Night Sweats and Hot Flushes in Menopause: Why They Happen and What Helps

Waking up during the night in soaked pyjamas, changing the sheets and then trying to function the next morning is exhausting. Then comes the sudden wave of heat halfway through the day, often at the most inconvenient times, like during an important meeting, leaving you anxious that everyone can see. It’s a common scenario for so many women transitioning through menopause.

With 86% of women aged 54-65  reporting hot flushes and 78% experiencing night sweats in the UK,* these are amongst the most common perimenopause and menopause symptoms. To some, they sound like a small inconvenience, but when they interrupt your sleep, concentration or confidence, they’re symptoms worth treating.

Understanding what’s happening to your body can help you make sense of symptoms that feel unpredictable. Here, we explain why hot flushes and night sweats happen, how long they last and what can help, including HRT, non-hormonal treatments and practical lifestyle adjustments you can make.

What Are Hot Flushes and Night Sweats?

Hot flushes and night sweats are vasomotor symptoms or episodes of intense heat, sweating, and chills, caused by changes in blood flow close to the surface of the skin.* They share the same underlying mechanism, but happen at different times of the day. A hot flush can happen at any time, but when it happens during sleep and causes sweating, it’s called a night sweat. 

A hot flush feels like a sudden wave of heat, often affecting your face, neck and chest, but you may also notice:

• Flushing or skin colour changes

• Sweating, ranging from slight dampness to a soaking episode

• A pounding or more noticeable heartbeat

• Anxiety or dizziness

• Chills once the heat has passed

Visible redness may be less noticeable on darker skin, even when the heat feels intense. Some hot flush episodes are mild, while others may require changing clothes. 

At night, you may wake up feeling hot and damp or find your nightwear and bedding soaked. The sweating may have passed by the time you wake, leaving you feeling cold instead. 

These symptoms can begin during perimenopause, the transition leading up to menopause, so you do not need to wait until your periods stop completely to experience them.

Why Do Hot Flushes and Night Sweats Happen?

Menopause is caused by your ovaries no longer producing as much oestrogen as they used to or releasing an egg each month. This change in your hormone levels affects your body’s temperature control centre, the hypothalamus. In effect, hot flushes and night sweats are an exaggerated response by your body to small changes in temperature. 

The role of oestrogen

Low oestrogen levels during menopause trigger sweating and widening blood vessels at the skin’s surface in an attempt to cool down, resulting in hot flushes and night sweats.* 

These changes can occur during perimenopause too, when hormone levels fluctuate, so it is possible to get hot flushes and night sweats before your periods stop. Their occurrence and severity can also differ from one month to the next. This variability can be frustrating as you may have several settled weeks and then find yourself repeatedly waking in the middle of the night to soaked bedclothes or flushing repeatedly during the day. 

Symptoms can also differ between women. Having fewer flushes does not mean someone is managing menopause better, and having severe symptoms does not mean you’re doing anything wrong. Hormonal changes are central to the development of hot flushes and night sweats, but there may also be certain triggers that cause them to happen. 

Common triggers

There are certain situations that can bring on a hot flush or make sweating more uncomfortable. Although triggers differ between people, some women can’t identify any. It may help to keep a symptoms diary to help you identify any patterns or potential triggers for your symptoms.

Common hot flush triggers include:

• Alcohol – acts as a vasodilator so widens blood vessels at the skin’s surface, which can trigger a feeling of heat and flushing

• Caffeine – raises your core body temperature and your metabolic rate which tricks your brain into thinking you are overheating, causing a hot flush or night sweat

• Spicy food or hot drinks – can provoke warmth and sweating. Chilli contains capsaicin, a chemical that binds to heat-sensing nerves and tells your brain that you are hot, so your body reacts by trying to cool itself down

• Stress – stress hormones activate the nervous system and raise your core body temperature. Some people find that stress-induced hot flushes are harder to settle 

• Warm rooms and heavy bedding – trapped heat and moisture can make you feel uncomfortable, making a hot flush or night sweat feel more intense or noticeable

• Smoking – chemicals in cigarettes disrupt your hormone levels, cause your blood vessels to narrow and stimulate the nervous system, triggering heat and sweating*

Don’t worry if you can’t identify a trigger, hot flushes and night sweats during menopause can also happen spontaneously without one.

