How to Handle Menopausal Hot Flashes (Without Losing Your Cool)

The great thing about your 40s and 50s is you’ve got wisdom and experience, and you know what you want and exactly how to get it—you’re on fire. The terrible thing is when you actually feel like you’re on fire. Hot flashes are a hallmark symptom of perimenopause that affect about 75 to 80 percent of women. ^{1 2}

Beyond causing discomfort, hot flashes can affect your risk of certain health conditions:

• A 2024 study in the American Journal of Obstetrics and Gynecology found that more frequent night sweats were associated with a higher risk of developing Alzheimer’s, though they don’t necessarily cause Alzheimer’s. ³
• A SWAN study published in JAMA Network Open in 2024 suggest that the more hot flashes you have, the greater your risk for developing type 2 diabetes. ⁴
• A Menopause study suggests that a combination of persistent hot flashes and a history of migraines may increase the risk of heart disease and stroke. ⁵

Here’s a primer on what’s happening in your body during a menopause hot flash, plus expert advice on how to dial down the heat.

About the Experts

Samantha Dunham, M.D., M.S.C.P., board-certified OB/GYN, co-director of the Center for Midlife Health and Menopause at NYU Langone Health in New York City.

Heather Hirsch, M.D., M.S., M.S.C.P., is a board-certified physician and menopause specialist.

What Are Hot Flashes?

Hot flashes, also called vasomotor symptoms of menopause (VMS), ⁶ are characterized by sudden bursts of intense heat often accompanied by flushing, sweating, and heart palpitations. They can last from 1 to 5 minutes and can happen multiple times a day. When hot flashes happen at night, they’re known as night sweats, and they can interfere with your sleep, even leading to long-term sleep loss. ^{7 8 9} Over time, lack of sleep can contribute to health conditions including cardiovascular disease, cognitive impairments, and mental health issues. ¹⁰

Symptoms of hot flashes

Hot flash symptoms may include: ^{11 12 13}

• A feeling of sudden heat radiating through your body (including your head)
• Flushing or blotching skin around your chest, neck, and face
• Sweating, sometimes profusely
• Chills and clammy skin as you start to cool down
• Heart palpitations or a racing heartbeat
• Anxious feelings

Some people describe a menopause hot flash as feeling like a human furnace or like they’re cooking from the inside out; others say their hot flashes start in their feet, radiating up through their torso and head and then back down.

Hot flashes feel different for each person, varying in discomfort from mild to severe. They can come and go in a flash or drag on for several minutes each time. ^{14 15 16 17} Some hot flashes are followed by a cold flash, like a shiver.

Menopause specialist Heather Hirsch, M.D., notes that most people seem to experience a specific type of hot flash. “I don’t really ever hear my ‘furnace’ people talking about cold flashes,” she says.

What Causes Hot Flashes?

Hot flashes are primarily caused by hormonal changes, in particular the wild fluctuations in estrogen during the menopause transition.

Experts don’t fully understand the mechanism, but they know that falling estrogen levels affect the way the body regulates its temperature, making it overly sensitive to shifts in temperature, even subtle ones.

“In our hypothalamus, the part of our brain that houses our body’s internal thermostat, estrogen helps control how much variability that thermostat allows our body to tolerate,” says Hirsch.

As estrogen declines, cells in the hypothalamus that normally help regulate reproductive hormones and body temperature (called KNDy neurons) become overactive. ¹⁸ “And the window of variability that your body can tolerate narrows,” she says. When you’re exposed to temperatures outside this narrow window, it activates your body’s cooling mechanisms, including sweating and widening of the blood vessels. ¹⁹

When Do Hot Flashes Start, and How Long Do They Last?

Hot flashes typically start during perimenopause, typically in your mid-40s, though it’s also possible to start in your 30s or your 50s. ²⁰

“Most women will experience at least several years of hot flashes,” says Hirsch. Studies suggest they usually affect women for about four to 10 years, with a 2015 study published in JAMA Internal Medicine noting that more than half of women in midlife experience frequent vasomotor symptoms for about seven years. Of the racial and ethnic groups studied, African American women seemed to suffer the longest in the menopause years, experiencing hot flashes for just over 10 years on average. ²¹

However, some women continue to have hot flashes into their 60s and 70s. ^{22 23}

Hot flashes in menopause tend to occur daily in the year after a person’s final period. About a third of women who get hot flashes report having more than 10 a day.

