Cold Flashes in Menopause & Perimenopause: Why You’re Feeling Chilly
Hot flashes aren’t the only body thermostat misfire during menopause.
You wake up dripping in sweat…and then all of a sudden, you have the chills, complete with shivering and goosebumps. Both hot and cold flashes are signs of menopause—the latter just isn’t as well known and is therefore underreported.
Menopause cold flashes often appear as an “afterburn” following a hot flash, as your body overcompensates to try to cool you down.
What Are Cold Flashes?
Cold flashes are sudden waves of coldness, sometimes accompanied by shivering and chills. They occur during menopause because the body struggles to regulate temperature as estrogen levels fluctuate. While cold flashes can happen on their own, they often follow a hot flash.
“They make you shiver suddenly and can happen at any time of day, but it’s especially frustrating when they happen during sleep,” says OB-GYN Yves-Richard Dole, M.D.
About the Experts
Yves-Richard Dole, M.D., a general OB/GYN at Mercy Medical Center in Baltimore.
Candice Knight, M.D., a board-certified family physician and integrative medicine specialist
What Causes Hot and Cold Flashes?
Hormonal fluctuations, especially declining estrogen, primarily drive cold flashes during menopause by affecting the brain’s temperature-regulating center. Here’s what happens during a cold flash:
- Fluctuations of estrogen disrupt the hypothalamus, the thermoregulation center of the brain. It misfires, sending signals to warm you up or cool you down when it doesn’t need to.
- Your body overcorrects, cooling you down too much and leading to menopause cold flash symptoms like goosebumps and shivering.
- Cold flashes are a vasomotor reaction in which blood vessels expand or constrict in response to hormonal and temperature fluctuations.
- Stress can also provoke a cold flash. Dips in estrogen act like a stressor, triggering the adrenal system to release extra cortisol. This panic attack-like response can create cold flash symptoms.
“Estrogen supports vasodilation—it helps blood vessels remain open and flexible,” Knight says. This helps the body regulate both circulation and body temperature.
Hot flashes can trigger cold flashes
You may be more likely to experience a cold flash immediately after a hot flash. “Many of my patients report this ‘afterburn’ effect where, following a hot flash, their body overcorrects and leaves them feeling chilled, particularly at night,” says Candice Knight, M.D., a board-certified family physician and integrative medicine specialist.
When fluctuations in estrogen lead to accidental temperature spikes, dilating the blood vessels, the body might overcompensate when it’s trying to come down from the hot flash. That could then cause blood vessels to quickly constrict, cutting off circulation and causing a chill.1
Other underlying causes of cold flashes
Menopause isn’t the only cause of cold flashes, so be sure to talk to your doctor to rule out these other causes:
- Hypothyroidism is an autoimmune condition associated with an underactive thyroid gland and therefore slowed metabolism and circulation. The condition commonly occurs during perimenopause and leads to feeling cold often, explains Knight.
- Adrenal dysfunction from chronic stress or general adrenal fatigue can impact the body’s ability to regulate temperature and keep it stable, Knight says.
- Iron-deficiency anemia may affect your circulation; low iron reduces oxygen delivery to tissues, and it can contribute to cold hands, feet, or whole-body chills, says Knight.
- Low body fat or malnutrition can cause cold flashes in those who have low weight, because there’s less fat insulating their organs, according to Knight. Micronutrient loss may also be a culprit of temperature fluctuations and chills. For example, vitamin B9 (folate) and/or vitamin B12 deficiencies can lower red blood cell count and impair circulation.2
More on Flashes
Feeling Cold All the Time in Menopause
Feeling cold all the time during menopause is different from experiencing a cold flash, which is a sudden and brief drop in body temperature. Cold flashes are similar to hot flashes—both are temporary and often triggered by the hypothalamus overreacting to temperature changes, explains Knight. Persistent feelings of chilliness, however, are more likely linked to reduced circulation, especially in the extremities, due to estrogen loss.
