Hot flashes are a typical menopausal symptom. They occur within 1-3 years of menopause and usually last about 6 months to 2 years. 88% of perimenopausal women experience hot flashes, and a few have them for about 30 years. the WHI and HERS studies suggest that 23%-37% of women aged 60-70 years, and 11%-20% of women over 70 years of age in their study populations still have hot flashes. Heat is a predisposing factor for numerous menopausal symptoms. When hot flashes occur, they are usually accompanied by palpitations, irritability, and anxiety. If they occur at night, they are called nocturnal sweats and can easily lead to interrupted sleep, resulting in poor concentration and memory loss the following day. Hot flashes also indicate the onset of menopause. Frequent episodes or profuse sweating of hot flashes seriously affect the quality of life and work. More than a hundred menopausal symptoms cause patients to visit multiple departments, multiple times, and undergo a variety of tests to exclude organic diseases, which significantly increases the medical burden, socioeconomic burden, and the risk of doctor-patient conflict. Risk factors for hot flashes are high body mass index, smoking, and low physical activity, which are very similar to those for cardiovascular disease, suggesting a possible association between hot flashes and cardiovascular disease. Cohort studies have shown that hot flashes are associated with aortic calcification, which is a subclinical cardiovascular disease and a high risk factor for developing cardiovascular disease. Possible Mechanisms of Hot Flashes It is well known that sex hormones undergo dramatic fluctuations and rapid declines during the perimenopausal period, which underlie the occurrence of hot flashes but are not the underlying cause. Neurotransmitter dysregulation due to the dramatic changes in sex hormones, resulting in malfunctioning of the hypothalamic thermoregulatory center and narrowing of the thermoneutral zone (range of thermoregulatory points), is the most widely accepted theory of the mechanism of hot flashes. Hypothalamic thermoregulation is similar to a thermostat. The thermoregulation point is divided into two points: the thermal threshold and the cold threshold, and the range between these two points is called the thermal neutral zone. If the body temperature is between the cold and hot thresholds, the thermoregulation center does not issue a signal to regulate body temperature; if the body temperature exceeds the hot threshold, heat dissipation increases, heat production decreases, and the body temperature drops to the normal level by sweating; when the body temperature is lower than the cold threshold, heat production increases, heat dissipation decreases, and chills raise the body temperature. After precise regulation, the body temperature remains within the cold and heat thresholds. When the thermoneutral band narrows, it is easy to be both cold and hot. It is also theorized that the contractile and diastolic functions of the peripheral vasculature are uncoordinated due to the lack of estrogen, which then leads to hot flashes and sweating. Effective Ways to Relieve Hot Flashes 1. Good Lifestyle is an Effective Way to Relieve Hot Flashes Quitting smoking is very important and provides many benefits beyond hot flash relief. Keep your living room ventilated and cool; wear clothes that are easy to put on and take off, layered and made of cotton to absorb sweat and dissipate heat in a timely manner; and eat a balanced, light diet to help smooth blood pressure and reduce the risk of hyperlipidemia. The Royal College of Obstetricians and Gynecologists of the United Kingdom and the North American Menopause Society point out that aerobic exercise and regular exercise are effective ways to relieve mild and moderate hot flashes. The possible mechanism of regular exercise to improve menopausal symptoms lies in stabilizing the thermoregulatory center, stabilizing peripheral vasoconstriction and diastolic function, coordinating skeletal muscles and benefiting the endothelin system and cytochrome system. 2. Pharmacological treatments are categorized into sex hormone therapy, complementary and alternative medicine, and so on. The clear benefits of sex hormone therapy (evidence-based medicine level A evidence) are improvement of menopausal symptoms such as hot flashes, improvement of urogenital atrophy symptoms, and improvement of quality of life. Regardless of the time of initiation of therapy and the age of the patient, the following potential risks exist: a slight increase in the risk of venous thrombosis and stroke, especially in the early stages of use; and an increased risk of breast cancer with increasing duration of use. The principles of sex hormone therapy are: strict control of indications and avoidance of contraindications (indications are improvement of systemic or local menopausal symptoms; start the drug as soon as possible if treatment is necessary; use the lowest effective dosage; choose the appropriate route of administration (oral, dermal or vulvovaginal); apply the shortest possible duration of use; and follow up in due course with the appropriate investigations to ensure the safety of the drug. Even if sex hormone therapy is initiated within 10 years of menopause, the risk of coronary heart disease is not reduced in the initial 2 years; the possible protective effect on the cardiovascular system of starting sex hormone therapy as early as possible after menopause will be reflected after 6 years of continuous use. However, such long-term sex hormone therapy should be administered on a balance of pros and cons, taking into account potential risks such as breast cancer. Complementary and alternative medicine (CAM) has been gaining attention in recent years. In the United States, approximately 76% of women aged 45-65 have used CAM to relieve menopausal symptoms. Complementary therapies are defined as methods in addition to conventional treatments, and alternative therapies are defined as methods in place of conventional treatments. CAM in the field of menopausal symptom treatment includes Chinese medicine, such as acupuncture, herbal medicine (the use of medicines under the guidance of Chinese medicine theory); botanical medicine, qigong, homeopathy, and so on. Among botanicals, several RCT studies have been conducted to confirm the efficacy as well as the safety of black cohosh extract. The drug has no estrogenic activity and can be safely used in breast cancer patients. The North American Menopause Society (NAMS) and the American College of Obstetricians and Gynecologists (ACOG) recommend black cohosh extract for the treatment of mild hot flashes. Lifemin is the original, standardized isopropyl alcohol extract of the rhizome of black cohosh, which has been confirmed by a Chinese multicenter, randomized, double-blind, parallel-controlled study that the effectiveness of relieving menopausal symptoms is equivalent to that of tibolone, and the side effects are significantly lower than those of tibolone; combined with the foreign literature, the effectiveness of this drug is equivalent to that of transdermal absorption of estrogens, and the side effects are similar to those of a placebo. Therefore, this drug is an effective and safe drug to relieve menopausal symptoms.