FEEL WELL • HOT FLASHES

Hot flashes & night sweats:
when your thermostat feels rewritten.

LAST REVIEWED: 2026-10-24 • By the LatelyWell editorial team • How we write & review

Hot flashes and night sweats are the symptoms most people link with menopause, and for good reason. Here is what they are, why they happen, what the evidence says about easing them, and when to get help.

What a hot flash actually is

A hot flash (called a "hot flush" in the UK and Australia) is a sudden wave of heat, usually felt most in the face, neck and chest. Many people also notice flushed skin, sweating, a racing or pounding heartbeat, and sometimes a feeling of anxiety just before or during the episode. Afterwards, as the body cools, it is common to feel chilled or shivery. Episodes often last a few minutes, although length, frequency and intensity vary hugely between people.

Night sweats are hot flashes that happen while you sleep. They can be mild enough that you simply kick off the covers, or heavy enough to soak sleepwear and bedding and leave you wide awake at 3am.

Doctors group hot flashes and night sweats together as "vasomotor symptoms". The Menopause Society describes them as the most common symptom of the menopause transition, affecting up to 80% of women at some point. The NHS lists them among the most common symptoms of both perimenopause and menopause.

Why they happen

The short version is that falling and fluctuating oestrogen levels affect the part of the brain that regulates body temperature, the hypothalamus. Researchers describe this as a narrowing of the body's "thermoneutral zone": the range of core temperature in which you feel comfortable. When that range narrows, a small rise in core temperature can trigger the body's full cooling response, which means widened blood vessels near the skin, sweating and a faster heartbeat, even though nothing about the room has changed.

More recent research has focused on a group of brain cells (sometimes called KNDy neurons) that become more active when oestrogen falls and that signal through a messenger called neurokinin B. This work is the basis for a newer class of non-hormone medicines, discussed below.

When they start and how long they last

Hot flashes often begin in perimenopause, the years before your final period when hormone levels rise and fall unpredictably, and they can continue after menopause (defined as 12 months without a period). The NHS notes that menopause symptoms can begin months or years before periods stop and can continue for some years afterwards. For some women they settle within a couple of years; for others they last much longer. There is no reliable way to predict your own timeline, which is one reason it makes sense to seek help if symptoms are affecting your life rather than waiting for them to pass.

Hot flashes can also happen suddenly and intensely after surgical removal of the ovaries, or with some cancer treatments that lower oestrogen. If that applies to you, your specialist team should be your first port of call, because treatment options can differ.

What can make an episode more noticeable

Commonly reported triggers include hot drinks, alcohol, caffeine, spicy food, warm rooms, stress and smoking. The National Institute on Aging suggests keeping track of what seems to set off your own hot flashes. Not everyone has the same triggers, and some people find no pattern at all, so it is better to observe than to cut out a long list of foods and drinks on principle.

A simple record helps here. For one or two weeks, note:

• The time of each episode and whether it woke you.
• A rough intensity (mild, moderate or severe) and how long it seemed to last.
• What you had eaten or drunk in the previous hour or so.
• Room temperature, clothing and stress level.
• How much it affected your day or your sleep.

Everyday comfort measures

These measures will not change the underlying cause, and the evidence that they reduce how often hot flashes happen is limited. But many people find they make episodes easier to live with:

• Layer clothing so you can take a layer off quickly. Breathable natural fibres or moisture-wicking fabrics are often more comfortable.
• Keep the bedroom cool with a fan, a window open where safe, and lighter bedding you can adjust during the night.
• Keep cold water nearby, especially at night.
• Notice your own triggers and reduce the ones that clearly matter to you, for example alcohol in the evening.
• Stop smoking if you smoke. The NHS recommends it for menopause symptoms and for long-term health.

The NHS also suggests regular exercise and a healthy weight. Weight loss in people with overweight has some evidence for reducing hot flashes, and The Menopause Society's 2023 position statement on non-hormone therapy lists it among the approaches it recommends. Exercise is good for heart, bone and mental health in midlife, but that same review did not find strong evidence that exercise alone reduces hot flashes.

Treatments with good evidence

If hot flashes or night sweats are bothersome, it is worth knowing that effective treatments exist. The right option depends on your symptoms, medical history, risks and preferences, and it is a decision to make with a qualified clinician.

Hormone replacement therapy (HRT)

HRT (called menopausal hormone therapy, or MHT, in the US and Australia) replaces oestrogen, usually alongside a progestogen if you still have a uterus. It is the most effective treatment for hot flashes and night sweats. In the UK, the NICE guideline on menopause (NG23) recommends offering HRT for vasomotor symptoms after discussing the short- and long-term benefits and risks. The Menopause Society's 2022 position statement says that for healthy women under 60, or within 10 years of their final period, the benefits of hormone therapy for bothersome symptoms generally outweigh the risks.

