What are hot flashes?
Characteristics of a night sweat or hot flash:
- Sensations of heat, usually in the upper body
- Ranges from heating up to full-on sweating
- Lasts between one and five minutes
- Chills may follow
- Can be accompanied by an increase in heart rate of 8-16 beats per minute
- Can be accompanied by nausea or a sense of dread
What are your “heat ups” like?
Like many other parts of perimenopause, each of our experiences with night sweats and hot flashes is unique.
Take a short survey and share what’s been true for you.
Sometimes I’ll have a hot flash or night sweat that literally takes my breath away and the sensation in my brain is that of hot, roaring white noise. It takes several minutes to recover. I am left drained, disoriented, and feeling like many brain cells have been destroyed.WLB Community Member
4 things to know about hot flashes
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60% to 80% of women experience hot flashes or night sweats at some point on the path to menopause. African American women report the longest total duration of VMS (median, 10.1 years).
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Some women report night sweats and hot flashes while they are still getting a monthly period before very noticeable menstrual cycle changes. Usually, periods have begun to get closer together, and there are subtle changes to the number of days of menstrual bleeding or the amount of bleeding.
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Estrogen is the first-line treatment for bothersome hot flashes, but there are also non-hormonal options for those who cannot or do not want to use hormonal products.
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Women’s experience of hot flashes varies — for some, it is a feeling of increasing warmth and for others they sweat, turn red, and experience a profound sense of dread sometimes with with a rapid heartbeat.
I also find that I am short of breath during this time and my heart races.WLB Community Member
WLB’s Nina shares her first experience with hot flashes — it was actually a nighttime occurrence — here.
These data are from the Women Living Better Survey. LRS stands for the late reproductive stage and MT for the Menopause Transition. These are two stages on the path to menopause (the final menstrual period).
Hot Flashes
Night Sweats
I have resorted to sleeping on bath towels. At least that way when I wake up drenched, I don’t have to change the sheets on the whole bed!WLB Community Member
Vasomotor Symptoms and Race/Ethnicity in Women with Monthly Periods (45-56 years)
Four Paths Of VMS
Source: SWAN (1,455 participants). A study examined the onset and frequency of VMS and found four trajectories:
|
Group
(% of participants)
|
Probability of VMS
(11 years before FMP)
|
Probability of VMS
(at FMP)
|
Probability of VMS
(11 years after FMP)
|
Peak VMS
(relative to FMP)
|
|---|---|---|---|---|
| Low Group (27%) | 10% | 25% | 5% | +1 year |
| Early Onset Group (18%) | 55% | 65% | 15% | at FMP |
| Late Onset Group (30%) | 10% | 65% | 30% | +3 years |
| High Group (25%) | 65% | 90% | 90% | +2 years, +14 years |
You can find these data graphed in this paper.
Remedies for hot flashes
*** For an overview of remedies, listen to our interview with Dr. Nanette Santoro about treatments for hot flashes and night sweats.
Hormonal Remedies
- Estrogen Therapy (ET) for those without a uterus
- Estrogen and Progesterone Therapy (EPT) for those with a uterus
Find an overview of specific product options for hormone therapy here.
Understand the differences between FDA-approved products and compounded products here.
Non-Hormonal Remedies
NK1/NK3 Inhibitors
There is a new type (“class”) of non-hormonal drug called NK1/NK3 inhibitors that were designed to reduce vasomotor symptoms. There are two products that are both once-a-day pills that act on the pathway in the brain that causes hot flashes and night sweats.
Fezolinetant (Veozah®) was approved by the FDA in 2023 for moderate to severe hot flashes.
Elinzanetant (Lynkuet®) was approved by the FDA in 2025 for moderate-severe hot flashes and sleep disturbance.
Similarities: Both agents target the KNDy pathway in the brain without hormones.
Differences: Veozah® has broader real-world data because it was approved earlier; Elinzanetant studied sleep and hot flashes in its trial. Liver function monitoring/testing through blood tests are required for both drugs but Veozah® requires more frequent testing.
Listen to our interview with Dr. Nanette Santoro about how these new drugs work — WLB Interview with Experts Series.
Other Non-Hormonal Remedies
The Menopause Society’s 2023 Non-Hormonal Position statement supported these as effective for VMS:
- Cognitive Behavioral Therapy (CBT)
- Clinical hypnosis
- SSRIs/SNRIs – Escitalopram (Lexapro), Venlafaxine (Effexor)
- Gabapentin
- Fezolinetant (Veozah) * Elinzanetant was not yet approved.
