The Expert Guide to Hot Flashes and Night Sweats

For many women, hot flashes and night sweats are some of the most annoying symptoms of menopause. These unpredictable spikes of heat always seem to come at the wrong moment: when you’re in a meeting, at a party or standing in the checkout line.

You quickly peel your top layers off only to put them back on a few minutes later, wear summer clothing in the dead of winter and blast the air conditioning. Your hot flashes and night sweats disrupt your sleep every few hours and you feel a little like a zombie the next day.

Sound familiar?

If you are experiencing hot flashes and night sweats in midlife, you are definitely not alone.

An estimated 85% of perimenopausal women experience hot flashes at some point. They may get more frequent and intense as you approach menopause. After menopause, about 80% of women experience hot flashes with 10-20% experiencing severe symptoms. Even 21% of younger premenopausal women experience hot flashes.

On average, women experience hot flashes for an average of 7.4 years. Those who first had hot flashes in perimenopause experienced them for longest—an average of 11.8 years.

Hot Flash or Something Else?

Women taking birth control pills usually will not get hot flashes, but perimenopausal women will sometimes get them in the ‘pill-free’ week. Eliminating the pill-free week by taking active pills every day should alleviate hot flashes.

If your hot flashes are not relieved by hormonal birth control, it’s important to rule out other causes. Thyroid problems, diabetes or pre-diabetes are the most common conditions that can cause hot flash-like symptoms. However, other rare conditions, such as autoimmune diseases and chronic infections, could also cause sweating.

Hot Flashes and Ethnicity

The Study of Women’s Health Across the Nation (SWAN) is a large, multi-site longitudinal, epidemiological study that began in 1994 and is still running today. One of the SWAN study’s important findings was a difference in how women of different ethnic and racial backgrounds experience hot flashes.

Japanese-American and Chinese-American women reported less severe hot flashes.
African-American women most frequently reported hot flashes and night sweats.

Compared to other racial/ethnic groups, African-American women had the longest duration of hot flashes, with about half experiencing hot flashes for more than 10 years. Hispanic women had the second-longest duration, followed by Caucasian, Chinese-American and Japanese-American women.

Hot Flash Science

Hot flashes are thought to be the result of hormone-related changes in the hypothalamus, the part of the brain that regulates the body’s temperature.

If the hypothalamus mistakenly senses that you are too warm, it starts a chain of events to cool you down:

Blood vessels near the surface of your skin begin to dilate (enlarge), increasing blood flow to the surface in an attempt to dissipate body heat.
This produces a red, flushed look to the face and neck in light-skinned women. It may also make a woman sweat to cool the body down. Women may also sense the heart beating faster.
The hot flash sensation may last a few seconds to a minute before it starts to subside. After the hot flash, you may feel a cold chill.

Hot Flash Triggers

While some hot flashes do not have clear triggers, most women can identify at least one factor that can cause a hot flash to occur.

Common hot flash triggers include:

Spicy food
Alcohol
Sugar
Caffeine
Warm temperatures
Hot baths
Heavy, tight or unbreathable synthetic clothing
Stress
Anxiety or nervousness
Anger
Smoking

It helps to take note of what’s happening when a hot flash starts. By tracking your triggers, you can begin to make small lifestyle adjustments and reduce the frequency and intensity of hot flashes.

Midday app offers a hot flash tracking tool to help you easily track and get insights about your triggers. Tap the (+) icon on the navigation bar to get started.

Your Options for Relieving Hot Flashes and Night Sweats

While it may feel like you have no control over hot flashes and night sweats, you have several options available to reduce their frequency and intensity.

Note that you may not be a candidate for certain types of relief based on your medical history.

Ideally, it would be best to discuss these choices with a healthcare provider experienced in treating menopausal women.

1. Lifestyle Changes

In many cases, healthcare providers recommend lifestyle-based changes before starting other treatment options like hormone therapy. Even if you are on hormone therapy, making changes to your lifestyle is still recommended to improve overall health and well-being in midlife.

Several lifestyle interventions can effectively reduce the impact of hot flashes in addition to avoiding triggers:

Quit smoking. Tobacco use has been linked to more severe and more frequent hot flashes! Another great reason to commit to quitting smoking if it is part of your life.
Consider a plant-based diet. A 2021 study showed that a plant-based diet including a daily serving of soybeans was effective in reducing the occurrence of hot flashes for the study participants over a three month period. While this was shown in a small sample size over a relatively short period of time, the study does suggest that these changes may be helpful. A plant-based diet can be helpful for other menopause symptoms and your overall health, making the switch even more worthwhile for many people.
Exercise. Experts currently recommend regular moderate-intensity exercise as both important for overall health and potentially beneficial for reducing hot flashes. When you regularly increase your heart rate and sweat during exercise, it may actually make your body react less strongly to a hot flash. It’s important to work up gradually if you’re just getting started, but all adults should aim to eventually reach a minimum of 150 minutes of moderate-intensity or 75 minutes of high-intensity exercise per week.
Mindfulness, stress reduction and hypnosis. Research has shown that mindfulness training and hypnotherapy can reduce the impact of hot flashes on quality of life, decrease stress and anxiety, and improve sleep.

Healthy lifestyle habits can do more than reduce hot flashes. The same changes in diet and exercise that manage hot flashes can also reduce your risk of other serious conditions that are more common in women like cardiovascular disease, dementia and osteoporosis.

Finding a healthcare provider who aligns with your values is important, especially if you want to try lifestyle changes to manage your symptoms. While the evidence strongly supports these changes, most physicians are not comfortable discussing them.

