreatic cell tumor (VIPoma), renal cell carcinoma: These tumors are rare, and flushing occurs in the presence of other symptoms. Medullary thyroid carcinoma is often characterized by a thyroid nodule and associated with a family history of the disease. VIPomas cause prolonged large amounts of watery diarrhea, dehydration, weakness, and low potassium levels. Renal cell carcinoma causes flank pain, blood in the urine, weight loss, fatigue, and sometimes fever.
- Certain neurological diseases: including multiple sclerosis, Parkinson’s Disease, and dysautonomia: These illnesses also do not cause flushing in isolation. Other neurological symptoms include weakness, balance and gait problems, tremor, rigid muscles, bowel and bladder abnormalities, abnormal speech, dizziness especially when changing positions, and pain.
- Alcohol: In this case, flushing occurs when drinking alcohol.
- Medications: Many medications can cause flushing, including blood pressure medications, some antibiotics, painkillers, medications used in chemotherapy, and others.
As you can see, most other causes of hot flashes besides menopause come with other symptoms as well. Talk to your doctor if you think your hot flashes or flushing may be caused by a This is why we recommend a medical examination and comprehensive blood testing, including thyroid blood tests, if your hot flashes do not improve within 3 months of starting therapy.