Hot Flushes Due To Menopause

Overview

A hot flush is a sudden wave of heat that spreads across your body, usually starting in your face, neck or chest. Your skin may turn red and feel hot, you may sweat, and your heart may beat faster. It usually lasts from a few seconds to about five minutes. When flushes happen at night and soak your bedding, they are called night sweats. Hot flushes are one of the most common signs of the menopause — the time in life when your periods stop and your hormone levels change.

Yes, very common. Around 3 in 4 women going through the menopause get hot flushes or night sweats at some point. For many they are mild, but for some they are strong enough to disturb sleep, work and daily life.

Hot flushes most often affect women between about 45 and 55, which is when the menopause usually happens. They can also happen earlier — for example after surgery to remove the ovaries, after some cancer treatments, or because of a medical condition or treatment that lowers hormone levels. Smokers and women who have a higher body weight often notice stronger symptoms. A small number of people going through the menopause transition do not get flushes at all.

Symptoms

Common symptoms

• A sudden feeling of heat spreading over the face, neck and chest
• Skin that looks red or blotchy and feels hot to touch
• Sweating, sometimes heavy, followed by feeling cold and shivery
• A pounding or racing heartbeat during a flush
• A feeling of anxiety or panic just before or during a flush
• Night sweats that wake you up and leave your bedding or nightclothes damp
• Trouble falling asleep or staying asleep because of flushes
• Flushes that come and go in waves, sometimes many times a day

Symptoms in children

• Hot flushes from the menopause do not happen in children, because they are linked to changing hormone levels later in life.
• If a child has repeated flushing, sweating or redness of the skin, it is worth seeing a doctor, as there can be other reasons for these symptoms.

Symptoms in older adults

• Flushes can carry on for years after the last period, though they usually become milder and less frequent.
• Night sweats that disturb sleep over a long time can add to tiredness, low mood and poor concentration.
• In later life, flushing can also be caused by other things, such as an overactive thyroid, some medicines or infections, so new or unusual symptoms should be checked by a doctor.
• The menopause years are also a good time to think about bone and heart health, which your doctor or nurse can review with you.

Causes

Main causes

• Falling levels of the hormone oestrogen around the menopause. Oestrogen helps keep the body's temperature control steady.
• When oestrogen levels drop, the brain's 'thermostat' becomes more sensitive and can think the body is too hot when it is not.
• The body then reacts to cool itself down — widening blood vessels near the skin (which causes redness and heat) and producing sweat.
• Sudden changes in hormone levels, such as after surgery to remove the ovaries or after some cancer treatments, can cause flushes too.
• Some medical conditions and some medicines can cause flushing, which is why a doctor may sometimes check for other causes.

Risk factors

• Smoking — smokers often report stronger and longer-lasting flushes
• Having a higher body weight
• Sudden menopause, for example after surgery to remove the ovaries
• Some treatments for breast cancer that lower oestrogen levels
• A history of strong premenstrual symptoms
• Stress, anxiety and poor sleep, which can make flushes feel worse
• Everyday triggers such as hot drinks, spicy food, alcohol, caffeine, hot rooms and tight clothing

When to see a doctor

See a doctor urgently if:

• Bleeding from the vagina after 12 months without a period
• Bleeding between periods, after sex, or periods that suddenly become very heavy
• A flush with a high temperature, confusion or feeling very unwell
• Chest pain, sudden breathlessness or fainting — call your local emergency number
• Feeling low, hopeless or having thoughts of harming yourself — seek help the same day

Book a routine appointment if:

• Flushes or night sweats that disturb your sleep, work or mood
• You are not sure whether your symptoms are due to the menopause
• You would like to talk about treatment options, including hormone-based and non-hormonal choices
• Your symptoms started before the age of 45, or your periods have stopped earlier than expected
• You are still having periods but have symptoms that bother you
• You want advice on contraception and staying healthy during the menopause years

Diagnosis

In most cases, your doctor can tell that hot flushes are linked to the menopause from your symptoms, your age and your periods. There is no single test for the menopause, and for most women over 45 no blood test is needed. Your doctor will ask about your periods, your symptoms, your sleep, your mood and your medical history, and may check your blood pressure. If your symptoms are unusual, started early, or could have another cause, they may arrange tests.

Tests that may be done

• A blood test to check hormone levels — used mainly if you are under 45 or your symptoms are unusual
• Thyroid function tests, as an overactive thyroid can cause flushing and a racing heartbeat
• A blood count, to look for anaemia or other general health issues
• Blood pressure and general health checks
• Tests to rule out other causes if you have bleeding after the menopause or other worrying symptoms

What to expect at your appointment

Your appointment is likely to be a conversation rather than a set of tests. It helps to write down your symptoms beforehand: how often flushes happen, how long they last, whether they wake you at night, and how they affect your day. It is also useful to note any medicines or supplements you take, and to ask about all the treatment options, including ones that do not involve hormones. You can bring someone with you if that helps.

