Managing Hot Flushes and Night Sweats

Understanding Hot Flushes

Hot flushes, called hot flashes in North America, represent the most characteristic menopause symptom, affecting approximately 75% of women during the transition. Each flush begins as a sudden sensation of intense heat, typically starting in the chest and rising to the neck and face. The sensation lasts from 30 seconds to several minutes, accompanied by rapid heartbeat, sweating, and often facial flushing.

Some women experience a cold, clammy feeling as the flush subsides. The experience varies dramatically between women. Some have occasional mild flushes barely interfering with daily life. Others endure dozens daily, severely disrupting work, sleep, social activities, and quality of life. Night sweats—hot flushes occurring during sleep—can drench nightclothes and bedding, causing repeated awakenings that compound into chronic sleep deprivation affecting mood, cognition, and overall functioning.

Why Flushes Happen

Hot flushes occur because declining estrogen affects the hypothalamus, the brain region that regulates body temperature. The hypothalamus normally maintains body temperature within a comfortable range called the thermoneutral zone. During menopause, this zone narrows dramatically, so slight increases in core temperature that wouldn't normally trigger a response now activate heat-loss mechanisms.

When the hypothalamus detects temperature slightly above this narrowed comfort zone, it initiates inappropriate responses to cool the body: blood vessels near the skin surface dilate (causing flushing), heart rate increases, and sweating begins. These mechanisms would be appropriate if you were genuinely overheated, but during a hot flush, they're triggered by minor temperature fluctuations that wouldn't affect women with normal estrogen levels. Stress, anxiety, warm environments, hot beverages, spicy food, and alcohol can all trigger flushes by raising core temperature or activating stress responses.

Lifestyle Strategies That Help

While lifestyle modifications won't eliminate significant hot flushes, they can reduce frequency and severity for many women. Dress in layers using natural, breathable fabrics like cotton or moisture-wicking materials rather than synthetic fabrics that trap heat. This allows quick adjustment when flushes begin. Keep your environment cool—lower bedroom temperature, use fans, and choose cool, well-ventilated spaces when possible.

Identify and minimize personal triggers. Common triggers include hot beverages, alcohol, spicy foods, caffeine, stress, and warm environments, though triggers vary between individuals. Keeping a symptom diary for two weeks helps identify your specific patterns. Maintaining a healthy weight reduces flush frequency and severity—research shows even modest weight loss improves symptoms. Regular exercise, while it doesn't directly reduce flushes, improves overall wellbeing and may lessen their impact.

Paced Breathing Technique

Paced breathing, also called slow breathing or therapeutic breathing, represents an evidence-based non-pharmacological approach to reducing hot flushes. The technique involves slow, deep breathing from the diaphragm at a rate of six to eight breaths per minute—much slower than the normal 12-14 breaths per minute. This activates the parasympathetic nervous system, calming the stress response that can trigger or worsen flushes. Practice paced breathing for 15 minutes twice daily and deploy it when you feel a flush beginning.

To practice: sit comfortably, place one hand on your chest and one on your abdomen, inhale slowly and deeply through your nose for a count of five (your abdomen should expand while your chest remains relatively still), then exhale slowly through your mouth for a count of five. Focus on making each breath slow, deep, and rhythmic. Research shows this technique can reduce flush frequency by approximately 40-50% when practiced consistently.

Medical Treatments: Hormone Therapy

Hormone replacement therapy (HRT) represents the most effective treatment for hot flushes and night sweats, reducing symptoms by 80-90% in most women. For women with a uterus, combined HRT (estrogen plus progestogen) is used; those who've had a hysterectomy can use estrogen alone. Both transdermal and oral formulations effectively treat vasomotor symptoms, though transdermal delivery offers safety advantages. Symptom relief typically begins within two to four weeks of starting HRT, with maximum benefit by three months.

Most women notice dramatic improvement in flush frequency and intensity as well as secondary benefits including better sleep, improved mood, and reduced anxiety. The effects are usually sustained as long as treatment continues. When women choose to stop HRT, symptoms may recur, though they're often less severe than initially, as most women are further past menopause when discontinuing.

Non-Hormonal Medical Options

For women who cannot or prefer not to use HRT, several non-hormonal medications show effectiveness for hot flushes. SSRIs and SNRIs (antidepressants) reduce flush frequency by 50-60% compared to placebo. Gabapentin reduces flushes by approximately 50%, proving particularly helpful for nighttime symptoms. Clonidine shows more modest effects, reducing flushes by 20-40%. These medications don't work as effectively as HRT but provide meaningful relief for many women. Each has a distinct side effect profile to consider when choosing among them.

Starting with a low dose and gradually increasing helps minimize side effects. Allow four to six weeks at a therapeutic dose to assess effectiveness before concluding a medication isn't working. Cognitive behavioural therapy specifically designed for menopause also reduces flush impact and distress even when frequency doesn't dramatically decrease.