How Long Do Menopause Hot Flushes and Night Sweats Last?

Hot flushes and night sweats can continue for several years, sometimes longer, lasting, on average, 7 to 10 years.* There’s no reliable way to predict your individual timeline. Some women may experience them for a short period, while others may have symptoms through perimenopause and well beyond their final period. 

Researchers have also found that some women are more likely to experience hot flushes and night sweats for longer than others. For example, women whose hot flushes started before their periods ended, experience them for an average of 9 to 10 years, while the average duration was 3.5 years in women who started getting hot flushes after their periods had stopped completely.** Other factors also influenced how long hot flushes lasted for, including:

• Smoking

• Being overweight

• Stress

• Depression and anxiety

• Ethnicity⁺

A hot flush itself can last anywhere between 30 seconds and 10 minutes, and can happen several times an hour, a few times a day, or a couple of times a week.ⱽ The prospect of years of symptoms can sound daunting, but there is help available. You can seek relief now rather than spending the next few years hoping that today or tonight will be better. 

The impact of night sweats and hot flushes on daily life

Repeated waking because of night sweats can have a knock-on effect. They can leave you feeling tired, irritable and less able to concentrate the next day. Night sweats may also affect your relationship, especially if they are waking your partner up too. Daytime flushes can interrupt work, social plans or ordinary conversations. The impact depends on more than how many episodes you have. One disruptive night after another can take its toll.

You may find yourself avoiding presentations at work, choosing clothes that hide sweat, or worrying about a flush before it even happens. At night, changing bedding and struggling to get back to sleep can add another layer to your frustration.

There’s no need to wait to reach a specific level of distress before seeking support. If your symptoms are affecting how you feel or function, that is enough to discuss them with a clinician. 

How to Manage Hot Flushes and Night Sweats

The good news is there are several ways you can manage hot flushes and night sweats during perimenopause and menopause. HRT is the main medical option for menopausal vasomotor symptoms, but it may not suit everybody, so non-hormonal options may be worth considering. Practical cooling measures and adjusting your lifestyle can also provide some relief. The important thing is to choose what feels right for you.

HRT treatment

Hormone replacement therapy (HRT) is widely recognised as the most effective treatment for menopausal hot flushes and night sweats. It works by replacing the falling hormone levels that happen during perimenopause and menopause. By improving your oestrogen levels, HRT can reduce the frequency of hot flushes and night sweats by 77%.*

NICE recommends HRT for women over the age of 40 who are experiencing menopause symptoms, including hot flushes and night sweats, based on your personal preferences, medical history and a discussion around the benefits and risks of taking HRT.**

Although HRT is effective, it may not be suitable for everyone. If you have a history of breast cancer or oestrogen-sensitive cancers, unexplained vaginal bleeding or active blood clots, your clinician may advise that HRT is not right for you. 

Which types of HRT help with night sweats and hot flushes? 

Hot flushes and night sweats are treated with systemic HRT, meaning hormones reach the bloodstream and act throughout the body. Oestrogen can be prescribed as tablets, patches, gel or spray.

If you still have your womb, you will usually also need a progestogen to protect its lining. After a hysterectomy, oestrogen-only HRT is usually appropriate. Your clinician will work with you to choose a suitable regimen based partly on whether you’re still having periods.

Low-dose vaginal oestrogen is different. It treats local symptoms such as vaginal dryness and irritation, but does not treat hot flushes or night sweats.

Can you start HRT during perimenopause?

Yes. If you are still having periods, but are getting menopause symptoms, waiting for your periods to stop altogether before seeking help could mean spending years with symptoms that could be treated. 

Are there risks to taking HRT?

Yes. However, for most healthy women under 60 experiencing menopause symptoms that are affecting their daily life, the benefits of HRT are likely to outweigh the risks.* Your clinician will discuss the benefits and risks of HRT with you during your consultation so you can make an informed decision about whether HRT is right for you. 

