Triggers for breakthrough hot flashes?

I’m on HRT and it works most of the time, but once in a while I still get a severe hot flash.

I know stress, dehydration, maybe caffeine, and missing even one dose of my oral* HRT can also result in hot flashes. Anyone got anything else I should be looking at? I’ve seriously wondered if I should look at carbs or chocolate too. Also not sure if illness could be adding to the problem.

I’ve increased my HRT dosages like 4-5 times over the last year so it’s starting to feel like HRT will only do so much. I’m beginning to wonder if I should consider that new non hormonal medication for hot flashes if this continues, but as I said, most of the time things are now manageable.

Thanks in advance

*For anyone concerned, the patch did NOT work for me and my doctor is very comfortable giving me oral HRT given low family risks and also the severe intensity of my symptoms.