A sudden wave of intense heat rising through your chest and face. Sweating through your pyjamas at 2am. Hot flushes and night sweats are the hallmark symptoms of perimenopause — and they can be utterly debilitating. Here is why they happen and how to get relief.
💡 📊 Up to 80% of perimenopausal women experience hot flushes. They can last anywhere from a few seconds to several minutes and may occur multiple times per hour in severe cases.
Why Do Hot Flushes Happen?
Hot flushes are caused by the hypothalamus — the brain's thermostat — becoming hypersensitive to small changes in body temperature. This hypersensitivity is triggered by declining oestrogen levels, which affect the neurotransmitters that regulate the hypothalamus.
When the hypothalamus detects what it perceives as overheating (even when your core temperature has not actually risen), it triggers a rapid heat-dissipation response: blood vessels near the skin dilate, causing the characteristic flush and sweating.
Common Triggers
- Hot drinks — particularly coffee and tea
- Alcohol — especially red wine
- Spicy food
- Hot environments or sudden temperature changes
- Stress and anxiety
- Tight or synthetic clothing
- Hot showers or baths
How Long Do They Last?
For most women, hot flushes begin in perimenopause and continue for 1–5 years after menopause. However, approximately 10% of women continue to experience them for 10 years or more. The severity and frequency vary greatly between individuals.
Effective Treatments
MHT — Most Effective
Menopausal Hormone Therapy is 90%+ effective at reducing hot flushes and night sweats. It is the gold-standard treatment and works by restoring oestrogen levels, removing the hormonal trigger. For women with frequent or severe hot flushes, MHT offers life-changing relief.
Non-Hormonal Medications
For women who cannot or choose not to use MHT, several non-hormonal medications have evidence for reducing hot flushes, including certain antidepressants (SSRIs/SNRIs), gabapentin, and clonidine. These require a prescription and discussion with your GP.
Lifestyle Strategies
- Keep a trigger diary and avoid your personal triggers
- Dress in layers and use moisture-wicking fabrics
- Keep your bedroom cool — 18–19°C is optimal
- Practice slow, deep breathing at the onset of a flush — this can reduce severity
- Regular aerobic exercise reduces frequency and severity over time