Hot flashes (called hot flushes in Australia and the UK) are the most recognised symptom of perimenopause — affecting up to 80% of women during the transition. They can range from mildly inconvenient to completely debilitating, disrupting sleep, work, and social life. Yet most women are never told why they happen or given a comprehensive management plan. Here is what you need to know.
Why Hot Flashes Happen
Hot flashes are caused by changes in the brain's temperature regulation centre — the hypothalamus. As oestrogen levels decline and fluctuate, the hypothalamus becomes hypersensitive to small changes in core body temperature. It responds by triggering a heat-dissipation response (vasodilation, sweating) that is disproportionate to the actual temperature change. The result is a sudden wave of heat, often accompanied by sweating, flushing, and a rapid heartbeat, lasting 1–5 minutes.
💡 💡 Duration: Hot flashes last an average of 7 years in most women — though some women experience them for over a decade. They are most frequent and severe in the 2 years around the final period.
12 Evidence-Based Strategies
Medical Treatments (Most Effective)
- Hormone therapy (HRT/MHT) — reduces hot flash frequency by 75–90%; the most effective treatment available
- Fezolinetant (Veozah) — a new non-hormonal prescription medication that targets the neural pathway causing hot flashes; reduces frequency by ~50%
- Low-dose SSRIs/SNRIs (paroxetine, venlafaxine) — reduce hot flash frequency by 40–65%; useful for women who cannot take hormones
- Gabapentin — particularly effective for night sweats; reduces frequency by ~45%
Lifestyle Strategies
- Keep cool — lower room temperature, use fans, wear moisture-wicking fabrics, keep a cold water bottle nearby
- Identify your triggers — common triggers include alcohol, caffeine, spicy food, hot drinks, stress, and warm environments
- Paced breathing — slow, diaphragmatic breathing (6 breaths per minute) during a hot flash reduces severity and duration
- Reduce alcohol — alcohol is one of the most consistent hot flash triggers and significantly worsens night sweats
- Maintain a healthy weight — adipose tissue produces oestrogen, but excess body fat also increases hot flash frequency
- Regular aerobic exercise — reduces hot flash frequency by 20–30% over 12 weeks
- Cognitive behavioural therapy (CBT) — reduces the distress and impact of hot flashes even when frequency does not change
- Mindfulness-based stress reduction (MBSR) — reduces hot flash severity and improves quality of life
When to Seek Medical Help
You should speak to your GP if hot flashes are occurring more than 7 times per day, significantly disrupting your sleep, affecting your work or social functioning, or causing significant distress. Effective treatments are available — you do not have to simply endure them.