MAB ReviewedLosing Your Cool: Understanding and Managing Hot Flashes in Perimenopause
Hot flashes—sudden waves of heat and sweating—are among the most common and disruptive perimenopause symptoms. They can strike anytime, often disturbing sleep and daily life. While driven by hormonal shifts, you don’t have to just live with them. From hormone therapy and non-hormonal medications to mind-body approaches, effective treatments exist. Tracking symptoms can also reveal triggers and support lasting relief.
Written by Caitlyn Tivy, DPT, OCS
Reviewed by Dr. Ariel Haddad
Founder, Helia Health
It’s time to talk about everyone’s favorite symptom of perimenopause: the hot flash.
If you’ve ever felt a sudden uptick in your body temperature that made you want to rip your clothes off in public, you’ve probably had a hot flash.
Hot flashes are one of the most common and frustrating menopause symptoms. They can happen during the day, at night, or both. For some people, they’re a minor inconvenience. For others, they interfere with quality of life, sleep, and daily comfort.
Let’s discuss what we know about what hot flashes are, how they feel, and what will help with hot flashes—whether they’re mild or severe.
How do hot flashes and night sweats differ?
Hot flashes and night sweats are both vasomotor symptoms: they’re related to the constriction and relaxation of blood vessels. The tiny muscles that surround your blood vessels are under the control of your autonomic nervous system: this means that they’re outside your conscious control .
Depending on who you ask, night sweats are just a bed-bound manifestation of daytime hot flashes. The Menopause Society, however, begs to differ. Each symptom has unique characteristics and impacts well-being differently .
People who experience hot flashes often describe them as sensations of intense heat or warmth that start in the upper body and spread from there .
Hot flashes can affect the whole body or just a portion, and they can last from a few seconds to an hour. A whole hour of overheating may sound daunting, but don’t worry: the average length of a hot flash is closer to 3-4 minutes .
Unlike night sweats, hot flashes aren’t defined by the presence of sweat. Although sweating often accompanies hot flashes, it doesn’t have to . Hot flashes aren’t restricted to time of day, either: they can occur day or night .
For more details on the differences, check out our breakdown of night sweats here.
What causes hot flashes?
While hot flashes and night sweats are probably unique symptoms, they appear to share similar causes and triggers. Let’s consider the possible contributors.
Hormonal triggers
Much like night sweats, hot flashes happen in response to hormonal changes.
During perimenopause, your estrogen levels begin to fluctuate–a lot. Sudden drops in estrogens—particularly estradiol, the estrogen produced when you ovulate—alternate with upticks. These “swings” in estrogen levels trigger chemical cascades that disrupt your body’s internal thermostat .
As a result, your body may perceive normal temperatures as too warm and react by widening blood vessels in your skin. This widening increases blood flow to your skin so excess body heat can dissipate into the air around you . The increase in blood flow is why some people with light skin appear reddened and flushed during a hot flash.
The nervous system
The autonomic nervous system responds to other hormones beyond estrogen. People who experience hot flashes may have higher baseline levels of stress-related hormones, such as cortisol and norepinephrine . These differences may help explain why some people get hot flashes and others don’t.
Your nervous system operates in feedback loops, and these loops can also trigger hot flashes. Your initial experiences of hot flashes can be physically and emotionally stressful, pushing your body into a stress response. Your nervous system responds by increasing its output of stress chemicals, thereby triggering additional hot flashes .
Other contributors
Other factors can trigger hot flashes or make them worse. Smoking is a common culprit; for example, nicotine stimulates the fight-or-flight part of your nervous system that also controls vasomotor symptoms .
Some people find that daily events like hot showers, spicy foods, caffeine intake, or even strong emotions can trigger hot flashes. These effects are quite subjective, so they’re hard to study and “prove," but that doesn’t mean they aren’t real experiences!
Keeping your cool: how to manage hot flashes
It may not be possible for every perimenopausal person to completely prevent hot flashes. Fortunately, there are many ways to effectively manage them. Medications, therapies, and simple habit changes can reduce how often hot flashes occur or how intense they feel.
