Managing Hot Flashes and Night Sweats During Menopause

Hot flashes and night sweats result from declining estrogen and changes in the brain's temperature control during menopause. They are common and can persist for years. Management options include lifestyle measures (cooling, trigger avoidance, exercise), effective treatments such as hormone therapy for appropriate candidates, non-hormonal drugs (certain antidepressants, gabapentin, clonidine), and behavioral therapies like CBT. Discuss individual risks and preferences with a clinician to choose the best approach.

What causes hot flashes and night sweats?

Hot flashes and night sweats are vasomotor symptoms that commonly occur as ovarian estrogen production declines during the menopausal transition. The brain's temperature-regulation center becomes more sensitive, which produces sudden feelings of heat, flushing, sweating and often sleep disruption.

How common and how long do they last?

Many women experience these symptoms during perimenopause and after the last menstrual period. Large studies show that vasomotor symptoms are common and can last several years; duration varies by individual and by factors such as age at onset and ethnicity.

Practical treatment options

Treatment choices fall into three broad approaches: lifestyle strategies, medical treatments (including hormone and non-hormonal drugs), and behavioral therapies. Often a combination works best.

Lifestyle and self-care

Simple changes can reduce frequency and severity. Wear layered clothing, sleep with a cool room and breathable sheets, avoid known triggers (hot drinks, alcohol, spicy foods), and practice paced breathing or relaxation when a hot flash starts. Maintaining a healthy weight and regular aerobic exercise can also help.

Hormone therapy

Estrogen (with a progestogen if the uterus is intact) is the most effective treatment for vasomotor symptoms. Current guidance supports considering hormone therapy for symptomatic women who are younger than about 60 or within 10 years of menopause onset, using the lowest effective dose for the shortest needed duration. Individual risks (cardiovascular disease, breast cancer history) and benefits should be discussed with a clinician.

Non-hormonal medications

For women who cannot or prefer not to use hormones, several non-hormonal options reduce hot flashes. These include certain antidepressants (some SSRIs and SNRIs), gabapentin, and clonidine. Low-dose paroxetine is an FDA-approved non-hormonal option for vasomotor symptoms. Effectiveness varies and side effects should be weighed.

Behavioral and complementary approaches

Cognitive behavioral therapy (CBT) has good evidence for reducing the impact of hot flashes and improving sleep and mood. Evidence for herbal or dietary supplements (soy isoflavones, black cohosh, etc.) is mixed; some people report benefit, but product quality and safety vary.

When to see a doctor

Talk to your clinician if hot flashes or night sweats interfere with daily life or sleep, start suddenly and severely, or are accompanied by other concerning symptoms. Your provider can assess underlying causes, review risks and benefits of therapies, and tailor a plan to your health priorities.