The Difference Between a Flush and a Hot Flash

In the book Fifty Shades of Grey, Anastasia Steele devotes a lot of time to flushing. This is not even close to one of the book’s themes.  I would probably not have noticed this particular feature if I did not have carcinoid cancer.  Skin flushing is a sudden reddening of the face, neck, or upper chest. Flushing is a normal body response that may occur when you are embarrassed, angry, excited, or experiencing some other strong emotion.  In the above book, Anastasia’s flushing is due to these reasons.

I started flushing in my mid-40’s; not very often – maybe once every 2-3 months. It would occur for a few minutes, almost always at mealtimes - either breakfast or lunch.  Since this was a seemingly random occurrence and I was starting to experience perimenopausal symptoms, I thought that the flushing was part of this hormonal change of life.  I could feel burning and the heat flow up to my face.  I could tell I was red even if no one said, as they sometimes did, “Wow Beth, your face is quite red”.  It was clear and noticeable but it only lasted a few minutes and then it would not recur for a few months.  There was no sweating involved, just a stinging/burning feeling, similar to getting slapped.   After a few instances of this flushing- and having some friends say that they don’t think it is from perimenopause - I considered that I might have a food allergy since it only happened around mealtime.  I tried to remember what I had eaten that would cause this flushing but I was not tracking closely. There did not seem to be any trigger foods. 
 
Below is a picture of me and my Aunt Judy – we had gone to lunch to celebrate her 80^th birthday.  This was in 2010, right around the time of my carcinoid diagnosis.  I am clearly red and it is right at lunchtime – a typical occurrence for me.

I started taking Sandostatin LAR in January 2011 and I have not had a flushing incident since, at meal or any other times.  I still get red and sweaty at the gym, as I always have. This redness is accompanied by sweating so I do not consider this flushing. 
  
I did not get the typical menopausal hot flashes until about 12 months ago at age 52.  This feeling is quite different than a flush.  When getting a hot flash, I get immediately sweaty, mostly around my hairline and neck and this can spread so that I feel sweaty all over.  The hot flashes seem to be worse when the weather is warm – i.e., they seem to take a break during the winter.  Hot foods, such as soup and tea can also exacerbate them.  I have moved to iced drinks instead of hot ones.  I also have hot flashes at night and they can disturb my sleep.  There is no flushing or redness associated with my hot flashes.
 

My ob-gyn said hot flashes can go on for 5-10 years and that it is good to wear layers so you can take them off, have heavy and light blankets on the bed so you can shed them and if you use an electric blanket, make sure it has dual controls.  I feel like my internal thermostat has gone haywire as the hot flashes can happen at any time with no notice.  This is quite normal and all my female friends in the same age range are having some version of this so we can all gripe together.

I think it is important to understand how to recognize flushing versus other symptoms.  Suntans, regular blushing/flushing as described above, rosacea or other conditions might cause you or your health care professional to think you are flushing due to carcinoid when you really may not be.  Alternatively, flushing due to carcinoid can be mixed up with other conditions as well.