Menopausal hormone therapy (MHT)
Also known as hormone replacement therapy, MHT is an effective treatment for hot flashes . When we say effective, we mean it: for the right person, MHT can ease hot flashes and night sweats by up to 90% .
However, hormonal medications aren’t right for everyone. People with a previous history or current diagnosis of certain medical conditions might not be good candidates for MHT .
Talk with your healthcare provider about the risks and benefits based on your medical history.
Non-hormonal medications
For folks who can’t or prefer not to use hormone therapy, there are other medications that can help reduce hot flashes. These include :
Selective serotonin reuptake inhibitors (SSRIs): perhaps best known as antidepressants, SSRIs also have many off-label uses, including reducing vasomotor symptoms.
Gabapentin: a nerve pain and anti-seizure medication which may help widen the temperature zone that feels neutral for you.
Oxybutynin: a specialized medication for overactive bladder that can also reduce the frequency and intensity of hot flashes and night sweats.
Providers typically prescribe these medicines “off-label”: the Food and Drug Administration (FDA) has approved them for other uses, but doctors have found them to be effective for treating hot flashes.
Mind-body techniques
Research into cognitive-behavioral therapy (CBT) and clinical hypnosis has identified potential roles for these techniques in treating hot flashes.
CBT helps you learn relaxation techniques, breathing exercises, and other coping mechanisms you can turn to when you feel a hot flash coming . Two randomized controlled trials from the early 2010s showed that CBT can significantly reduce the severity of hot flashes .
Clinical hypnosis uses suggestion and mental imagery to help you settle into a deeply relaxed state . As the name implies, trained, licensed clinicians provide clinical hypnosis.
Another randomized controlled trial from 2013 found that hypnotherapy reduced both the frequency and severity of hot flashes, and it did so significantly more than a control treatment .
In addition to improving how participants perceived their hot flashes, hypnosis treatment measurably decreased their skin temperature during a flash. It changed their mental and physical responses during hot flashes !
Mind-body techniques can be helpful tools to manage hot flashes, but please understand: this isn’t meant to imply you can “think your way through” these symptoms. They aren’t “all in your head” or “just anxiety."
Vasomotor symptoms are very real, unpleasant, and disruptive parts of perimenopause. You deserve effective treatment that works for you, your medical history, and your life.
Natural remedies
Herbal remedies may offer some relief for mild hot flashes, but more research is needed to understand how well they work and whether they’re safe. In 2023, the Menopause Society released a position statement on dietary and herbal supplements, advising against their use to treat hot flashes. This advice was based on two key points:
No research has found any supplement that works better than a placebo for reducing hot flashes.
While some supplements may not do much of anything for your symptoms, others can be downright dangerous.
Certain herbs and supplements may have estrogen-like effects and could potentially interfere with other medications or cause side effects such as liver injury .
Always check with your doctor before trying any supplement. Remember: just because the package says “natural," it doesn’t automatically mean safe!
How tracking helps you get treatment
Tracking vasomotor symptoms can help you identify patterns and triggers for your hot flashes. You may find that hot flashes are more likely to happen during stressful situations, for example, or at specific times of day.
Many perimenopausal people don’t realize how many night sweats they actually experience: the number is often even higher than you realize ! Wearable tracking devices can help you quantify these symptoms and present an accurate picture to your provider.
Tracking with Amissa can also help you identify if symptoms are changing over time. If you’re trying a new medication or other treatment for hot flashes, tracking helps you and your provider see what’s helping (and what isn’t).
Questions to ask your provider
Hot flashes are a common feature of the menopause experience, but that doesn’t mean you have to just “suck it up” and suffer through them. Here are some questions to get the treatment discussion started with your healthcare provider:
My hot flashes are [getting worse/interfering with my daily life/making it hard to work]. Do you have suggestions for treatments I could try to manage hot flashes?
Would menopausal hormone therapy be safe for me? Are there non-hormonal medications that could help?
DISCLAIMER
This article is intended for educational purposes only, using publicly available information. It is not medical advice, and it should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.
Want support through the transition?
Sign up for early access to Amissa and stay informed as we grow.