Hot flashes in menopause: causes and what actually helps
Hot flashes are sudden waves of heat, sweating and flushing caused by changing hormone levels in perimenopause and menopause. Hormone therapy works best, and newer non-hormonal medicines and CBT are good options for many women.
See a doctor if hot flashes start when you are not near menopause, or come with fever, weight loss, cough or pain. Also get checked if they start months or years after other menopause symptoms ended.4
What it is and how common it is
A hot flash is a sudden feeling of heat, usually in the face, neck and chest. Your skin may redden and you may sweat, then feel chilled. A typical episode lasts one to five minutes.1
Hot flashes are very common. Up to three in four people have them around menopause, and up to one in three report more than ten a day.1 When they happen at night, they are called night sweats.
They often last longer than people expect. In the large US SWAN study, frequent hot flashes lasted a median of 7.4 years. They lasted longer for women whose symptoms started early in perimenopause, and for African American and Hispanic women.2
Why it happens in menopause
Falling estrogen affects the part of the brain that controls body temperature.1 A group of brain cells called KNDy neurons becomes overactive when estrogen drops.3
These cells then send faulty signals to the temperature center. The body reacts as if it were overheating. Blood vessels in the skin widen and you start to sweat, even though you were not too hot.3
This pathway is what the newer non-hormonal medicines target.3 Common triggers include hot drinks, alcohol, caffeine, spicy food, warm rooms, stress and smoking.1
What else can cause it
Menopause is the most common cause in midlife, but not the only one. A doctor may want to rule out:
- An overactive thyroid or other thyroid problems.1,4
- Infections, including flu and, more rarely, tuberculosis.1,4
- Side effects of medicines, such as some antidepressants and diabetes drugs.4
- Anxiety disorders and alcohol or drug use.4
- Rare conditions such as lymphoma, other blood cancers or hormone-producing tumors.4
Flushing with fever, unexplained weight loss or swollen glands needs a check-up.4
Treatment options
Hormone therapy is the most effective treatment.5 In a Cochrane review of 24 trials, it cut hot flash frequency by about 75% compared with placebo.6 For most healthy women under 60, or within 10 years of menopause, the benefits usually outweigh the risks.5
Women who cannot or prefer not to use hormones have more choices than before. Fezolinetant (sold as Veozah in the US) and elinzanetant (Lynkuet) block signals in the brain's temperature center. Both are prescription-only, and availability differs by country.8,9
Some antidepressants, gabapentin and oxybutynin also reduce hot flashes.7 Talk to your doctor or pharmacist about which option suits your health history.
Everyday measures
Simple steps can make hot flashes easier to live with:1
- Dress in layers you can take off quickly.
- Keep your home and bedroom cool, and keep a cold drink nearby.
- Notice your own triggers and cut back on them.
- Stay active, keep a healthy weight and avoid smoking.
These steps help comfort, but trial evidence that they reduce hot flashes is limited.7 Weight loss is the exception, which The Menopause Society does recommend.7
What helps: options rated
| Option | Evidence | What the research shows |
|---|---|---|
| Hormone therapy (HRT) | The most effective treatment. Oral hormone therapy reduced hot flash frequency by about 75% versus placebo across 24 trials.6,5 | |
| Fezolinetant and elinzanetant | Both are approved for moderate to severe hot flashes after large placebo-controlled trials.8,9 Fezolinetant carries a US boxed warning about rare liver injury, with liver blood tests advised.8 Elinzanetant is approved in the US, UK, EU, Canada, Australia and Switzerland.9 | |
| Other non-hormonal prescriptions | The Menopause Society recommends certain SSRI and SNRI antidepressants, gabapentin and oxybutynin. Most are used off-label for hot flashes and are less effective than estrogen.7 | |
| CBT | Recommended by The Menopause Society for hot flashes.7 It aims to make hot flashes less bothersome and to ease related stress and sleep problems. | |
| Clinical hypnosis | The Menopause Society recommends clinical hypnosis for hot flashes.7 The trial base is smaller than for CBT. | |
| Layering, cooling the room and avoiding triggers | Widely advised and low risk.1 Rated some because trials are lacking and The Menopause Society does not count them as treatments.7 | |
| Popular supplements (black cohosh, soy isoflavones) | The Menopause Society does not recommend supplements, herbal remedies or soy products for hot flashes.7 Most experts agree.1 | |
| Cooling products (fans, cooling pads, wearables) | Only small pilot trials exist. In one, a handheld cooling device did not beat a sham device on symptom scores.10 |
Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.
Related
Sources
- Hot flashes: causes, triggers and management, Cleveland Clinic
- SWAN study finds frequent hot flashes and night sweats last a median of 7.4 years, ScienceDaily report on JAMA Internal Medicine paper (2015)
- KNDy neurons explained: the brain science behind hot flashes, Pharmacy Times
- Night sweats: causes, Mayo Clinic
- 2022 Hormone Therapy Position Statement press release, The North American Menopause Society (2022)
- Oral hormone therapy versus placebo for hot flushes and night sweats, Cochrane (2004)
- 2023 Nonhormone Therapy Position Statement press release, The North American Menopause Society (2023)
- FDA adds warning about rare occurrence of serious liver injury with Veozah (fezolinetant), US Food and Drug Administration (2024)
- Lynkuet (elinzanetant) approved in the EU for vasomotor symptoms of menopause or breast cancer endocrine therapy, Bayer press release (2025)
- Randomized clinical trial of a handheld cooling device for menopausal vasomotor symptoms, Climacteric (2015)