MAB ReviewedSweating the Not-So-Small Stuff: How Menopausal Night Sweats Affect Your Days
Night sweats can turn sleep into a struggle, but you don’t have to suffer through them. With the right treatment and simple lifestyle shifts, relief is possible. Tracking your symptoms helps you and your provider find what works best for you.
Written by Caitlyn Tivy, DPT, OCS
Reviewed by Dr. Ariel Haddad
Founder, Helia Health
Understanding menopause-related night sweats
If you’ve ever woken up drenched in sweat with the need to change your pajamas or bed sheets, you know the feeling. While not all episodes of sweating at night are caused by perimenopause, night sweats are a common experience among those in the menopause transition.
Are night sweats and hot flashes the same thing?
Medically speaking, night sweats and hot flashes fall in the same category of “vasomotor symptoms." Researchers think they are triggered by similar bodily processes. Depending on who you ask, they are either different manifestations of the same phenomenon or two distinct symptoms.
Current opinion at the Menopause Society falls in the second camp. According to a :
Hot flashes can occur in the daytime or at night. They feature the sensation of increased warmth, but may or may not involve sweating.
Night sweats, as the name implies, occur at night and involve intense sweating.
Most research groups hot flashes and night sweats together. However, some menopausal people only experience night sweats or hot flashes, but not both.
Let’s be clear: vasomotor symptoms are driven by real bodily changes. Your skin gets measurably warmer, and your body’s thermoneutral zone—the range of temperatures at which you’re comfortable—narrows (;). However, your personal experience of a hot flash or night sweat is unique, and it may be different from your friends’ or family members’.
How long do night sweats last?
The Study of Women’s Health Across the Nation (SWAN) was a groundbreaking study of female health during the menopause transition. SWAN data from over 3,300 perimenopausal women with diverse racial and ethnic backgrounds found that the average person experienced hot flashes and night sweats for over 7 years .
Other studies have identified a small percentage—about 14%—who experience these symptoms for over a decade . The duration and intensity of night sweats can vary by race/ethnicity.
Asian-American women, for example, tend to have VMS for a shorter time (about 5.5 years) than White women. In contrast, African-American women may experience night sweats and hot flashes for longer than either of the former .
What causes night sweats during menopause?
Although night sweats and hot flashes may be different symptoms, researchers think that similar bodily processes drive them both. A complex interplay between hormones—particularly estrogens—and other chemicals drives menopausal night sweats.
It’s more complicated than just decreased estrogen in perimenopause. A 2020 study found that rapid swings in a specific estrogen called estradiol—the form of estrogen released during ovulation—trigger these unpleasant sweat symptoms. When estradiol levels in the brain suddenly drop due to perimenopausal fluctuations, this triggers a cascade of other chemical responses .
This is why people in very early perimenopause can experience night sweats even when their periods are still regular and their average estrogen levels haven’t dropped . In response to a drop in estradiol, the concentrations of a bunch of inflammatory chemicals increase. The neurotransmitter norepinephrine also ticks up, and in doing so, it disrupts the hypothalamus, your brain’s temperature regulation center .
The result of all these changes: a narrowed thermoneutral zone. When this zone of comfort narrows, even slight changes in core temperature can trigger your body to sweat excessively in an effort to cool down. Voilá, here come the night sweats!
Can stress make night sweats worse?
Unfortunately, yep. After all, what doesn’t get worse when you’re under stress?
While stress isn’t the primary cause of night sweats, it can certainly intensify them. Stress activates the autonomic nerves that regulate body temperature and other automatic processes. By influencing the “fight-or-flight” side of your nervous system, stress dials up the volume on all your body’s autonomic functions, including sweating.
Ready for a sneaky little twist?
Your initial experiences of hot flashes and night sweats cause your body to release stress-related chemicals. These chemicals can trigger other problems such as anxiety, depression, and poor sleep . Over time, these problems can create a vicious cycle of even more stress, which in turn worsens your night sweat symptoms .
