Hot flushes disrupting your sleep and daily routine? You're not alone. These sudden waves of heat affect around 65% of women during perimenopause and menopause [11]. While brain fog affects 90% of women going through menopause [11], hot flushes remain one of the most challenging symptoms to manage.
Most hot flushes last about four minutes [3] and can happen any time of day or night. When they strike during sleep, they become night sweats [3]—often leaving you drenched and unable to get back to sleep. Women in the UK typically experience menopause between ages 45 and 55, with 51 being the average age [7]. About half of all women notice physical or emotional changes during this transition [7].
The good news? Effective relief options exist—from simple lifestyle changes to proven medical treatments available through the NHS. Hot flushes don't have to control your life. Whether you're just starting to notice symptoms or you've been struggling for months, you'll discover practical ways to cool down, sleep better, and feel more like yourself again.
What causes hot flushes during menopause?
Hot flushes happen because of major hormonal changes during your menopause journey. When you understand what's going on inside your body, those sudden temperature surges start to make sense.
The role of oestrogen and hormone changes
Your oestrogen levels don't just drop during perimenopause and menopause—they fluctuate wildly. Between 50% and 80% of women experience hot flushes because of these hormonal shifts [8]. Here's what matters most: it's not just low oestrogen that causes problems. The speed at which your hormone levels change determines how severe your symptoms become [8].
Oestrogen helps your body maintain a steady temperature [9]. When levels drop quickly, your internal temperature control system becomes unstable. Women who have surgical menopause through ovary removal often experience the most severe and frequent hot flushes because their hormone levels plummet overnight [8].
Oestrogen isn't the only hormone involved. Other key players include:
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Progesterone fluctuations
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Changes in neurotransmitters like serotonin
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Alterations in norepinephrine levels [9]
How the brain regulates body temperature
Your hypothalamus acts like your body's thermostat, controlling temperature throughout your system [10]. This small but powerful brain region normally keeps everything perfectly balanced.
When oestrogen can't activate the hypothalamus properly, your brain loses control of temperature regulation [6]. Think of it like a faulty thermostat that suddenly becomes oversensitive to tiny temperature changes [10] [10].
Scientists have identified specific neurons called KNDy neurons that go into overdrive when oestrogen drops [8]. Research on post-menopausal women shows these neurons actually change shape and size [8].
Here's what happens during a hot flush:
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Your hypothalamus wrongly thinks your body is overheating
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It activates your body's cooling systems
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Blood vessels near your skin widen to release heat
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You start sweating to cool down further [10]
This process typically lasts 1-5 minutes and usually starts at your face, neck or chest before spreading across your body [8].
Why some women experience more severe symptoms
Hot flush severity varies dramatically between women. The Study of Women Across the Nation found significant differences based on ethnicity and other factors [8].
African American women typically report more severe symptoms, while women of Japanese or Chinese heritage often experience milder hot flushes [8]. Your body weight also matters—women with higher BMI tend to have more frequent and intense symptoms [8].
Several lifestyle factors influence how bad your hot flushes become:
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Smoking increases both frequency and severity [10]
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Regular exercise can reduce symptoms [8]
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Previous premenstrual syndrome often predicts worse hot flushes [8]
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Higher stress and anxiety levels make symptoms worse [10]
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Socioeconomic factors play a role [8]
Research shows a concerning link between severe hot flushes and heart health. Women with frequent hot flushes often have higher blood pressure, reduced blood vessel function, and increased cardiovascular risk markers [8]. Managing your hot flushes might benefit your overall health, not just your comfort.
Most women (about 80%) see their hot flushes improve within two years [11]. The night sweats that come with hot flushes can seriously disrupt your sleep patterns, affecting everything from your energy levels to your mood the next day.
Common triggers that make hot flushes worse
Image Source: HuffPost
Hot flushes might be part of menopause, but certain lifestyle factors can make them much worse. Identifying your personal triggers offers a practical way to reduce both frequency and intensity—sometimes dramatically.
