One minute you’re fine, the next a wave of heat rushes up your chest and face, your heart races and you’re desperate to open a window. Hot flashes (also called hot flushes) are the most common symptom of perimenopause and menopause, and they can be exhausting, especially at night.
In short: hot flashes are caused by hormonal changes that make your body’s “thermostat” more sensitive. Simple changes like keeping cool, avoiding your triggers and slow breathing can help, and there are effective medical treatments, including HRT and newer non-hormonal medicines. You don’t have to just put up with them.
What is a hot flash?
A hot flash is a sudden feeling of intense heat, usually in your face, neck and chest. It often comes with flushed skin, sweating and a fast heartbeat, and can be followed by chills as your body cools down. Most last from 30 seconds to a few minutes. When they happen during sleep, they’re called night sweats.
What causes hot flashes?
As oestrogen levels fall and fluctuate during perimenopause, the part of your brain that controls body temperature (the hypothalamus) becomes more sensitive. Even a tiny rise in temperature can make it think you’re overheating, so it rapidly tries to cool you down by widening blood vessels and making you sweat.
How long do hot flashes last?
Most women experience hot flashes at some point around menopause. They usually start in perimenopause and, for many women, continue for several years. Research suggests the average is around seven years, and some women have them for longer. Everyone is different, which is why it’s worth finding relief rather than waiting it out.
Common hot flash triggers
Keeping a simple diary for a couple of weeks can help you spot your personal triggers. The most common ones are:
- Alcohol, especially red wine
- Caffeine
- Spicy food and hot drinks
- Warm rooms, hot showers and heavy bedding
- Stress and anxiety
- Smoking
- Tight or synthetic clothing
12 ways to find relief
Everyday cooling tricks
- 1. Dress in layers of breathable cotton, linen or bamboo so you can quickly take one off.
- 2. Keep cool water close and sip it when you feel a flash starting.
- 3. Carry a small fan or a cooling face mist in your bag.
- 4. Lower the temperature at home and at work where you can.
Natural remedies for hot flashes at night
- 5. Keep your bedroom cool, around 16–19°C (60–67°F), with a fan near your bed.
- 6. Choose light, layered bedding and moisture-wicking pyjamas so you can adjust quickly.
- 7. Try a cooling pillow or flip your pillow to the cool side.
- 8. Avoid alcohol, caffeine and big, spicy meals in the evening.
Mind and body
- 9. Paced breathing: when a flash starts, breathe slowly and deeply, about six breaths a minute. Many women find it helps them feel calmer and more in control.
- 10. Cognitive behavioural therapy (CBT): there is good evidence that CBT can reduce how much hot flashes bother you and improve sleep.
- 11. Move your body: regular exercise supports sleep, mood and a healthy weight, and many women find hot flashes easier to cope with when they’re fitter. Try our 30-day walking plan.
Medical treatment
- 12. Talk to your doctor: hormone replacement therapy (HRT) is the most effective treatment for hot flashes and night sweats. If HRT isn’t right for you, there are non-hormonal prescription options, including certain antidepressants in low doses, gabapentin and newer medicines designed specifically for hot flashes. Your doctor can help you weigh the benefits and risks.
What about supplements?
Many supplements are marketed for hot flashes, such as black cohosh, evening primrose oil and red clover, but the evidence that they work is weak or mixed. Some foods containing soy may help a little for some women. Always check with your doctor or pharmacist before taking a supplement, because some can interact with medicines.
When to see a doctor
Book an appointment if hot flashes are affecting your sleep, work or wellbeing, or if you have night sweats along with unexplained weight loss, fever or other new symptoms, as these can have other causes.
Frequently asked questions
Why are hot flashes worse at night?
Your body temperature naturally changes during sleep, and warm bedding or a warm room can easily push you over your new, more sensitive threshold.
Can you have hot flashes before your periods stop?
Yes. Many women start having them in perimenopause, while they still have periods.
Does losing weight help hot flashes?
For some women who are carrying extra weight, losing some of it may reduce hot flashes. Combining walking, strength training and enough protein is a healthy way to start.
The bottom line
Hot flashes are common, but they’re not something you have to suffer through. Learn your triggers, keep cool, look after your sleep and talk to your doctor about treatment if they’re affecting your life. For simple daily habits that help, download our free Fit After 40 Starter Kit.
This article is for general information only and isn’t medical advice. Please speak to your doctor about your symptoms and treatment options.