Other chemicals are common triggers of night sweats, too. For example, nicotine from tobacco products or vaping stimulates your sympathetic nervous system—that’s the part responsible for your fight or flight response. This may explain why smokers are 60% more likely to experience night sweats and hot flashes than non-smokers .
Do night sweats increase the risk for other health problems?
Night sweats have been correlated with markers for other health conditions, including:
Elevated levels of stress hormones such as cortisol
Higher risk of type 2 diabetes, especially for those who experience night sweats alone or in addition to hot flashes .
Depression .
Importantly, these correlations don’t necessarily equal causation. While there’s a relationship between night sweats and some of these symptoms, it’s not clear if night sweats cause those symptoms (or vice versa).
Depression is a great example: menopausal people who experience vasomotor symptoms are also more likely to experience depressive episodes. However, hot flashes and night sweats alone aren’t responsible for all the depression symptoms .
What are the treatment options for menopausal night sweats?
If you find that menopause-related night sweats are messing with your sleep and your sanity, you don’t have to just “tough it out." Let’s consider some of your options.
Menopausal hormone therapy
Menopausal hormone therapy (MHT) is an effective way to treat hot flashes and night sweats in those who are candidates for it . MHT can significantly reduce vasomotor symptoms by up to 90% in some cases . Talk with your healthcare provider to determine if you’re a good candidate.
Research released in the early 2000s seemed to suggest that MHT could increase the risk of heart disease. However, later reassessment of these data revealed that this risk was limited to specific groups, such as women over 60.
For those who begin MHT early in the menopause transition–within 3 to 6 years of their last period–MHT may even protect against heart disease .
Some people have other medical conditions that make them poor candidates for MHT. For example, those with a history of breast cancer.
Other medications
For those who can’t or don’t want to take hormones, several non-hormonal medications may help. These include :
Gabapentin
Fezolinetant
SSRIs and SNRIs
Oxybutynin, a medication often used for bladder issues
All of these may reduce the frequency or severity of hot flashes and night sweats. However, they can come with side effects, so it’s important to weigh the pros and cons with your provider.
What are the non-medication treatment options for night sweats?
For some people, any type of pharmaceutical isn’t an option for managing night sweats. Fortunately, non-medication options can help, too.
Cognitive-behavioral therapy (CBT)
The Menopause Society recommends CBT as a tool for managing night sweats and hot flashes . CBT can help you learn relaxation strategies, breathing exercises, and other techniques that reduce how much these symptoms interfere with your daily life .
Small habit shifts
Small lifestyle and habit shifts can also make a difference when it comes to sleep disruption from night sweats. Here are some simple sleep hygiene strategies to help you keep your cool :
Keep your bedroom cool with air conditioning or fans.
Use breathable bedding and wear loose-fitting clothes to bed.
Avoid heavy meals, alcohol, and caffeine before bedtime.
Research hasn’t been able to prove that regular exercise can reduce the severity of night sweats . However, it can help indirectly by addressing other contributors to night sweats, such as stress levels and body weight .
How can tracking night sweats help you manage them?
You might be surprised by how frequently you’re having night sweats. Research using motion detection shows that women don’t consciously register every single nighttime hot flash that disturbs their sleep .
By measuring your body temperature automatically via your smartwatch, Amissa can help you establish a baseline for how often you experience night sweats.
As you institute simple changes in your routines or start new medications, you can monitor their effects on your night sweats. Data is knowledge, and knowledge gives you the power to decide what’s working for you and what isn’t.
Questions to ask your provider
So you’ve got all this data from your tracking—now what? Here’s how to take this data to your healthcare provider to start the discussion:
I’ve noticed that the nights I sleep the worst are also the ones in which I have the most night sweats. Do you have suggestions for how I can address these night sweats to see if they help with my sleep?
I’ve been tracking my sleep since making [XX change], and I haven’t yet seen a big change in my night sweats. Are there any other treatment options we can consider?
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.
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