Common Hot Flash Triggers

Certain environments, foods, drinks, habits, and emotions can trigger menopause hot flashes.

Although hot flash triggers vary from person to person, they can include: ^{24 25 26 27}

• Hot environments: Whether it’s a steaming shower, a warm room, or a sunny summer day, heat from external temperatures can catapult your body into a hot flash.
• Getting overheated: Working up a sweat may create body heat that feels more intense when it triggers VMS.
• Spicy food: That caliente chili or Sichuan hot pot could leave you sweating, especially during a hormonal shift. You may want to stick with cooling foods.
• Hot, caffeinated, or alcoholic beverages: Consider trading steaming lattes and happy hour cocktails for chilled decaf and non-alcoholic sippers, since caffeine and alcohol may warm you up a little too much.
• Lack of sleep: Women who get good quality sleep report having fewer and less frequent hot flashes. ²⁸
• Anxiety and stress: Watch out for this double whammy. Anxiety and stress may not only trigger hot flashes, but they may also leave you feeling anxious and stressed after having them. ^{29 30}
• Smoking: Studies suggest cigarette smoking may increase your risk of hot flashes, as well as their severity and frequency. ³¹
• Excess weight: Being overweight is associated with multiple health conditions, including hot flashes. Losing weight may help ease VMS. ^{32 33}

How to Find Relief from Menopausal Hot Flashes

Hot flashes can be treated with a range of medications, supplements, complementary approaches, and lifestyle changes.

“Hot flashes impact your quality of life pretty quickly, and there’s no medal for sticking it out until they’re ‘bad,’” says Hirsch. “If you’re noticing them, they’re affecting you, so it’s worth considering treatment.”

If you’re on the fence about treatment for hot flashes in menopause, Dunham suggests tracking your symptoms to assess how bothersome they are. “Everyone has a different threshold for seeking help,” she says. “For most people, it’s when they’re having sleep problems, which can also lead to mood changes, brain fog, and fatigue.”

Hot flashes may also impact your day-to-day, she says, for example, how you interact with colleagues or how you need to carry a change of clothes in case you sweat through them.

Hormone replacement therapy (HRT)

“The most effective and gold standard for treating vasomotor symptoms is FDA-approved menopause hormone therapy,” says Dunham. “An estrogen can be used to treat the symptoms, and if the patient has a uterus, then they need something like a progestogen to protect the endometrial lining of the uterus from growing from the estrogen.” Treatment will be tailored to patients’ needs, as well as any health risks that may be of concern, she says.

You might start menopause hormone therapy during “late” perimenopause, when your periods become irregular and you start getting menopause symptoms.

“When people are in menopause and symptomatic with hot flashes and night sweats, and we’re also thinking about bone health and risk for osteoporosis, I think more about estrogen,” she says. For hormone replacement therapy, she may prescribe transdermal treatment (patch, cream, gel, mist), transvaginal (ring), or oral estrogen medications.

HRT treatments may include: ^{34 35 36 37 38}

• Estrogen and progesterone
• Estrogen only
• Estrogen and bazedoxifene (a selective estrogen receptor modulator, which decreases the risk of breast cancer and also boosts bone health)

Testosterone may also be included in an HRT regimen. Limited studies suggest it may help improve VMS, but most major medical societies do not endorse its use for treating menopause hot flashes. ^{39 40 41}

Lifestyle choices

Whether or not you’re taking medication, these self-care strategies can help calm menopause hot flashes: ^{42 43 44 45 46 47 48}

• Pay attention to potential hot flash triggers and do your best to limit or avoid them.
• Eat a healthy diet. A large Australian study found that women who ate a Mediterranean-style diet were 20 percent less likely to have hot flashes and night sweats. Study participants who ate high-fat and high-sugar diets were 23 percent more likely to have VMS. ⁴⁹
• Exercise. While the science on perimenopause exercise and VMS has been mixed, a small 2016 study in Menopause suggests that cardiorespiratory exercise (like running, cycling, and swimming) may reduce hot flashes. ⁵⁰ If exercising triggers (or worsens) your hot flashes, try dressing in layers and working out in cool environments.
• Manage stress and anxiety. It’s not easy, but reducing stress and anxiety supports well-being and may reduce hot flashes. ^{51 52}
• Maintain a healthy weight for better overall health and mobility as you age, and fewer, less intense hot flashes. ^{53 54}
• Don’t use tobacco products, since they’re harmful to your health and can make hot flashes worse. ⁵⁵
• Carry a portable fan with you to cool off when the inferno starts (and keep a change of clothes at work or in your car).
• Try to get good sleep. Lowering the temperature in your bedroom, making sure your covers are easy to remove, and keeping a fan by the bed may help stave off night sweats—or at least minimize their disruption. ⁵⁶