- Oxybutynin
- Weight loss
- Stellate ganglion bloc
- Paced respiration
- Supplements/herbal remedies
- Cooling techniques
- Avoiding triggers (e.g. caffeine, alcohol, spicy foods)
- Exercise
- Yoga
- MBI
- Relaxation
- Suvorexant
- Soy foods and soy extracts, soy metabolite equol
- Cannabinoids
- Acupuncture
- Calibration of neural oscillations
- Chiropractic interventions
- Clonidine
- Dietary modification and pregabalin
- Identify and avoid triggers
- wine, sugar
- stressful thoughts
- Dress in layers to be able to cool down quickly
- Keep a small fan handy
- Cooling techniques
- Cooling sleep pads
- Run hands under cold water
- Keep an ice pack under your pillow
- Paced breathing
- Acupuncture
Something to note: In trials of nonhormone treatments of VMS, the placebo effect is 20% to 66%. In addition, those with more anxiety show higher placebo response.
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A summary of research related to VMS from The Study of Women’s Health Across the Nation (SWAN), a multi-year, multi-ethnic study of midlife women.
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Menopause and MHT in 2024: addressing the key controversies
A White Paper from the International Menopause Society (IMS)
AN EXPERT PERSPECTIVE: DEBATING MENOPAUSAL HORMONE THERAPY
When women are struggling with the decision about whether to try menopausal hormone therapy (MHT) for vasomotor symptoms that are making them feel lousy — and especially if they have multiple symptoms attributable to reductions in estrogen — I suggest they try them for 3 months. This way they have a precise idea of their unique benefit. If they don’t feel better, that’s easy. If taking MHT really makes a difference for them, then we have a discussion of their personal risks and we have a better sense of the benefits specific to them. It makes for a much better conversation.
Nanette Santoro, MD
Professor and E. Stewart Taylor Chair
Divisions of Reproductive Endocrinology and Infertility & Reproductive Sciences
Department of Obstetrics and Gynecology
Potential hormonal causes
While the exact understanding is not known, the leading theory is that changes in estrogen levels cause a narrowing of the “thermoneutral zone” (the zone in which we feel comfortable, not sweaty or cold) in women with hot flashes.
Take note: Night sweats can also be caused by many other serious medical conditions (the Mayo Clinic has a good list) so be sure to mention the onset of night sweats to your doctor to determine the root cause.
- Higher FSH
- Lower Estradiol
- Adiposity (obesity)
- Smoking
- Negative mood
- Anxiety
- Low socioeconomic factors
- Adverse childhood events (ACEs)
REFERENCES
- Gold EB, Colvin A, Avis N, Bromberger J, Greendale GA, Powell L, Sternfeld B, Matthews K. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women’s health across the nation. Am J Public Health. 2006 Jul; 96(7): 1226-35.
- Hale GE, Hitchcock CL, Williams LA, Vigna YM, Prior JC. Cyclicity of breast tenderness and night-time vasomotor symptoms in mid-life women: information collected using the Daily Perimenopause Diary. Climacteric. 2003 Jun; 6(2):128-39.
- Tepper PG, Brooks MM, Randolph JF, et al. Characterizing the Trajectories of Vasomotor Symptoms Across the Menopausal Transition.Menopause (New York, NY). 2016; 23(10):1067-1074. doi:10.1097/GME.0000000000000676.
- Rossmanith WG, Ruebberdt W. What causes hot flushes? The neuroendocrine origin of vasomotor symptoms in the menopause.Gynecol Endocrinol. 2009 May; 25(5): 303-14.
- Sood, R. et al. Paced breathing compared with usual breathing for hot flashes. Menopause. 2013 Feb; 20(2):179-84.
- Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms.Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007244. doi: 10.1002/14651858.CD007244.pub2.
- Maclennan AH, Broadbent JL, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD002978.
- Randolph JF, Jr., Sowers M, Bondarenko I, et al. The relationship of longitudinal change in reproductive hormones and vasomotor symptoms during the menopausal transition. J Clin Endocrinol Metab. 2005;90(11):6106–6112
- Freeman EW, Grisso JA, Berlin J, et al. Symptom reports from a cohort of African American and white women in the late reproductive years. Menopause. 2001;8(1):33–42.
- Freeman EW, Sammel MD, Lin H, et al. The role of anxiety and hormonal changes in menopausal hot flashes. Menopause. 2005;12(3):258–266.
- vanDie MD, Teede HJ, Bone KM, Reece JE, Burger HG. Predictors of placebo response in a randomized, controlled trial of phytotherapy in menopause. Menopause 2009;16:792-796. doi: 10.1097/GME.0b013e318199d5e6
- Reed SD, Lampe JW, Qu C, Copeland WK, Gundersen G, Fuller S, Newton KM. Premenopausal vasomotor symptoms in an ethnically diverse population. Menopause. 2014 Feb;21(2):153-8. doi: 10.1097/GME.0b013e3182952228. PMID: 23760434.