Why they are often an early marker of vascular dysfunction
By John Hogg, MD, DABR, DABVLM, RPVI, RPhS, RVT, RVS Founder, Medical Vein Clinic
You experience a wave of heat. Your face flushes. Your neck and torso get sweaty. You reach for a fan or max your car’s AC.. The heat explosion lasts a few minutes, and then you get back to your day, hoping no one noticed the beads on your lips and your makeup sliding.
But, hot flash is not just a temperature event. It is a vascular event. And the important connection between the two is something I want every woman over 40 to understand.
What Actually Happens During a Hot Flash
As estrogen declines, the brain loses some of its ability to regulate body temperature. It misreads normal conditions as overheating and sends a signal to cool the body down. In response, blood vessels near the skin open quickly to release heat. That sudden rush is the flush you feel.
It is uncomfortable, and then it passes.
But from a vascular standpoint, there is more going on. That rapid opening of the blood vessels is not how a healthy circulatory system is designed to work. Blood vessels are meant to adjust gradually and precisely based on the body’s needs. A hot flash forces that response all at once, triggered by a signal that is not entirely accurate. It is a misfire in the system.
Findings from the SWAN Heart Study, a large, long-term look at women’s cardiovascular health, show that even occasional hot flashes, less than one per day, can be linked to arteries that do not open as well as they should when blood flow increases. This is called endothelial dysfunction. I think of it as an early warning light.
As hot flash frequency increases, so does the impact. Women with frequent hot flashes, especially those with ten or more per day, tend to show higher levels of aortic calcification, or plaque buildup in the body’s largest arteries. Plaque is what narrows arteries over time and sets the stage for heart attack, stroke, and peripheral arterial disease.
The Vein Side of the Story
Most research on hot flashes focuses on arteries. In practice, the story is broader.
When I evaluate patients, they often come in with a mix of symptoms, leg pain with walking, cramping at night, cold feet, heaviness, swelling, or visible veins, which point to both arterial and venous issues simultaneously. That is not a coincidence.
The same hormonal changes that drive hot flashes and affect arterial function also impact the veins. As estrogen declines, the vascular system loses some of its structural support. Vein walls become less elastic, and the valves that move blood back to the heart become less reliable. Over time, blood begins to pool, and chronic venous insufficiency develops.
If you are experiencing frequent hot flashes, start the conversation with your physician about your cardiovascular health. Review your blood pressure, cholesterol, and markers of inflammation.
If you are also noticing leg symptoms such as heaviness, swelling, visible veins, or skin changes, a vascular evaluation should be part of that conversation. It is non-invasive, efficient, and gives a clear picture of how your circulation is functioning.
Recognizing the signals early and acting on them can make a big difference in your health.
Healthy Legs Take You Further™
Dr. John Hogg, MD, DABR, DABVLM, RPVI, RPhS, RVT, RVS, is a board-certified radiologist specializing in Vascular & Interventional Radiology and the CEO/Founder of Medical Vein Clinic. With more than 30 years of experience, Dr. Hogg has established San Antonio’s leading vascular treatment clinic, helping thousands of patients since opening in 2017. To learn more, visit https://www.medicalveinclinic.com.