Since estrogen helps regulate both circulation and temperature, declining levels can contribute to feeling cold all the time in menopause. Research has found that declining estrogen can cause blood vessels to constrict, keeping blood flow (and therefore, heat) in your core.3
How to Treat and Manage Cold Flashes During Menopause
If you’re experiencing menopause cold flashes or feeling cold all the time, visit your primary care physician or OB/GYN. She may want to test for and rule out underlying causes such as iron deficiency or a thyroid imbalance. “In many cases, these underlying issues don’t exist in isolation but interact with estrogen withdrawal to create a perfect storm,” says Knight. “When stress is high, when nutrient status is poor, or when thyroid function is suboptimal, even minor hormone shifts can feel amplified.”
Once you’ve checked in with your healthcare provider about menopause cold flashes or general temperature issues, Knight has some other tips for warming up, including lifestyle changes, supplements, and medications to consider.
Start with simple lifestyle shifts
- Balance blood sugar with protein-rich meals so that your body temperature doesn’t spike or dip as much after meals.
- Reduce intake of caffeine, alcohol, and processed food, all of which can constrict blood vessels and lead to cold flashes.
- Try gentle movement to reduce perimenopause chills, including walking, resistance training, and yoga, which can calm cortisol levels and support circulation.
- Start your morning with some cold exposure, like a splash of a cold shower or a quick walk in the cool morning air, to help build tolerance to shifts in body temperature.
Look into natural remedies and supplements
- Magnesium glycinate can stabilize the nervous system and vascular function, according to Knight.
- Omega-3 fatty acids support brain and vascular health.
- Adaptogens like ashwagandha or rhodiola can help to quell a stress response, and therefore may keep your body temperature better regulated.
- Black cohosh may have the potential to ease menopause symptoms, particularly hot flashes.4 However, the research isn’t conclusive, and you should not start using black cohosh (or anything else) without checking with your physician, notes Knight.
Discuss hormone therapy with your doctor
You may be a candidate for hormone replacement therapy (HRT), which is commonly prescribed for vasomotor symptoms of menopause. The estrogen in HRT recalibrates the hypothalamus to regulate the body’s internal temperature and can also help stabilize circulation. HRT is often delivered in the form of an estrogen patch, plus oral progesterone. Other options for estrogen therapy include higher-dose vaginal rings, spray, gels, or cream.
Consider other medications
Non-hormonal medications can also help your body’s overall temperature regulation, including certain antidepressants called SSRIs. One popular SSRI choice for vasomotor symptoms is paroxetine (the brand name is Brisdelle).
Recently, another non-hormonal medication, called fezolinetant or Veozah, was approved by the FDA for hot flashes. Because it works on a receptor that plays a role in the brain’s regulation of body temperature, it is possible that it could help with cold flashes as well.
The Bottom Line
Cold flashes during menopause can come on suddenly, or follow a hot flash. These temperature swings are caused by fluctuating hormone levels. Hormone replacement therapy, some supplements, and other medications can help ease cold flashes, as can healthy habits like eating well, exercising, and, prioritizing sleep.
Zhang, Z. et al. (2021) The Effects of Estrogens on Neural Circuits That Control Temperature.
↑Cleveland Clinic. (2022) Folate Deficiency Anemia.
↑Amargandy, S. et al. (2020) Arterial Stiffness Accelerates Within 1 Year of the Final Menstrual Period: The SWAN Heart Study.
↑National Center for Complementary and Integrative Health (2024) Black Cohosh.
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About the author
Deborah Skolnik is a journalist whose career has included staff positions at magazines and newspapers, including Woman’s Day, Parenting, and the New York Daily News. Her work has also appeared in the New York Times.
About the reviewer
Natalie Kunsman, M.D., is a board certified physician specializing in functional, anti-aging, and regenerative medicine. She is a fellow of the American Academy of Anti-Aging medicine and the American Academy of Family Physicians.