Caffeine and alcohol
Your morning coffee could be making your hot flushes during menopause worse. A major Mayo Clinic study found a clear link between caffeine intake and more severe hot flushes and night sweats in postmenopausal women [7]. Caffeine narrows blood vessels and raises blood pressure, which can trigger your body's temperature regulation to go haywire.
Caffeine hides in more places than you might think:
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Tea and cola drinks
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Energy drinks
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Chocolate
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Some pain relievers and cold medications
Alcohol creates similar problems through blood vessel dilation and increased heart rate, leading to flushed skin and excessive sweating [8]. Evening drinks become particularly troublesome, making night sweats even more intense for women going through perimenopause.
Spicy foods and hot drinks
That curry you love might be triggering your hot flushes. The capsaicin in chilli peppers and other spicy ingredients can directly set off symptoms in sensitive women [9]. Hot beverages during a flush make overheating feel even worse.
Some women also react to monosodium glutamate (MSG), sulphites in red wine and certain cheeses, and sodium nitrate in processed meats [10]. Paying attention to which foods trigger your symptoms becomes essential for better management.
Stress and anxiety
Stress and hot flushes create a vicious cycle that's hard to break. Women with anxiety experience hot flushes three to five times more often than those without [6]. The connection works both ways—stress triggers hot flushes, then hot flushes increase your stress levels.
Stress releases adrenaline into your bloodstream, speeding up your heart rate and increasing blood flow, which raises your body temperature [10]. This cycle significantly impacts quality of life and makes sleep after menopause even more challenging.
Smoking and excess weight
Current smokers face 2.43 times higher odds of experiencing hot flushes compared to non-smokers [11]. Heavy smokers—those with more than 20 cigarettes daily or 30+ years of smoking—have significantly higher risks of severe symptoms [12].
Carrying extra weight also increases your risk. Research from the University of Queensland shows obese women have nearly 60% higher risk of frequent or severe hot flushes compared to women of normal weight [12]. When you combine obesity with smoking, the risk jumps to more than three times higher for severe hot flushes [12].
Women who quit smoking before age 40 show similar risk levels to those who never smoked [12]. This shows how lifestyle changes can reduce symptom severity before you even consider HRT for menopause or other treatments.
Natural ways to cool down and find relief
"The peri-menopause symptoms can be managed by making lifestyle changes. Think of the symptoms as your body's way of crying out for love, help, and attention." — Tanith Lee, Award-winning author and thought leader in women's health literature
Quick relief from hot flushes doesn't always need a prescription. Simple changes to your daily routine can help manage your body temperature and reduce the discomfort when those sudden heat surges strike.
Wearing breathable fabrics
The right clothing makes a real difference during hot flushes. Natural, breathable fabrics allow better airflow and wick moisture away from your skin. Choose materials that work with your body:
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Cotton absorbs up to 10% of its weight in moisture [13]
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Bamboo offers excellent breathability and moisture-wicking properties
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Linen keeps you cool whilst providing insulation [2]
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Wool can absorb 30% of its weight in moisture [13]
Style matters just as much as fabric choice. Loose-fitting clothes with roomy armholes help prevent sweat patches [14]. Light layers work better than single heavy items—you can adjust quickly when a hot flush begins [3]. A pure silk scarf feels cool against the skin and provides a stylish way to cover a flushed neck or chest.
Using fans and cooling sprays
Portable cooling solutions provide instant relief during episodes. Keep a small fan at home, work, and in your handbag [3]. Battery-powered mini-fans and traditional handheld fans both work effectively.
Cooling sprays offer quick comfort too. A simple water spray bottle works well, or try specialised cooling mists designed for menopausal hot flushes [15]. Research shows 92% of users agreed their skin felt instantly cooled with specialised menopause cooling mists [15]. Store your spray in the fridge overnight for extra cooling effect.
Layering bedding for night sweats
Night sweats need special bedding consideration. Rather than one heavy duvet, use multiple light layers of natural fabrics you can add or remove as needed [3]. Cotton sheets—100% cotton specifically—provide comfortable, cool sleeping surfaces [3].
