Midlife Night Sweats: 4 Reasons Your Body Gets Hot and How to Cool Off

You’re dreaming of floating in the Mediterranean, waves lapping against your skin—only to wake up drenched, tangled in sweat-soaked sheets. Overheating at night is no Italian vacation. It’s disruptive and uncomfortable, and if it happens too often, it can leave you exhausted and desperate for answers.

The most common reason women get so hot at night in midlife is hormonal shifts linked to perimenopause and menopause. But night sweats at this age can also be triggered by blood sugar fluctuations, thyroid disorders, and even certain medications. The good news? Once you identify the cause of why your body gets so hot at night, there are plenty of ways to cool things down.

About the Expert

Susan J. Baumgaertel, M.D., an internal medicine physician in Seattle, Washington, and the creator of the MenopauseMenu, an online community for women in perimenopause and menopause.

Why You’re So Hot at Night & How to Cool Down

Night sweats don’t have a one-size-fits-all cause. Your age, hormones, and health history all play a role in why your body gets so hot at night. But most cases boil down to these four main reasons:

• Hormone changes from perimenopause and menopause
• Hormone changes before perimenopause
• Low blood sugar
• Hyperthyroidism

1. Hormone changes during menopause & perimenopause

As estrogen and progesterone levels decline in perimenopause, your brain’s internal thermostat—the hypothalamus—becomes more sensitive to temperature fluctuations.

Estrogen plays a direct role in stabilizing this thermostat. When estrogen declines, your body’s “neutral zone”—a temperature range where it doesn’t need to trigger cooling mechanisms like sweating—shrinks dramatically. The hypothalamus perceives normal body temperature as too hot, even when there’s no actual temperature change. The result? Hot flashes, or their nocturnal twin: night sweats.

“A hot flash or night sweat is the body’s attempt to cool you down,” explains internal medicine doctor Susan J. Baumgaertel, M.D.

Medically, these heat waves are called vasomotor symptoms of menopause (VSMs), and 80 percent of women experience them during the menopause transition. ¹

When hot flashes happen at night, they can cause sleep disruptions, stress, and depression. ² In fact, a 2022 study found women with nighttime hot flashes experience higher levels of stress and depression than those who experience them during the day, thanks to sleep disruptions. ³ To make matters more frustrating, stress exacerbates hot flashes, making it more likely you’ll wake up sweating at night. ⁴

Researchers used to think that hot flashes tapered off for most women within five years. ⁵ But more recent studies have found that they can continue into your 60s and 70s. ⁶

Treat it:

Reducing caffeine and practicing relaxation techniques can lessen the intensity and frequency of night sweats. ^{7 8} But in many cases, hormone replacement therapy (HRT, also called menopause hormone therapy or MHT) is needed to curb them. ⁹

Available as pills, patches, and creams, HRT can reduce hot flashes within three months. ^{10 11}

If HRT isn’t an option because of personal preference or your health history, non-hormonal treatments can help:

• Elinzanetant: The drug targets neurokinin-1 (NK1) and neurokinin-3 (NK3) receptors in the hypothalamus to help reduce the frequency and intensity of hot flashes. ^{12 13}
• Fezolinetant: This drug also blocks NK3 receptors from reacting to a brain chemical called neurokinin B that tells the body it’s too hot even when it isn’t. ¹⁴ In a 2023 study, women had fewer hot flashes and night sweats within three weeks of starting the medication. ¹⁵
• Paroxetine: This antidepressant is also FDA-approved to treat menopause hot flashes and night sweats by stabilizing serotonin, a brain chemical that helps regulate body temperature. One study published in Menopause found that paroxetine cut nighttime awakenings from hot flashes by 39 percent (compared to 28 percent with a placebo). ¹⁶

2. Hormone changes before menopause

About 1 in 100 women experience night sweats prior to perimenopause. ¹⁷ Two common causes: primary ovarian insufficiency (POI) and premenstrual dysphoric disorder (PMDD).

POI occurs when there’s a problem with the follicles, the small sacs in the ovaries where eggs grow and mature. Women with POI often experience irregular periods and low estrogen. ¹⁸ Just like in menopause, low estrogen can throw off the hypothalamus, leading to hot flashes and night sweats.

Premenstrual dysphoric disorder (PMDD) is a more severe version of premenstrual syndrome (PMS)
caused by an abnormal nervous system response to hormonal fluctuations in the days leading up to your period. ¹⁹ This can lead to imbalances in estrogen and lead to night sweats. ²⁰

Treat it:

HRT is often recommended for POI, while women with PMDD may be prescribed antidepressants, birth control pills, or hormone therapy. ²¹

3. Low blood sugar with type 1 or type 2 diabetes

For those with type 1 or type 2 diabetes, night sweats can be a warning sign of low blood sugar (hypoglycemia).

When blood sugar drops, the body releases adrenaline, a hormone that activates the nervous system and triggers sweating and hot flashes. ²² Blood sugar can crash at any time, but a sugary snack before bed or alcohol in the evening can cause it to drop at night.

Like hormonal hot flashes, night sweats caused by low blood sugar are concentrated in the upper body. Unlike hormonal hot flashes, they’re typically accompanied by other distinct symptoms, such as hunger pangs and dizziness. ²³

Treat it:

Medications like metformin and insulin may be needed to control blood sugar and stop you from waking up sweating. Your doctor may suggest lifestyle changes with the medication, like eating a protein + carb snack before bed (like Greek yogurt or nut butter on toast) and limiting alcohol and high-sugar foods in the evening.

4. Hyperthyroidism

Your thyroid controls metabolism and body temperature. ²⁴ When it’s overactive (hyperthyroidism), the gland produces more thyroid hormone than the body needs, which causes your metabolism to speed up. A faster metabolism impacts the hypothalamus’s ability to regulate temperature, which can lead to sweating and hot flashes during the day or at night ²⁵.

Hot flashes from hyperthyroidism can feel similar to hormone-driven hot flashes, but one clue that they’re connected to your thyroid is that they’re often accompanied by a racing heartbeat, nervousness, shaking, or a tremor in the hands. ²⁶

About one in eight women will develop a thyroid condition at some point. ²⁷ Baumgaertel adds that while common, only women with an overactive thyroid (hyperthyroidism) experience hot flashes and night sweats.

Treat it:

If you suspect hyperthyroidism, a doctor can confirm with a blood test. Medication can treat the condition, and lifestyle changes (like sleeping in a cold room and avoiding spicy food) can ease nighttime sweating.

How Overheating at Night Can Impact Long-Term Health

Beyond the discomfort, sleep disruptions caused by night sweats can impact long-term health. Poor sleep in menopause is linked to:

• Increased stress
• Higher risk of heart disease
• Metabolic dysfunction and weight gain ²⁸

About the author

Angela Myers is a health writer, award-winning health communications researcher, and digital marketing consultant for health companies. She covers healthy aging, women's health, and mental health for outlets including Forbes, AARP, and Well+Good, among others.

About the reviewer

Dr. Shelly Chvotzkin, D.O., F.A.C.O.O.G., is a physician board certified in obstetrics and gynecology. She is a member of the American College of Osteopathic Obstetricians and Gynecologists (ACOG), the American Osteopathic Association (AOA), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the Menopause Society (formerly known as the North American Menopause Society or NAMS).