Combined HRT increases the risk of breast cancer with the risk increasing with duration of use while oral HRT can increase blood clot risk.* That’s why it is important to share your medical history with your clinician. Some circumstances may rule out HRT use completely, while others may mean you need a particular type of HRT instead. 

Non-hormonal options

If HRT is not suitable for you or you would prefer not to take hormonal medication, non-hormonal treatments are available. Some prescription medications act on the brain pathways that are involved in temperature regulation, while others may be considered according to your symptoms or medical history. Your clinician can explain their benefits, limitations and monitoring requirements.

Current NICE guidance includes a targeted non-hormonal medicine for moderate to severe vasomotor symptoms when HRT is unsuitable. Other medicines may also be considered individually, although they are not routinely recommended as first-line treatment for flushes alone.*

Menopause-specific cognitive behavioural therapy (CBT) is another evidence-based option. It can help with the distress associated with flushes and sweats, as well as related sleep difficulties, and can be used alongside HRT or as an alternative. CBT doesn’t mean symptoms are imagined. It offers practical ways to respond to symptoms and reduce their disruption.

Lifestyle adjustments

Making small adjustments to your lifestyle can make hot flush episodes easier to handle and can support better sleep. They can be made alongside hormonal and non-hormonal treatments, but they should not replace medical treatment if your symptoms are severe. 

You could try:

• Wearing lighter clothing layers that are easy to remove if you feel your temperature is rising

• Adjusting your bedding to suit, for example, several lighter layers or sheets may be easier to manage than one heavy duvet

• Using a handheld fan or cool drink for relief during a hot flush, and a fan or open window to keep your bedroom cool at night

• Reducing your exposure to a personal trigger

• Getting regular exercise to help support sleep, mood and general health

• Stress management techniques, such as breathing exercises, mindfulness or yoga to reduce stress and help balance your hormones

• Getting support to help you quit smoking if you are currently smoking

If your nights are frequently being disrupted, it can also help to have spare nightwear and a towel nearby. It won’t prevent night sweats but it can make the process of dealing with the situation less stressful. 

In Summary

Hot flushes and night sweats can begin during perimenopause and continue long after your periods stop. Changing oestrogen levels affect temperature regulation, while the resulting sleep disruption can make everyday life harder.

They are common, treatable symptoms. HRT offers the most effective relief, and non-hormonal treatments provide alternative options when HRT isn’t suitable or isn’t your preference, while lifestyle adjustments can help provide comfort alongside either approach.

If hot flushes or night sweats are getting you down, a Hers clinician can review your symptoms and health history and talk you through whether HRT could be suitable for you.

FAQs

Can you get night sweats before your period stops (perimenopause)?

Yes. You can experience night sweats during perimenopause before your periods stop completely. They are caused by hormone fluctuations and can occur while you still have regular periods as well as when they become lighter, heavier or irregular. 

Does HRT stop hot flushes completely?

It depends. HRT can significantly reduce hot flushes, and some people find they stop, but complete relief isn't guaranteed. If HRT isn't relieving your hot flushes, speak to your clinician about reviewing your treatment.

What's the difference between a hot flush and a hot flash?

There isn’t one - they mean the same thing. The term ‘hot flush’ is used in the UK, while ‘hot flash’ is more common in the US. They both describe a sudden episode of heat, often with sweating and flushing. If a hot flush occurs during sleep, you may be experiencing a night sweat.

Are night sweats always a sign of menopause?

No. Menopause is one possible cause of night sweats, but anxiety, certain medications, low blood sugar, pregnancy and other medical conditions can also cause night sweats. See a doctor if night sweats regularly wake you or worry you, especially if they come with other symptoms like unexplained weight loss.

How quickly does HRT work for hot flushes and night sweats?

HRT usually starts to reduce hot flushes and night sweats within 2 to 4 weeks, but it can take up to 3 months to feel the full benefits. Your clinician should review your treatment after 3 months to assess effectiveness and side effects. Contact your clinician sooner if you have concerns.