Hi, The possible causes of hot flashes are: - Decreased estrogen levels, which can be seen in pregnancy, second half of menstrual cycle, in perimenopausal period etc. - Increased metabolism, can be seen in pregnancy - Other conditions like hyperthyroidism, stress and anxiety can also lead to hot flashes These conditions sometimes can be associated with dizziness and lethargy also. Inter menstrual spotting may indicate ovulatory spotting or implantation bleeding or due to hormonal imbalance. If you had unprotected intercourse around the time of ovulation, there is possibility of pregnancy. In that case, if you miss your expected date of menstrual period, please go for urine pregnancy test once to find out the possibility. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Sree Gouri S. R., OBGYN