Feeling Flushed: Understanding and Managing Hot Flushes

Written by: Victoria Biddick

• NZ Associate Registered Nutritionist (ARNutr)
• BAppSc (Human Nutrition), BAppSc (Food Science)

The advice below is general advice, for any specific tailored advice relevant to any health conditions please talk to your health professional.

Have you been waking up in the night hot, then suddenly feeling chilled to the bone, or experiencing sudden flushing to your face or body after drinking your normal glass of wine? You may be experiencing a hot flush, a symptom of menopause.

Hot flushes and night sweats are a well-known marker of menopause, occurring in both the peri- and post-menopause phases. They affect approximately 75% of women, with 25% being severely affected (1). Also described as vasomotor symptoms, hot flushes and night sweats are a major contributing factor to disturbed sleep during menopause, negatively affecting quality of life, relationships, careers, and well-being. Symptoms may resolve in 2–5 years, but the average duration is 7 years. Recent research also indicates it may be a marker of cardiovascular disease, with greater severity and earlier onset of vasomotor symptoms indicating greater risk for metabolic diseases (2).

What do they feel like?

A hot flush is a sensation of extreme heat. It can be felt on your upper chest, face, and other parts of your body (1). You may start to sweat, and your skin may get flushed or blotchy. Your heart rate may increase. Some individuals feel anxious and/or experience dizziness and heart palpitations. After feeling hot, you may suddenly feel cold or chilled.

Night sweats are hot flushes that happen in the evening and are often accompanied by intense sweating, disrupting sleep and requiring a change of sleepwear and bedding. They can last anywhere between 1 to 5 minutes.

Everyone will experience vasomotor changes uniquely. For some individuals, they can be very mild and barely noticed; for others, so intense that they impact daily life and activities. They can happen daily or occasionally (1).

Why do they happen?

You guessed it, it’s due to declining oestrogen levels. Oestrogen receptors are present throughout our body, and in this case, the thermoregulation area in the brain is affected (1). This makes the body more sensitive to small temperature changes by decreasing the thermoneutral zone. As a result, you experience a sensation of extreme heat, prompting your body to cool itself off. To achieve this, your blood vessels dilate, sending more blood to the surface of your skin to dissipate the heat (1).

What to do about Hot Flushes

There are a variety of ways to deal with hot flushes and night sweats. What options you select will depend on the impact they have on your daily life (3).

Lifestyle Modifications

Making some lifestyle and behavioural changes can improve your well-being and help you cope with symptoms.

Keep your Environment Cool by:

• Wearing adjustable natural fibre clothing: Dress in thin layers so you can easily remove a layer if needed. Opt for cardigans instead of jerseys, sleeveless blouses or tops, and clothing made of breathable natural fibres like cotton or merino wool.
• Using a hand fan or electric fan as required.
• Keeping your bedroom cool: Lower your room temperature at night by opening a window or turning down the heating thermostat. During summer, take a cool shower just before bed to cool your body. If you share a bed, use two single duvets so you can choose a lighter option. Flip your pillow to the cool side if it feels warm. Keep some iced water by your bed for a quick cooling drink.

Avoid Triggers of Hot Flushes

Identifying and avoiding triggers can help manage hot flushes. Keeping a diary of when your hot flushes occur can be useful in pinpointing these triggers. Some common triggers include:

• Spicy foods
• Hot drinks before bed
• Alcohol
• Caffeine
• Smoking
• Stress

By recognising and avoiding these triggers, you may be able to reduce the frequency and intensity of your hot flushes.

Maintain a Healthy Weight

There is evidence that weight gain can increase the severity of hot flushes, and weight loss can reduce their frequency (1). For tips on how to do this in a sustainable way, see our other articles on:

• Nourishing your body
• Smart swaps
• Finding balance

Exercise Regularly

While exercise alone doesn’t reduce hot flushes, it has many other benefits that improve our overall well-being. Exercise helps with weight maintenance, cognitive functioning, depression, sleep, bone density, and reducing the risk of cardiovascular disease (3). If you’re not moving regularly, now could be a great time to get started. For ideas on the best exercise for perimenopause, check out our webinar Embrace the Change.

