Why A Hot Flush Can Feel Like a Panic Attack

For many women, hot flushes are just an annoying part of peri- and post-menopause.  They experience a sudden wave of heat and some sweating, then, like a wave, it ebbs away.

 

But there are a lot of women for whom their hot flushes don’t make a benign visit and casually flow away, for many, a hot flush is a very big deal.  A hot flush can mean an intense surge of anxiety, panic, or an overwhelming feeling of dread.  They might have all the symptoms of severe anxiety, that is, a racing heart, chest pain, shortness of breath, trembling or shaking, or extreme muscle reactions, from tension to numbness. 

These symptoms don’t mean that something has gone terribly wrong, they’re the result of our brains trying to protect us.  Our brains are constantly monitoring our bodies to keep us safe.  If we accidentally reach out and touch something hot, for example, an iron that we didn’t realise was switched on, our brains tell us instantly, to pull our hands away.  If we develop a fever, our brains register the serious threat to safety and encourage us to seek coolness and rest, our conscious thoughts are aware that sipping cool drinks and resting are what a feverish illness needs.

Now, think of this system facing a sudden, intense surge of heat.  Our brains don’t seem to have a category for, ‘menopausal hot flush’.  Now it’s sure that it’s dealing with a real and serious threat and kicks into overdrive.  The brain is seeing this sudden intense heat as "DANGER! FEVER! HEATSTROKE! ACT NOW!"

We could think of this system as an organic, finely tuned smoke alarm.  This alarm will detect fire and thick smoke, but it will also detect slightly scorched toast.  This doesn’t mean the alarm is broken, it just means that it’s very, very sensitive. Both alerts are entirely automatic. The symptoms of a hot flush can feel like the symptoms of a panic attack, as the symptoms of a smoke alarm for scorched toast can sound like the symptoms for an out of control fire. Trying to consciously stop that primal alarm, in the moment, would be like shouting at a smoke alarm, “It’s just toast!”

This is all uncomfortable enough, but what can the aftermath be, when our conscious brain tries to make sense of what just happened. Then there is a secondary layer of discomfort. 

Negative Interpretations can pop up, for example, "I can't cope with this," "This is unbearable," "Something is terribly wrong with me," or "I'm losing control"

Self-Consciousness and Shame can be felt. If a hot flush strikes in public, thoughts like "Everyone is staring" or "This is so embarrassing" can add to the distress.

Anticipatory Anxiety the vivid memory of the intense fear often leads to dread and worry about future hot flushes, causing some women to avoid warm environments, social situations, or activities they once enjoyed.

This creates a self-perpetuating cycle: the hot flush triggers the primal alarm, the alarm is terrifying, and the thoughts about the terrifying alarm then fuel more anxiety and distress, making future hot flushes even more feared.

Finding Relief

It's natural to want to "disrupt" or "fight" this overwhelming feeling, but battling against your own automatic nervous system can, ironically, amplify your distress. We can’t change the way our brains work, what we can do is change our acceptance of how they work and reframe our experience.

Firstly,

Validate Your Experience: Crucially, your intense fear and panic are real.  These feelings are as real as if you were facing an actual threat to your safety. These feelings are understandable; they’re baked into the way the brain works. Also, you’re not the only woman who lives with these real, intense feelings.

Understand the "Why": Learning about your brain’s primal alarm system can be empowering. It shifts the experience from "I've gone mad" to "My brain is just trying to protect me, but it's misinterpreting the signal." I like to think of myself shouting at a smoke alarm, you can find what works for you.

Regulate Your Nervous System: We can’t stop the alarm, we need to accept that, but we can waft a tea towel in front of the smoke alarm sensor – we wouldn’t be able to do that if we were dealing with an actual fire. There are lots of somatic, or body techniques to self-soothe, to acknowledge the message and calm the systems down.

Cultivate Self-Compassion: Be kind to yourself. It's challenging to experience this intense internal turmoil. Practicing self-compassion helps you move from self-criticism to a place of acceptance and gentle self-support.

