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.
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. Be sure to check out Midday’s library of mindfulness and other mind-body resources linked below and under Wellness in the Discover section.
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.
Midday can also fill in the gaps with resources to show you how to optimize your lifestyle habits during menopause.
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.
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.
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.