Medication

Hormonal Treatment

• Hormone Replacement Therapy (HRT): The most effective treatment for hot flushes, night sweats, and other symptoms of menopause (1). If you are not on HRT and experiencing night sweats and other symptoms of menopause, it could be a good time to discuss this option with your GP.

Non-Hormonal Treatment

• If you are not on HRT and looking for a non-hormonal treatment that will help you with hot flushes, there are other medications that help you. These are other medicines who have another primary purpose (not menopause) such as antidepressants and nerve blockers. If you are not bothered by any other symptoms of menopause then talk to your GP to see if these may be suitable for you.
• Some medications available within New Zealand include Gaba (Nerve blocker), SSRI and Venlafaxine antidepressants. 

Natural Remedies

Herbal and botanical therapies are not subject to the same testing regime as other medications (4) and use of these should be approached with caution especially if you have any existing medical conditions and are on medication. We highly recommend talking with your GP before taking any herbal remedies or supplements.

• Black Cohosh: Systematic reviews indicate there is currently insufficient evidence to support the use of black cohosh for hot flushes. However, the effect of black cohosh on other outcomes, such as health-related quality of life, sexuality, bone health, night sweats and cost-effectiveness are not yet established.
• Isoflavones: A wide range of products containing plant or phytoestrogens, including soy products and red clover, are available as over the counter remedies for hot flushes. There have been varied outcomes in some short-term studies suggesting that there may be some benefit in using these products early in menopause, but there is a lack of long term studies. The available evidence suggests that isoflavones do not relieve long term menopausal vasomotor symptoms any better than placebo.
• Evening Primrose Oil: No evidence to support this supplement is effective for hot flushes (4).
• If you are interested in reading more about natural and alternative options please read the fact sheet provided by the Australasian Menopause Society here.
• Nikki Bezzant’s book, This Changes Everything, investigates alternative therapies and is good resource for anything menopause.
• If you're interested in exploring natural options further, it's recommended to consult a qualified medical naturopath or herbalist. When selecting a natural practitioner, look for membership in a governing body such as MNZAMH and qualifications like an NZQA diploma in naturopathy or medical herbalism.

Mind and Body-Based Therapies

Some different therapies that can be beneficial in the management of hot flushes include:

• Cognitive Behaviour Therapy: Evidence supports this being effective at reducing hot flushes and improving sleep and wellbeing (3). You can access this treatment through psychologists and CBT therapists. Find out more about this treatment here.   Yoga: While evidence on yoga reducing hot flushes is mixed, yoga can assist with stress management which can be a trigger for vasomotor symptoms.

• Yoga: While evidence on yoga reducing hot flushes is mixed, yoga can assist with stress management which can be a trigger for vasomotor symptoms.

• Paced Breathing: Can help with anxiety that can accompany hot flushes but does not reduce severity of hot flushes (3).

Hot flushes and night sweats are common symptoms of menopause that can significantly impact our quality of life. Understanding the triggers and implementing lifestyle modifications can help to manage these symptoms. Exploring medication options, both hormonal and non-hormonal, and mind-body therapies, can provide relief. By taking a proactive approach, you can better manage hot flushes and improve your overall well-being during menopause. Remember, you don't have to navigate this journey alone, reach out for support and take control of your health and well-being.

P.S. A hot flush and a hot flash are the same thing! In the US, the term "hot flash" is used, while in the NZ,UK and the rest of the world, it's called a "hot flush."

References

1. Australasian Menopause Society (2020). What is menopause?
2. Ryu, K. J., et al. (2020). Vasomotor Symptoms: More Than Temporary Menopausal Symptoms. Journal of Menopausal Medicine, 26(3), 147–153.
3. Australasian Menopause Society (2018). Lifestyle and behavioural modifications for menopausal symptoms.
4. Australasian Menopause Society (2024). Non-hormonal treatments for menopause.