By understanding your brain's primal response and learning to work with your body, you can transform your experience of hot flushes from one of overwhelming dread to one of greater calm, acceptance, and a renewed sense of control over your well-being. If you're struggling, reaching out to a professional who understands this complex interplay can offer invaluable support on your path to greater peace.

 

Navigating AI for Mental Health Support

The Rise of AI

The technology behind Large Language Models (LLMs) has been developing for years, early versions have been powering search engines since 2018, but there were no tools to allow the public to converse with them. This changed in 2022 with the public release of ChatGPT, which had a conversation interface. There is a growing area of research which is exploring the potential and limitations of Gen-AI Chatbots, that is the type of AI that can create new content and ideas, while a chatbot engages in authentic two-way conversations.

A recent clinical trial tested a Gen-AI chatbot called 'Therabot’ (Heinz, et al, 2025). The study included participants with diagnosed conditions such as Major Depressive Disorder and Generalised Anxiety Disorder and reported promising results, including an average of 51% reduction in depression symptoms and a 31% reduction in generalised anxiety symptoms over four weeks. Users reported a significant 'therapeutic alliance' with the chatbot, a factor often linked to positive outcomes in human therapy.

However, this ever-expanding field of research also highlights the limitations and risks of such tools, emphasising ongoing concerns regarding safety, accurate crisis response, and the absence of genuine human understanding or accountability.

Potential Benefits

• Anonymous Support – AI can act as a sounding board for discussing thoughts and feelings anonymously
• Unlimited Availability – immediate, round-the-clock support with quick answers to questions about symptoms, conditions, and therapy types.
• Educational – AI will have information on all therapeutic modalities and can be used for ideas for mindfulness exercises, journaling prompts, and thought reframing techniques.

Possible Risks and Limitations

• Lack of Empathy and Human Connection – AI cannot genuinely empathise with or understand the nuances of human experience, an LLM will never have experienced any human emotions.
• No Crisis Support – AI isn’t equipped to intervene, diagnose or connect users to emergency services.

Caution

• Accuracy & Bias: AI models learn from vast datasets, which can contain biases or misinformation. Their responses might be incorrect or even harmful.
• No Diagnosis or Personalised Treatment: AI cannot diagnose mental health conditions or develop tailored treatment plans based on a full clinical assessment.
• Confidentiality & Privacy Concerns: Shared data isn’t confidential or safe. Users have no guarantee how their sensitive information will be used or stored.
• Lack of Accountability & Regulation: There's no licensing body for AI. If an AI gives harmful advice, there's no professional accountability.
• Superficiality: AI interactions are superficial, lacking the depth needed to address complex trauma, deep-seated issues, or personality disorders.
• Risk of Dependency: Users could become overly reliant on AI, potentially isolating themselves from real human connections.

The value of a human psychotherapist in an AI world

AI has its uses, but it isn’t a panacea. AI offers new possibilities to both clients and therapists, for example, I’m happy to use it to make sure my worksheets are as useful and concise as possible. AI can be helpful in creating journalling prompts, and while I’m willing to go through AI scripts with clients, I’m aware of the limitations. AI isn’t a substitute for professional mental health care. As a therapist I focus on the following, Genuine empathy, active listening, and ability to build a therapeutic relationship.
Ability to assess complex situations, work in collaboration with clients, and tailor treatment.
Understanding of non-verbal cues, tone, and cultural nuances.
Ethical and confidential framework, I have to be accredited, insured, and undertake regular clinical supervision.

The risks of AI interaction from AI itself

"Despite my capacity for generating vast information and mimicking human interaction, I lack true consciousness, genuine empathy, and lived experience. My responses, derived from patterns, are susceptible to factual inaccuracies and ingrained biases, fundamentally limiting my ability to offer nuanced ethical judgment, a true therapeutic connection, or the real-time, compassionate understanding that only a human can provide." (Gemini, July 2025)

REBT is a deeply collaborative process. I work with you to identify, challenge, and dispute irrational beliefs. This isn't a generic output; it's a dynamic, personalised journey of discovery and change.