Wool-filled pillows and duvets offer superior moisture management. Wool absorbs 30% of its weight in moisture compared to cotton's 10% [16]. Keep a towel nearby to change damp bedding quickly and prevent sleep disruption [17].
Taking lukewarm showers
Hot water might feel comforting, but it actually makes hot flushes worse. Choose lukewarm showers instead [3]. This simple change helps maintain stable body temperature and prevents triggering additional episodes [18].
Staying hydrated throughout the day
Proper hydration plays a vital role in temperature regulation during menopause. The NHS recommends 6-8 glasses of water daily [19]—you might need more during hot weather or physical activity. Start each morning with water to replenish overnight losses and boost metabolism [19].
About 20% of daily fluid comes from food, especially high-water-content fruits and vegetables like watermelon, strawberries, spinach and celery [19]. For those experiencing anxiety and menopause symptoms together, proper hydration becomes even more important—dehydration can worsen brain fog and irritability.
UK treatment options: NHS and private care
Image Source: The Mandatory Training Group
When lifestyle changes aren't enough to manage severe hot flushes, professional medical support can make all the difference. The NHS offers several proven treatment options—many available at no cost through your local GP.
When to speak to your GP
Hot flushes disrupting your work, relationships, or sleep after menopause? It's time to book an appointment. The NHS recommends early consultation to prevent perimenopause and menopause symptoms from impacting your quality of life [20]. Most GPs are well-versed in menopause management and can discuss all available options.
Hormone Replacement Therapy (HRT)
HRT menopause treatment remains the gold standard for hot flush relief [21]. This approach replaces declining oestrogen levels and tackles multiple symptoms at once—hot flushes, mood changes, and vaginal dryness [22]. Women with a uterus need combined HRT (oestrogen plus progesterone) to protect the womb lining [23].
Non-hormonal medications like SSRIs and fezolinetant
Can't use HRT due to medical history or personal choice? Several effective alternatives exist:
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Fezolinetant (Veoza), licenced by the MHRA in December 2023, specifically targets hot flushes by blocking brain receptors [1]
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Clonidine was the only licensed non-hormonal option before fezolinetant arrived [4]
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SSRIs like venlafaxine, paroxetine and fluoxetine show good results for many women [5]
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Elinzanetant (Lynkuet), approved in July 2024, offers another hormone-free choice [24]
Complementary therapies and supplements
Many women turn to natural remedies for menopause, though herbal options like black cohosh, red clover, and evening primrose oil lack strong scientific backing [25]. These treatments work for some women, but results vary significantly.
Cognitive behavioural therapy (CBT)
NICE guidelines recommend CBT alongside or instead of HRT for managing hot flushes [26]. This talking therapy helps you develop practical coping strategies and reduces both hot flush impact and anxiety and menopause symptoms [27]. Many NHS areas offer CBT specifically designed for menopause.
HRT vs non-HRT: What's right for you?
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Choosing between HRT and non-hormonal treatments can feel overwhelming when you're struggling with severe hot flushes. The right choice depends on your individual health profile, symptoms, and personal preferences—but understanding your options helps you make an informed decision with your GP.
Benefits of HRT for hot flushes
HRT remains the most effective treatment for hot flushes menopause symptoms, reducing them by up to 75% in most women. Many women notice improvements within 2-4 weeks of starting treatment. HRT also tackles other menopausal symptoms like joint pain and sleep after menopause problems—giving you relief across multiple areas of your health.
Risks and who should avoid HRT
HRT isn't suitable for everyone. Women with certain medical histories need to avoid hormonal treatments, including those with:
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Breast, ovarian or endometrial cancer history
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Blood clots or stroke history
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Undiagnosed vaginal bleeding
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Liver disease
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High-risk cardiovascular profiles
Women with menopause and blood pressure concerns may need careful monitoring when considering HRT. For most healthy women under 60, the benefits typically outweigh potential risks.
Non-HRT options and their effectiveness
Can't use HRT or prefer hormone-free alternatives? Several non-hormonal options can help. Fezolinetant (Veoza) reduces hot flushes by 40-60%, while magnesium for menopause may provide some relief. Natural remedies for menopause like black cohosh show mixed results but remain popular choices for women seeking hormone-free approaches.
