Night Sweats and Hot Flashes in Perimenopause: Just the Facts

Understanding, Managing, and Reducing Symptoms

What Are Night Sweats and Hot Flashes?

Hot flashes and night sweats are both classified as vasomotor symptoms (VMS), which affect the body's ability to control temperature regulation. While they share the same underlying cause, they occur at different times of the day.

A hot flash is a sudden and intense sensation of heat, usually concentrated in the upper body, particularly the face, neck, and chest. Many women describe it as a 'wave' of heat that comes out of nowhere, lasting anywhere from a few seconds to an hour. During a hot flash, the skin may turn red or flushed, heart rate may increase, and sweating often follows. In some cases, after the episode subsides, women experience chills as the body cools down. Night sweats are hot flashes that occur during sleep. However, they are often more disruptive because they cause excessive sweating that soaks pajamas and bed sheets, waking women up multiple times a night. This leads to poor sleep quality, daytime fatigue, irritability, and difficulty concentrating. Chronic sleep disturbances due to night sweats can have a cumulative effect, contributing to increased stress levels and making perimenopausal symptoms worse overall.

While these symptoms can vary widely in intensity and frequency, research indicates that up to 85% of women experience hot flashes and night sweats during perimenopause, with some continuing to experience them for years after menopause.

Why Do Hot Flashes and Night Sweats Happen?

One major cause of hot flashes and night sweats is hormonal fluctuations, specifically estrogen levels. Estrogen plays a crucial role in regulating the hypothalamus, which is the part of the brain responsible for controlling body temperature. As estrogen levels drop, the hypothalamus becomes more sensitive to slight changes in body temperature, mistakenly perceiving that the body is overheating even when it is not. In response, the body attempts to cool itself down by triggering vasodilation, or the widening of blood vessels near the skin's surface, which causes the characteristic heat surge and sweating.

Other factors can exacerbate these symptoms, including increased cortisol levels from stress, changes in blood sugar regulation, being overweight, and inflammation in the body. Some women also have a genetic predisposition to experiencing more severe vasomotor symptoms, making them more vulnerable to intense and frequent hot flashes.

While hormonal shifts are one of the root causes, certain triggers can make hot flashes and night sweats more severe. These include spicy foods, caffeine, alcohol, smoking, high-stress levels, a sedentary lifestyle, and warm environments. Identifying and managing these triggers can be a key step in reducing the severity of symptoms.

How Long Do Hot Flashes and Night Sweats Last?

The duration of vasomotor symptoms varies widely from woman to woman. Some may only experience them for a few months, while others may deal with them for a decade or longer. Research shows that the average duration of hot flashes and night sweats is around 4–7 years, but some women experience them for more than 10 years.

The frequency of these symptoms also varies. Some women only have occasional episodes, while others experience multiple episodes per day. The severity can also fluctuate, with certain periods being more intense than others. Women who experience chronic stress, poor sleep, or underlying health conditions may find that their symptoms last longer and are more difficult to manage.

How to Reduce and Manage Hot Flashes and Night Sweats

While there is no way to completely prevent vasomotor symptoms, there are several effective strategies to reduce their severity and frequency. Managing hot flashes and night sweats requires a comprehensive approach, including adjusting your sleep environment, making dietary changes, practicing stress management, and exploring medical or natural treatments. Since night sweats occur during sleep, optimizing your sleep environment is crucial for minimizing their impact. Keeping the bedroom cool and well-ventilated can help prevent excessive overheating. Using light, moisture-wicking bedding and pajamas can also make a significant difference. Many women find that using a cooling pillow or mattress topper helps regulate temperature throughout the night.

Many women notice that certain foods, drinks, or activities increase the likelihood of experiencing a hot flash or night sweats. The most common triggers include caffeine, alcohol, spicy foods, and high-sugar meals. Reducing or eliminating these triggers can significantly reduce the frequency and severity of symptoms. Diet plays a crucial role in balancing hormones and reducing inflammation. Including phytoestrogen-rich foods—such as soy products, flaxseeds, and lentils—may help support estrogen levels naturally. Additionally, magnesium-rich foods, like dark leafy greens, nuts, and seeds, may help with nervous system regulation and stress management, which can indirectly improve vasomotor symptoms.

Since increased cortisol levels can exacerbate hot flashes and night sweats, finding effective ways to manage stress is essential. Techniques such as deep breathing exercises, meditation, and gentle yoga can help calm the nervous system and reduce symptom intensity. Studies have found that mindfulness and relaxation-based therapies can improve both the frequency and severity of vasomotor symptoms. Establishing a relaxing nighttime routine, such as taking a lukewarm bath, reading, or practicing deep breathing, can help reduce nighttime disruptions.

For women who experience severe hot flashes and night sweats, hormone replacement therapy (HRT) may be an option. HRT is highly effective in reducing symptoms by restoring estrogen levels, but it is not suitable for everyone. Recently, a non-hormonal medication was approved for the treatment of vasomotor symptoms. Fezolinetant (Veozah) reduces moderate to severe vasomotor symptoms due to menopause. Other non-hormonal treatments, such as antidepressants (SSRIs), gabapentin, and clonidine, may also be beneficial for some women.

Final Thoughts

Hot flashes and night sweats are a normal part of perimenopause, but that does not mean they have to take over your life. By making strategic lifestyle changes, managing triggers, and exploring treatment options, women can regain control and reduce the impact of these symptoms. Every woman’s experience is different, but with patience and the right tools, relief is possible.