What you really need to know about menopause hot flushes

Menopause and hot flushes are virtually synonymous for a good reason: They’re incredibly common during this phase of life, with up to 80% of women experiencing them in some way during the menopausal transition — whether that’s feeling a little warm during a work meeting or having to change into a fresh blouse in the middle of the day

That might sound discouraging, but the good news: There are options to manage them.

Hot flushes are sudden bursts of heat, typically from the chest up, caused by hormonal shifts that disrupt the body’s temperature regulation. They can vary wildly — some feel mild warmth, while others break into a sweat.

One survey found that among women who experienced hot flushes, about one-third had them just a few days per month, while nearly a quarter experienced them daily. Duration varies but often lasts one to two minutes.

Hot flushes don’t just feel hot— they may come with facial flushing, sweating, chills, and even anxiety.

“Some people feel like they’re having a panic attack — so, heart racing is also one that I hear about,” says Dr. Camille Moreno, D.O., medical director of the Midlife Women’s Health and Menopausal Medicine program at the University of Utah.

When hot flushes happen at night, they’re called night sweats: “[They’re] the physical symptom of waking up drenched in sweat,” says Moreno. As a result, women may need to change clothes or sheets in the middle of the night.

Hot flushes often begin in perimenopause, the transitional phase before menopause. This can start in the late 40s, but there’s no fixed age.

“There’s no way of knowing you’re having a true menopause hot flush unless your healthcare provider can pair it with other symptoms, like an irregular period or brain fog,” says Dr. Sally MacPhedran, M.D., director of the Midlife Women’s Centre at University Hospitals Cleveland Medical Centre.

The precise mechanism is still debated, but most experts agree it involves the hypothalamus, the brain’s thermostat. During perimenopause, estrogen levels drop, narrowing your thermoregulatory zone.

“Once women start losing estrogen, this thermoregulatory zone narrows, so our threshold basically decreases,” says Moreno. That means even a small rise in body temperature can trigger a hot flush or night sweat.

Some triggers are temperature-related; others are internal. These include:

• Alcohol

• Caffeine

• Hot drinks

• Spicy food

• Stress

• Sleep deprivation

• Smoking

“When there's inflammation going on, you can really experience a cluster of symptoms, which can throw off the homeostasis in the body,” says Moreno.

There’s no one-size-fits-all solution, but treatments options fall into a few key categories:

Commonly known as hormone replacement therapy (HRT), this is considered the gold standard. “It can be the most effective treatment option for hot flushes and night sweats,” says Moreno. It works up to 80% of the time by restoring estrogen and stabilising body temperature.

MHT may also help with other menopause symptoms, like sleep issues and low libido, notes MacPhedran. Your doctor will be able to help you figure out if MHT is the right option for you.

Veozah (fezolinetant), launched in 2023, is the first non-hormonal, non-antidepressant treatment for hot flushes — and about 70% effective, Moreno says.

Otherwise, “we rely on SSRI and SNRIs, which are used for depression and anxiety — but also used off-label for hot flushes and night sweats,” says Moreno. Depending on the antidepressant, it can be effective anywhere between 40-70% of the time. (At this time, only one SSRI, Brisdelle, is approved by the FDA for hot flushes).

“These medications affect the serotonin receptors in the brain, which also help regulate the temperature control that’s found in the hypothalamus,” Moreno explains.

Moreno calls these “foundational interventions,” a.k.a. those that you have control over regardless of prescription medications. Beyond avoiding your triggers, a healthy diet can help — namely, the Mediterranean diet, says MacPhedran, which is linked with less hot flushes and night sweats. The reason isn't entirely clear, but it might be the diet’s impact on inflammation and blood sugar, she says. A series of studies have also found cognitive behavioural therapy to be beneficial, too — particularly for people whose hot flushes are triggered by stress.

OTC supplements or medications that promise to nix your hot flushes for good — such as black cohosh — generally don’t work. “Most of my patients have waited to come to see me, and they've told me that they've tried all of these over-the-counter supplements and they're still pretty miserable,” says Moreno.

If hot flushes are disrupting your life, talk to your doctor — even if they seem “mild.”

“It doesn't matter if it's mild or severe — that’s a perception,” says MacPhedran. Given that hot flushes can last an average of 7.5 years and are linked to increased health risks (such as cardiovascular disease) early intervention matters.

If your concerns aren’t being addressed, Moreno recommends seeking out a specialist.
Learn more about menopause treatments

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