Treatment

There are many ways to manage hot flushes, and the best approach depends on how much they affect your life, your health history and what matters to you. Some women do well with lifestyle changes alone. Others benefit from hormone-based treatment that replaces the oestrogen the body is no longer making. Others prefer non-hormonal options or talking therapies. Your doctor or nurse can explain the benefits and risks of each option so you can choose together.

Self-care at home

• Wear layers you can take off, and choose loose cotton clothing
• Keep a small fan or a cool drink nearby at home and at work
• Cut down on known triggers such as hot drinks, spicy food, caffeine and alcohol, one at a time, to see what helps
• Keep your bedroom cool, use light bedding and cotton nightclothes, and try a fan at night
• Stop smoking — this often reduces the strength and length of flushes
• Try slow, steady breathing when you feel a flush starting, which can make it feel less intense
• Keep active and drink water regularly through the day
• Let family, friends and work colleagues know what is happening so they can support you

Medical treatments

Doctors can offer treatment in a few broad ways. The most effective option for many women is hormone replacement therapy, which tops up the oestrogen the body is no longer making, given as patches, gels, sprays or tablets — your doctor will talk through the different forms, the benefits and the risks for you personally. For women who cannot or prefer not to use hormones, there are non-hormonal prescription medicines that can reduce flushes, and talking therapies such as cognitive behavioural therapy (CBT) have good evidence for helping people cope with flushes and night sweats. Some people also try herbal or over-the-counter products, but these are not always well studied, and they can interact with other medicines — check with your pharmacist or doctor first. Never start, stop or change a treatment without medical advice.

When is surgery considered?

Surgery is not used to treat hot flushes themselves. Surgery to remove the ovaries can actually cause flushes, because it makes hormone levels fall suddenly. Surgery may be needed for other gynaecological conditions, and your doctor would discuss this with you separately.

Living with this condition

Hot flushes can be unpredictable, which is often the hardest part. Planning ahead helps: keep a change of clothes at work, carry a small fan, and choose bedding and clothing you can adjust easily. Tracking when flushes happen can help you spot patterns and triggers. On difficult days, be kind to yourself — symptoms usually ease over time, and treatment can make a real difference.

Lifestyle tips

• Stay physically active — regular movement is linked with better sleep and mood
• Stop smoking, and ask for help if you need it
• Limit alcohol and caffeine, especially in the evening
• Build a relaxing bedtime routine and keep a cool, dark bedroom
• Manage stress with breathing exercises, gentle exercise or a talking therapy
• Keep up social contact — isolation can make symptoms feel harder to cope with
• Talk to your employer if flushes are affecting you at work; simple changes like a desk fan or flexible hours can help

Diet and exercise

There is no special diet that stops hot flushes, but eating well can help you feel better overall. Aim for plenty of vegetables, fruit, wholegrains, beans and pulses, plus calcium-rich foods such as milk, yoghurt or fortified plant drinks to support bone health. Cut back on very spicy food, hot drinks, alcohol and caffeine if you notice they set off flushes. Regular activity — walking, swimming, cycling, strength work or anything you enjoy — supports sleep, mood, bone strength and heart health. Aim for something most days, and build up gradually if you are new to exercise.

Mental health and emotional wellbeing

Hot flushes and night sweats can chip away at sleep, concentration and confidence, and it is very common to feel anxious, irritable or low during the menopause. These feelings are understandable and treatable. Talking to someone you trust, trying a talking therapy, or speaking to your doctor can help a great deal. If you ever feel hopeless or have thoughts of harming yourself, please reach out for crisis support straight away — call your local emergency number or a crisis helpline in your country. You deserve help, and you are not alone.

Prevention

You cannot prevent the menopause or the hormone changes that cause hot flushes. But you can reduce how much they affect you by avoiding your personal triggers, not smoking, staying active and keeping to a healthy weight. If you are having treatment that will lower your hormone levels, such as certain cancer treatments, talk to your care team beforehand about how to manage flushes.

Vaccines

There is no vaccine for hot flushes. It is still worth keeping up to date with any vaccines your local health service recommends for your age and health.

Screening programmes

Screening does not apply to hot flushes themselves, but the menopause years are a good time to keep up with routine NHS screening you are invited to, such as cervical screening and breast screening, and to ask your doctor about bone health and heart health checks if you have concerns.

Complications

If left untreated

• Broken sleep and ongoing tiredness, which can affect work, memory and mood
• Anxiety, low mood or loss of confidence
• Discomfort and embarrassment in social or work situations
• Lower interest in sex or discomfort during sex, often linked with vaginal dryness that can come with the menopause
• Weaker bones over time as oestrogen levels fall, which raises the risk of fractures later in life
• A higher long-term risk of heart and circulation problems after the menopause

Long-term outlook

The outlook is good. Hot flushes are a normal, temporary part of the menopause and are not harmful in themselves. For most women they become milder and less frequent over time, and there are many effective ways to reduce them. With the right support — self-care, treatment if you need it, and people around you who understand — most women manage this stage of life well and feel like themselves again.

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