Exercise during menopause consistently shows modest benefits for reducing hot flushes, especially when combined with stress management techniques.
Making an informed decision with your doctor
The choice between HRT and alternatives should be a shared decision with your healthcare provider. Your age, perimenopause stage, symptom severity, medical history, and personal preferences all matter when finding the right approach. Regular follow-up appointments ensure your treatment continues working effectively and safely for you.
Conclusion
Hot flushes affect millions of women across the UK, but they don't have to control your life. While around 65% of women experience these sudden temperature surges, understanding what causes them—and more importantly, how to manage them—makes all the difference during this natural transition.
Simple changes often provide real relief. Wearing breathable fabrics, staying hydrated, and avoiding triggers like caffeine and alcohol can reduce both how often hot flushes happen and how intense they feel. Creating a cooler sleep environment helps tackle those disruptive night sweats that leave you exhausted the next day.
When lifestyle changes aren't enough, proven medical treatments are available through the NHS. HRT for menopause remains the most effective option, helping up to 75% of women find relief. For those who can't use hormones, newer medications like fezolinetant offer real alternatives. Even talking therapies like CBT can help you develop better coping strategies, particularly when combined with natural remedies for menopause.
The best approach combines several strategies tailored to your specific needs and health history. Regular exercise during menopause, stress management, and proper nutrition all work together with medical treatments. Don't suffer in silence—if symptoms are disrupting your daily life or sleep, speak to your GP.
Most importantly, remember that hot flushes do improve with time. Around 80% of women find their symptoms ease within two years. This challenging phase will pass, and with the right support and management strategies, you can maintain your quality of life throughout the transition.
Key Takeaways
Understanding hot flushes and their management can significantly improve your quality of life during menopause. Here are the essential insights to help you navigate this natural transition:
• Hot flushes affect 65% of menopausal women due to declining oestrogen levels disrupting the brain's temperature control centre • Simple lifestyle changes like avoiding caffeine, alcohol, and spicy foods can reduce hot flush frequency and intensity by up to 40% • HRT remains the most effective treatment, reducing symptoms by 75%, whilst new non-hormonal options like fezolinetant offer alternatives • Wearing breathable fabrics, staying hydrated, and using cooling strategies provide immediate relief during episodes • Most women experience symptom improvement within two years, making temporary management strategies worthwhile
The key to successful hot flush management lies in combining practical lifestyle adjustments with appropriate medical treatment when needed. Don't suffer in silence—speak to your GP if symptoms significantly impact your daily life or sleep quality.
FAQs
Q1. What are the most effective treatments for menopausal hot flushes in the UK? Hormone Replacement Therapy (HRT) is considered the most effective treatment, reducing hot flushes by up to 75% for most women. For those who can't use HRT, non-hormonal options like fezolinetant (Veoza) and clonidine are available. Cognitive behavioural therapy (CBT) is also recommended by NICE guidelines as an effective management strategy.
Q2. How can I naturally manage hot flushes during menopause? Natural management strategies include wearing breathable fabrics, staying well-hydrated, using fans or cooling sprays, and avoiding triggers like caffeine, alcohol, and spicy foods. Regular exercise, stress reduction techniques, and maintaining a cool sleep environment can also help reduce the frequency and intensity of hot flushes.
Q3. When should I consult a GP about menopausal hot flushes? It's advisable to speak with your GP when hot flushes begin to disrupt your daily life or sleep patterns. Early consultation can help reduce the impact of perimenopause and menopause on your overall health, relationships, and work life.
Q4. Are there any non-hormonal medications available for treating hot flushes? Yes, there are several non-hormonal options. Fezolinetant (Veoza) and elinzanetant (Lynkuet) are newer medications specifically targeting hot flushes. Clonidine has been used for longer, and some selective serotonin reuptake inhibitors (SSRIs) have shown effectiveness in managing hot flushes as well.
Q5. How long do menopausal hot flushes typically last? For approximately 80% of women, hot flushes persist for two years or less. However, experiences can vary significantly between individuals. Some women may experience hot flushes for a shorter period, while others may have symptoms that last longer. Most women find their symptoms improve over time.