HRT is not right for everyone. A history of certain cancers, blood clots, stroke or liver disease can change the picture, and the type of HRT (for example oestrogen patches or gel compared with tablets) can affect some risks. A clinician can talk through your individual risk.

Non-hormone prescription options

For people who cannot or prefer not to take HRT, several non-hormone medicines have evidence for reducing hot flashes. These include some antidepressants in lower doses (certain SSRIs and SNRIs), gabapentin and oxybutynin. Clonidine is also sometimes used. Each has possible side effects that are worth discussing.

A newer option is fezolinetant, which works on the neurokinin B pathway described above. The US Food and Drug Administration approved it in 2023 for moderate to severe hot flashes caused by menopause, and it carries a warning about possible liver injury, so liver blood tests are part of using it. Availability and approval differ by country, so ask what is offered where you live.

Cognitive behavioural therapy (CBT)

CBT does not stop hot flashes from happening, but there is good evidence that it can reduce how much they bother you and how much they disrupt sleep and daily life. NICE recommends that CBT be considered for vasomotor symptoms, and The Menopause Society also recommends it. Clinical hypnosis has evidence too, according to the same 2023 statement.

What about supplements and "natural" remedies?

Many products are marketed for hot flashes, including black cohosh, red clover, soy isoflavones, evening primrose oil and various blends. The Menopause Society's 2023 non-hormone statement did not recommend herbal supplements for hot flashes, citing a lack of consistent evidence. NICE notes that the quality and dose of herbal products can vary, and that some can interact with other medicines. St John's wort, for example, interacts with many prescription drugs.

If you want to try a supplement, tell your doctor or pharmacist what you are taking, especially if you take other medicines or have a history of breast cancer.

Night sweats need context

Night sweats are common in perimenopause and menopause, but they are not always caused by menopause. Infections, some medicines, thyroid problems, low blood sugar and, rarely, more serious conditions can cause them too. The NHS advises seeing a GP if you have night sweats alongside a high temperature, unexplained weight loss, a persistent cough or diarrhoea, or lumps or swellings, or if you are worried.

When to see a doctor

Book an appointment if:

• Hot flashes or night sweats are affecting your sleep, work, relationships or wellbeing.
• You are under 45 and have menopause-type symptoms. NICE recommends that people under 45 are assessed, and that menopause under 40 (premature ovarian insufficiency) is investigated.
• Your symptoms are new, unusual, or come with other symptoms such as fever or weight loss.
• You have had breast cancer or another hormone-sensitive condition and are struggling with symptoms.

In the UK, NICE says a blood test is usually not needed to diagnose perimenopause or menopause in women over 45 with typical symptoms. Doctors can usually make a diagnosis from your symptoms and your periods, which is another reason a clear symptom record is useful.

Our guide to preparing for a menopause appointment walks through what to bring and what to ask.

Frequently asked questions

How long do hot flashes last?

It varies a lot. The NHS notes that menopause symptoms can start months or years before periods stop and can continue for some years afterwards. For some women hot flashes settle within a couple of years; for others they last longer.

What is the most effective treatment for hot flashes?

HRT (called MHT in the US and Australia) is the most effective treatment for hot flashes and night sweats, and NICE recommends offering it for these symptoms after discussing benefits and risks. It is not suitable for everyone, and non-hormone medicines and CBT are other options to discuss with a clinician.

Are night sweats always caused by menopause?

No. Night sweats can have other causes, including infections, some medicines and other medical conditions. Night sweats with fever, unexplained weight loss or feeling unwell should be checked by a doctor.

What can I do tonight to feel cooler?

Keep the bedroom cool, use a fan, wear light layers you can remove easily and keep a cold drink by the bed. These are among the simple measures suggested by the NHS. See our guide to a better sleep environment.

Where to find reliable information

If you want to read further, these organisations publish free, evidence-based information for the public:

• UK: the NHS menopause pages, the NICE menopause guideline and the Women's Health Concern factsheets from the British Menopause Society.
• US: The Menopause Society, ACOG and the National Institute on Aging.
• Australia: Jean Hailes for Women's Health and the Australasian Menopause Society.

Guidance differs a little between countries, and treatment names and availability vary, so check what applies where you live and talk to a clinician about your own situation.

The bottom line

Hot flashes and night sweats are common, and they are treatable. Comfort measures can make episodes more bearable, but you do not have to "just get through it" if symptoms are affecting your life. HRT is the most effective option for many people, and there are proven non-hormone medicines and psychological approaches for those who need or prefer them. A few weeks of notes on when, how often and how badly symptoms affect you is the most useful thing to bring to that conversation.

Educational information only; not medical advice, diagnosis or treatment. Seek professional care for symptoms that are severe, persistent, worsening or concerning.