Hot Flushes and Night Sweats: What's Happening and What Helps

TL;DR: Hot flushes happen when falling oestrogen narrows the brain's comfortable temperature range, so a tiny rise in body heat sets off flushing and sweating. They often last 7 years or more, and longer on average for Black women. Lifestyle steps can take the edge off, HRT is the most effective treatment, and there are good non-hormonal options too. See a doctor if symptoms affect your life or come with red flags like unexplained weight loss.

You are in a meeting, at church, or stirring a pot of stew, and suddenly heat rises from your chest to your face. Your skin flushes, sweat breaks out on your neck and upper lip, your heart races, and a minute or two later you are chilled and damp. At night, you wake up with your wrapper or sheets soaked through, and lie awake for an hour afterwards. If this sounds familiar, you are not imagining it and you are not alone. Hot flushes and night sweats, which doctors call vasomotor symptoms, are among the most common signs of perimenopause and menopause.

What is a hot flush?

A hot flush is a sudden feeling of heat in the face, neck and chest. The NHS describes how it can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy, and usually lasts several minutes. When it happens at night it is called a night sweat. How often they come varies a lot, from now and then to many times a day, and night sweats can break your sleep and leave you exhausted and foggy.

Why do hot flushes happen?

Your brain keeps your core temperature inside a comfortable band. Above the top of that band you sweat to cool down, below the bottom you shiver to warm up. Research summarised in a review by Robert Freedman explains that in menopause this band, called the thermoneutral zone, becomes greatly reduced, so small elevations in core body temperature trigger a hot flush. Falling oestrogen is part of the reason, though not the whole story. Your body is responding to a tiny rise in heat as if you were overheating: blood vessels in the skin open up, you flush and sweat to lose heat fast, and then you feel cold once it passes.

This is why hot flushes usually begin during perimenopause, the years before your final period when hormone levels swing up and down. We explain this stage in more depth in perimenopause: what's happening to my body.

How long do hot flushes last?

Often longer than people expect. The NHS says menopause symptoms usually last for 7 to 9 years, sometimes longer. In SWAN, a large US study that followed more than 3,000 women of different ethnic backgrounds through menopause, the median total duration of frequent hot flushes and night sweats was 7.4 years, with African American women reporting the longest median duration at 10.1 years. The NHS also notes that women from a Black ethnic background are more likely to have hot flushes that are severe and continue longer.

Those are averages from one country, and many women have a much shorter or milder experience. But if you are a Black woman whose flushes have dragged on for years, this research suggests that is a recognised pattern, not a sign that something is wrong with you. We look at what the research says, and what it leaves out, in menopause in African women.

Triggers and simple things that help

Many women learn their own triggers over time. Common ones include hot drinks, spicy food, alcohol, caffeine, warm or stuffy rooms, and stress. It is worth being clear about the evidence here: a 2023 review by The Menopause Society (formerly NAMS) found the evidence was too limited to recommend trigger avoidance or cooling techniques as treatments. That does not mean they are useless, only that they have not been proven to reduce flushes in trials. If you notice that pepper soup or a second cup of coffee sets you off, adjusting costs little.

Practical steps many women find make flushes easier to live with:

• Dress in layers of cotton or linen, so you can take one off quickly. A light wrapper or cardigan you can shrug off is easier than a heavy outfit.
• Keep cool at night with a fan, a window open where it is safe, light bedding, and a glass of cold water by the bed. Keep a spare nightdress nearby so you can change without fully waking up.
• Stop smoking. The NHS notes smoking can make menopause symptoms worse.
• Keep alcohol within recommended limits, which the NHS says may affect symptoms.
• Look after your weight and sleep. In SWAN, a higher body mass index was linked with more frequent hot flushes, and The Menopause Society lists weight loss as a supported option. Our guide to sleep and hormones has more on protecting rest when night sweats wake you.

Treatments that work

If hot flushes are affecting your work, sleep, mood or relationships, you do not have to just push through. There are effective treatments, and a good clinician will talk them through with you.

Hormone replacement therapy (HRT). HRT replaces the oestrogen your body is making less of, and it is the most effective treatment for hot flushes. NICE, which sets clinical guidance in England, advises that doctors offer HRT to people with vasomotor symptoms associated with menopause. It is not right for everyone, and the benefits and risks depend on your age, health and history. We cover this in detail in our upcoming guide to HRT benefits and risks.

Non-hormonal options. For women who cannot or prefer not to take HRT, NICE and The Menopause Society point to several options with evidence behind them:

• Menopause-specific cognitive behavioural therapy (CBT), a talking therapy that NICE recommends considering for hot flushes, and for the sleep problems and low mood that can come with them.
• Fezolinetant, a newer non-hormonal tablet that works on the brain's temperature control centre. NICE recommends it as an option for moderate to severe hot flushes when HRT is unsuitable.
• Certain prescription medicines, including some antidepressants (SSRIs and SNRIs) and gabapentin, which The Menopause Society found effective. NICE advises these are not routinely offered first for hot flushes alone, so they are usually considered case by case.

Herbal remedies. Black cohosh, soy isoflavones and similar products are widely sold. NICE notes there is some evidence they may help, but product quality varies and some can interact with other medicines. The NHS advises that you talk to a doctor before taking herbal supplements.

When should I see a doctor about hot flushes?

See a doctor if hot flushes or night sweats are affecting your daily life and you want to know your options. You do not need to wait until symptoms are severe. Get checked sooner if:

• You have night sweats along with a very high temperature, a cough, or weight loss you cannot explain, as these can point to causes other than menopause
• You have palpitations, a fast or pounding heartbeat
• Your periods are getting heavier rather than lighter
• You have any vaginal bleeding after 12 months without a period, which the NHS says should always be checked

Night sweats can also be caused by infections, anxiety, low blood sugar and some medicines, so a doctor may want to rule these out. This post is education, not medical advice.

Getting ready for that appointment

Many women in Nigeria, Ghana, Kenya and across the diaspora tell us they were brushed off, or told flushes are "just age" and something to bear quietly. Arriving with a clear record helps. Asele lets you log symptoms like hot flushes, night sweats and sleep alongside your cycle, so you can see how often they happen and how they shift over months. The Asele Health Brief turns that into a summary you can take to your doctor. And Amara, our in-app assistant, can talk through what you are noticing in Yoruba, Hausa, Igbo, Swahili, French or English. You can find us at Asele.

For more on the midlife transition, read thriving through menopause or listen to Blush and Bloom episode 36 on perimenopause support. Hot flushes are common, but common does not mean you have to suffer through them.

References

1. NHS. Symptoms of menopause and perimenopause. nhs.uk
2. NHS. Things you can do to help menopause and perimenopause symptoms. nhs.uk
3. NHS. Night sweats. nhs.uk
4. Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol, 2014. pmc.ncbi.nlm.nih.gov
5. Avis NE, et al. Duration of menopausal vasomotor symptoms over the menopause transition (SWAN). JAMA Intern Med, 2015. pmc.ncbi.nlm.nih.gov
6. Gold EB, et al. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition (SWAN). Am J Public Health, 2006. pubmed.ncbi.nlm.nih.gov
7. The North American Menopause Society. The 2023 nonhormone therapy position statement. Menopause, 2023. pubmed.ncbi.nlm.nih.gov
8. NICE. Menopause: identification and management (NG23). nice.org.uk
9. NICE. Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause (TA1143). nice.org.uk