Natural remedies, supplements, and mind-body approaches

HRT is the most effective remedy for hot flashes in menopause and perimenopause, but there are over-the-counter treatments and mind-body approaches you can try without a prescription.

Complementary therapies may include: ^{57 58 59}

• Herbal remedies and other supplements: Black cohosh, cannabinoids, chasteberry, dong quai, evening primrose oil, ginseng, milk thistle, omega-3 fatty acids, plant estrogen (soy, red clover, flaxseed), vitamin E, tart cherry, and wild yam are among the dietary supplements that may help manage menopause symptoms. Some small studies support these types of products, but research is limited. Talk to your doctor to help you better understand the risks and benefits of natural remedies and supplements for menopause hot flashes.
• Mind-body solutions: The Menopause Society supports using hypnosis and cognitive behavioral therapy (CBT) to help manage hot flash symptoms. The findings from a 2024 scoping review suggest hypnosis is more effective than CBT, which also proved helpful, but showed mixed results. ⁶⁰
• Mindfulness meditation: Results from a 2025 systematic review suggest that mindfulness-based interventions, like meditation, may help women cope better with symptoms of menopause. An additional study suggests that mindfulness-based stress reduction can help reduce distress from hot flashes and night sweats. ^{61 62}

Non-hormonal prescription medications

Although not as effective as HRT, certain medications that don’t contain hormones can offer some relief for hot flashes, too.

FDA-approved nonhormonal treatments: ^{63 64 65}

• Paroxetine (Brisdelle): An SSRI that may offer modest relief for VMS. Multiple studies suggest that paroxetine is one of the most effective SSRIs for decreasing menopause hot flashes and their intensity through the stabilization of serotonin. ^{66 67}
• Fezolinetant (Veozah): A daily pill that blocks a pathway in the brain to help regulate temperature and reduce hot flashes. This selective neurokinin3 receptor antagonist has also demonstrated efficacy as an HRT alternative for treating VMS in studies. ^{68 69} The FDA has added a black box warning on this drug because in rare cases, it can cause liver damage, so talk to your doctor about the risk-benefit ratio for you. ⁷⁰

A new drug, Elinzanetant, may soon join this list. The neurokinin-1,3 receptor agonist has been shown to reduce the frequency and severity of menopause-related hot flashes. It’s currently in Phase 3 trials.

Off-label nonhormonal treatments may include: ^{71 72 73}

• Selective Serotonin Reuptake Inhibitors (antidepressant medication)
• Serotonin-Norepinephrine Reuptake Inhibitors (antidepressant medication)
• Gabapentin (anti-seizure medication)
• Clonidine (blood pressure medication)

“One SSRI (paroxetine) is FDA-approved for VMS, and we use other SSRIs and SNRIs off-label, since they’ve been shown to be effective for hot flashes,” says Dunham. “We also use gabapentin, which enhances sleep.” Studies suggest that these treatments can reduce the frequency and severity of vasomotor symptoms by 10 to 64 percent. ⁷⁴

Navigate Menopause With Confidence

Get expert guidance and support on symptoms, treatments, and lifestyle changes, delivered every Monday.

"*" indicates required fields

Name*

Email*

Subscribe to*

Hone In: Men’s health, performance, and longevity

Hone Your Life: Women’s health, hormones, and well-being

Join The Hone Newsletter

About the author

Jen Laskey is a veteran health and wellness journalist with over a decade of experience and a member of the Association of Health Care Journalists. Her work has appeared in outlets including NBC News, MSN, and The Healthy. With a gift for translating complex science into clear, engaging content, she helps readers make sense of their health and take informed action.

About the reviewer

Marilyn Lajoie, M.D., is an internist who specializes in hormone therapy for men and women. She holds degrees in integrative medicine from Saba University School of Medicine and chiropractic medicine from Northeast College of Health Sciences.