2. Cognitive Behavioral Therapy (CBT)

CBT is a framework for building awareness of thoughts and feelings in challenging situations and reshaping our reactions to better serve us. Studies have shown that CBT is the number one evidence-based holistic strategy that can be useful in coping with hot flashes. In this context, it means recognizing and reframing negative thoughts during hot flashes and implementing helpful strategies in the moment like paced breathing.

Studies of CBT for hot flashes show that participants can significantly reduce how bothered they are by hot flashes, even if the hot flashes themselves don’t go away. Some studies even report that CBT may decrease the frequency of hot flashes/night sweats.

3. Menopausal Hormone Therapy (MHT) and Bioidentical Hormone Therapy (BHT)

Menopausal Hormone Therapy (MHT)

MHT was previously known as hormone replacement therapy (HRT). It’s an FDA-approved treatment used to alleviate menopause symptoms, including hot flashes, night sweats, vaginal dryness and bone loss. It contains estrogen and/or progesterone, depending on whether you still have your uterus.

Bioidentical Hormone Therapy (BHT)

BHT uses hormones that come from plants, while traditional MHT is generally made from synthetic materials or animal products. While bioidenticals are often marketed as “natural,” they are still chemically processed in order to be effective as a medication for humans. Some forms of BHT are FDA-approved, while others—and any compounded BHT medications—are not.

According to the North American Menopause Society, MHT and BHT should be prescribed at the lowest dose and for the shortest period of time it remains effective—five years or less for women up to age 59 or within 10 years of reaching menopause.

The risks increase the further out you get from menopause and with advancing age.

Check out the Expert Guide to Menopausal Hormone Therapy program to learn more about whether you are a good candidate for MHT.

3. Non-Hormonal Medications

The FDA-approved non-hormonal medications to manage hot flashes:

Fezolinetant (brand name Veozah). This is the newest FDA-approved non-hormonal medication to treat hot flashes. It’s a once a day oral medication that has been shown to reduce frequency and severity of hot flashes. Fezolinetant is not appropriate for those with kidney or liver disease. Users are advised to undergo regular liver function testing while taking the medication.
Paroxetine (brand name Brisdelle). A selective serotonin reuptake inhibitor (SSRI) also used to treat depression

Often prescribed but not FDA-approved to manage hot flashes:

Gabapentin (brand name Neurontin). A drug for chronic nerve pain
Clonidine (brand name Catapres). A blood pressure drug

4. Herbal Remedies

The consensus among the medical community is that more research is needed to determine the safety and effectiveness of herbal treatments. However, many women still try various remedies in the hope that they will find relief from hot flashes and other menopause symptoms. If you decide to try an herbal remedy, make sure you talk to your provider about potential health risks and interactions with other medications you may be taking.

Black cohosh is the most widely studied of the herbal remedies. While some women report that it has helped them, research has shown mixed results. There is some concern that blue cohosh (not black cohosh) may be associated with liver damage. It is unclear whether blue cohosh actually causes liver damage. Black cohosh also interacts with many prescribed medications and should not be used at the same time as other herbs. According to the National Center for Complementary and Alternative Medicine, some commercial black cohosh products have been found to contain the wrong herb or to contain mixtures of black cohosh and other herbs that are not listed on the label.
Red clover has had no consistent or conclusive evidence in controlled studies that shows it can reduce hot flashes. As with black cohosh, some women claim that red clover has helped them. Studies report few side effects and no serious health problems with use. But studies in animals have raised concerns that red clover might have harmful effects on hormone-sensitive tissue.
Dong quai has been used in Traditional Chinese Medicine to treat gynecologic conditions for more than 1,200 years. Yet, only one randomized clinical study of dong quai has been conducted on its effect on hot flashes, and found that it was not useful in reducing them. The North American Menopause Society states that dong quai should never be used by women with fibroids or blood-clotting problems such as hemophilia or by women taking drugs that affect clotting such as warfarin (Coumadin) as bleeding complications can result.
Evening primrose oil is also said to relieve hot flashes. However, the only study to date found no benefit. Reported side effects include inflammation, problems with blood clotting and the immune system, nausea and diarrhea. It has been shown to induce seizures in patients diagnosed with schizophrenia who are taking antipsychotic medication. Evening primrose oil should not be used with anticoagulants or phenothiazines (a type of psychotherapeutic agent).
Phytoestrogens are estrogen-like substances found in some cereals, vegetables, legumes (like soy) and herbs. They have not been consistently shown to be effective in studies, and their long-term safety is unclear.
Valerian root contains phytoestrogens, and a small study found it to be effective in reducing the frequency and intensity of hot flashes. However, phytoestrogens are controversial, and researchers recommend additional research to confirm the safety and effectiveness of phytoestrogen-based herbal remedies. Valerian is also believed to help with sleep, but the evidence is inconsistent.
Licorice root was shown in a small study to relieve the frequency and intensity of hot flashes. In large amounts and with long-term use, licorice root can cause high blood pressure and low potassium levels, which could lead to heart and muscle problems. More research is needed to determine its effectiveness and safety for hot flashes.

Find The Right Solution For You

There are many options at your disposal to reduce the severity and intensity of hot flashes and night sweats.

Midday app has a range of science-backed solutions, including those we shared here. Your Midday coach can support you to get the most out of your chosen strategy. If you want to connect with a healthcare provider, she can also help you to ask the right questions and navigate the healthcare system to get the care you need.

Talk to your healthcare provider about the options we’ve outlined. If your provider doesn’t seem knowledgeable or doesn’t take the time to explain these options, search the North American Menopause Society’s database for a certified menopause practitioner in your area.

You deserve to have a healthcare provider that understands this complex and challenging period in your life and can support you to feel your best every day.