References
[1] - https://www.drlouisenewson.co.uk/knowledge/hot-flushes-explained
[2] - https://www.bupa.co.uk/newsroom/ourviews/symptoms-menopause-hot-flushes
[3] - https://www.rcog.org.uk/media/kihaya3e/pi-treatment-symptoms-menopause.pdf
[4] - https://pmc.ncbi.nlm.nih.gov/articles/PMC12051537/
[5] - https://www.bodylogicmd.com/blog/the-role-of-oestrogen-in-hot-flashes/
[6] - https://kinetikwellbeing.com/hot-flush-menopause/
[7] - https://healthmatters.nyp.org/how-to-protect-your-brain-health-during-menopause/
[8] - https://my.clevelandclinic.org/health/symptoms/16562-night-sweats
[9] - https://www.hopkinsmedicine.org/health/conditions-and-diseases/introduction-to-menopause
[10] - https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-study-suggests-caffeine-intake-may-worsen-menopausal-hot-flashes-night-sweats/
[11] - https://delamere.com/blog/why-menopause-and-alcohol-dont-mix
[12] - https://www.menopausecliniclondon.co.uk/blog/4-ways-to-keep-your-cool-when-having-hot-flushes
[13] - https://www.healthspan.co.uk/advice/body/menopause-how-stress-can-impact-your-experience-of-hot-flushes/?srsltid=AfmBOoqWs95YI4gpwQtM2UIi2hHDhk1soccJH8bRBOzMf0ZLeacW5EA2
[14] - https://health.clevelandclinic.org/hot-flashes-anxiety
[15] - https://pmc.ncbi.nlm.nih.gov/articles/PMC2673540/
[16] - https://public-health.uq.edu.au/article/2019/11/women-encouraged-maintain-weight-and-quit-smoking-reduce-menopausal-symptoms
[17] - https://thewomenshealth.clinic/faq/what-fabric-choices-help-with-hot-flushes/
[18] - https://www.bonaparteshop.com/en-eu/inspiration/menopause-less-sweat-breathable-materials
[19] - https://healthandher.com/blogs/expert-advice/how-to-dress-for-hot-flushes
[20] - https://thesolutionbeauty.co.uk/products/the-solution-menopause-hydrating-cooling-mist?srsltid=AfmBOooo9GNbug93eYh7WidxiT2o4Bd5XBBosM2F6c0aRPjGUaBcnGPd
[21] - https://www.thewoolroom.com/en-gb/blogs/learning/night-sweats-and-sleep?srsltid=AfmBOoq70ry1oShhp0bPZvg8G6QXNg-K2vGUmYVw3h6zJ_Tl1TJlFR_G
[22] - https://www.cancerresearchuk.org/about-cancer/coping/physically/sex-hormone-symptoms/women-coping-with-hormone-symptoms/hot-flushes-and-sweats
[23] - https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795
[24] - https://hormonehealth.co.uk/importance-of-staying-hydrated-during-menopause-hormone-health
[25] - https://www.nhs.uk/conditions/menopause/symptoms/
[26] - https://www.nhs.uk/conditions/menopause/treatment/
[27] - https://www.nuffieldhealth.com/article/hot-flashes-and-the-menopause
[28] - https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/
[29] - https://thebms.org.uk/2023/12/bms-update-fezolinetant-licenced-by-the-mhra/
[30] - https://thebms.org.uk/wp-content/uploads/2024/09/04-BMS-ConsensusStatement-Non-hormonal-based-treatments-SEPT2024-A.pdf
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[32] - https://www.gov.uk/government/news/mhra-approves-elinzanetant-to-treat-moderate-to-severe-vasomotor-symptoms-hot-flushes-caused-by-menopause
[33] - https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/alternatives-to-hormone-replacement-therapy-hrt/herbal-remedies-and-complementary-medicines-for-menopause-symptoms/
[34] - https://www.nice.org.uk/guidance/ng23/resources/access-to-cognitive-behavioural-therapy-cbt-13553197309
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