The advice below is general advice. For any specific or tailored advice relevant to your health conditions, please talk to your health professional.
Have you been waking in the night feeling hot, then suddenly chilled to the bone, or experiencing flushing to your face or body after your usual glass of wine? You may be experiencing hot flushes — a common symptom of menopause.
Hot flushes and night sweats are a well-known marker of menopause, occurring in both peri- and post-menopause. They affect approximately 75% of women, with around 25% experiencing severe symptoms. These vasomotor symptoms are a major contributor to disturbed sleep during menopause and can negatively impact quality of life, relationships, careers, and wellbeing.
Symptoms may resolve within 2–5 years, but the average duration is closer to 7 years. Emerging research also suggests hot flushes may be a marker of cardiovascular disease, with earlier onset and increased severity linked to greater metabolic risk.
What Do They Feel Like?
A hot flush is a sensation of intense heat, commonly felt across the upper chest, face, and body. You may start to sweat, your skin may flush or become blotchy, and your heart rate may increase. Some people experience anxiety, dizziness, or heart palpitations.
After the heat passes, you may suddenly feel cold or chilled. Night sweats are hot flushes that occur at night and are often accompanied by heavy sweating, disrupted sleep, and the need to change bedding or clothing.
Everyone experiences vasomotor symptoms differently. For some, they are mild and barely noticeable; for others, they are intense and disruptive. They may occur daily or only occasionally.
Why Do They Happen?
Hot flushes occur due to declining oestrogen levels. Oestrogen receptors exist throughout the body, including the brain’s temperature regulation centre. As oestrogen declines, the thermoneutral zone narrows, making the body more sensitive to small temperature changes.
This triggers blood vessels to dilate in an effort to cool the body, sending more blood to the skin’s surface and creating the sensation of intense heat.
What to Do About Hot Flushes
There are several ways to manage hot flushes and night sweats. The most appropriate approach depends on how much they impact your daily life.
Lifestyle Modifications
Making lifestyle and behavioural changes can improve wellbeing and help you manage symptoms more effectively.
Keep Your Environment Cool
- Wear adjustable natural fibres: Dress in light layers using breathable fabrics such as cotton or merino wool.
- Use fans: Hand-held or electric fans can provide immediate relief.
- Cool your bedroom: Open windows, lower heating, shower before bed, use lighter bedding, flip pillows, and keep iced water nearby.
Avoid Common Triggers
Identifying and avoiding triggers may reduce the frequency and severity of hot flushes. Keeping a symptom diary can be helpful. Common triggers include:
- Spicy foods
- Hot drinks before bed
- Alcohol
- Caffeine
- Smoking
- Stress
Maintain a Healthy Weight
Weight gain has been linked to increased severity of hot flushes, while weight loss may reduce frequency. Sustainable approaches to weight management can be found in our related articles:
Exercise Regularly
Exercise alone does not reduce hot flushes, but it supports overall wellbeing, including weight maintenance, sleep, mental health, bone density, and cardiovascular health. If you’re not currently exercising, now may be a good time to begin.
Medication Options
Hormonal Treatment
- Hormone Replacement Therapy (HRT/MHT): The most effective treatment for hot flushes and night sweats. If symptoms are affecting your quality of life, discuss this option with your GP.
Non-Hormonal Treatment
- Some medications originally prescribed for other conditions, such as antidepressants or nerve blockers, may help manage hot flushes.
- Options available in New Zealand include gabapentin, SSRIs, and venlafaxine.
Natural Remedies
Herbal and botanical therapies are not subject to the same testing standards as medications and should be approached cautiously. Always consult your GP before using supplements.
- Black cohosh: Insufficient evidence to support effectiveness.
- Isoflavones: Mixed evidence, with no proven long-term benefit.
- Evening primrose oil: No evidence supporting effectiveness.
Further information is available from the Australasian Menopause Society and reputable menopause resources.
Mind and Body-Based Therapies
- Cognitive Behaviour Therapy (CBT): Evidence supports its role in reducing hot flush impact and improving sleep and wellbeing.
- Yoga: May assist with stress management, which can be a trigger.
- Paced breathing: Can help manage anxiety associated with hot flushes.
Hot flushes and night sweats are common during menopause and can significantly impact quality of life. Understanding triggers and taking a proactive, informed approach can help you manage symptoms effectively.
P.S. A hot flush and a hot flash are the same thing — “hot flash” is commonly used in the US, while “hot flush” is used in NZ, the UK, and elsewhere.
References
- Australasian Menopause Society (2020). What is menopause?
- Ryu, K. J. et al. (2020). Journal of Menopausal Medicine, 26(3), 147–153.
- Australasian Menopause Society (2018). Lifestyle and behavioural modifications for menopausal symptoms.
- Australasian Menopause Society (2024). Non-hormonal treatments for menopause.
