What is Facial Flushing in Menopause?

You are not alone if you have intense heat in your face during a hot flash

Pensive woman looking down
Vladimir Godnik/Getty Images

Facial flushing, or a red, hot, burning face, is a common symptom that may range from being an annoyance to a debilitating, distressing experience.

While there are many causes of a red face, menopause is one of the more common ones.

Facial Flushing and Menopause

A common cause of a red, hot, and burning face in women is menopause, and it usually accompanies a hot flash—a sensation of intense warmth in the body that lasts from 30 seconds to 5 minutes.

You may be surprised to learn that hot flashes occur in 80 percent of women going through menopause, and most women with hot flashes also experience facial flushing. This is called a vasomotor flush, and it is seen as a redness starting in the chest and neck area that then rises to cover the face.

How Menopause Causes Facial Flushing

The red face and overall hot flash is caused by a lowering of the set point of the heat-regulating center in the brain, or more accurately, in the hypothalamus. This lowered set point fools the brain into thinking the body temperature is too high and must be lowered.

During a flush, blood vessels in the skin widen causing redness, and a hot, burning sensation. Then the body wants to lower its temperature quickly, so it narrows the blood vessels in the skin, allowing heat to escape. This is why women sweat first, and then sometimes shiver during the course of a hot flash.

The reason why facial flushing occurs in menopause is because the hormone estrogen stabilizes this heat-regulating center in the brain. As a woman approaches menopause, her estrogen levels begin to decline, as her ovaries stop functioning. This withdrawal from estrogen causes heat regulation instability.

Treatment of Facial Flushing from Menopause

Facial flushing is treated with the same therapies as those used to treat hot flashes. While facial flushing cannot be necessarily cured, it can be properly managed. The most effective therapy is estrogen therapy, which is usually given by mouth (orally) or through the skin (transdermally). In women with an intact uterus, progesterone is given with estrogen to prevent overgrowth of uterine tissue. 

There are also non-hormonal therapies available like the antidepressant Brisdelle (paroxetine). In addition, certain blood pressure medications such as clonidine have been shown to reduce flushing by regulating the same chemicals in the brain that transmit heat-regulating information. Other potential therapies include progestins, Effexor (venlafaxine), and Neurontin (gabapentin). 

Herbal preparations containing soy have been shown to reduce the frequency of flushing. However, studies have not shown any benefit from the herbs dong quai, ginseng, black cohosh, or St. John's Wort.

Since hot foods and emotional stress can exacerbate facial flushing, lifestyle behaviors that may help a woman include avoiding hot beverages and spicy foods and engaging in relaxing exercises like progressive muscle relaxation.  

It is important to remember that these therapies work by decreasing the number and/or severity of a woman's facial flushes (and hot flashes) in order to improve her quality of life. In other words, if a woman's facial flushing does not bother her, there is no need to treat it. 

Sources:

Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 2014 Jul;142:115-20.

Nair PA. Dermatosis associated with menopause. J Midlife Health. 2014 Oct-Dec;5(4):168-75.

The North American Menopause Society. (2014). The Menopause Practice: A Clinician’s Guide, 5th ed. Mayfield Heights, OH: The North American Menopause Society.

Continue Reading