Some Like It Hot

Hot flashes and night sweats in perimenopause

I don’t know the moment when hot became cool, transitioning from a simple temperature description to a term that indicates something desirable. The use of “hot” in advertising, music, and entertainment showcases how it has become deeply ingrained in our perceptions of attractiveness, influencing everything from fashion to personal relationships.

But hot in perimenopause signifies something else completely: hot flashes and night sweats. Both of these symptoms fall under the umbrella term of “vasomotor symptoms” and are the exact same thing, just at different times. Hot flashes happen in the day and night sweats happen when sleeping. For this article, I’ll call them both “hot flashes” to make things easier.

Hot as Hades

In Western countries, between 70 – 80% of women will experience hot flashes at some point, either in perimenopause or menopause. The confusion about hot flashes stems from the fact that we can develop them at different times from each other.

Some women develop hot flashes during perimenopause (usually not the first sign, though, this article explains further) even while having regular menstrual cycles, and some women develop them only after their final menstrual period. It’s also not uncommon for women in their 60s to have them, depending on when they started.

Hot flashes can be:

• Mild (only you notice)

• Moderate (sweat is visible to others)

• Severe (frequent and intense, debilitating; about 30% of the women who get hot flashes)

They used to think that hot flashes as a symptom lasted 2 – 3 years, but researchers now know that they can last 7 – 10 years. 2 - 3 years may have been accurate at some point, but our lives have changed dramatically in recent decades. They also know that women with infrequent or less intense hot flashes tend to continue for more than 10 years.¹

Fancy a game of Would You Rather?

Would you rather have more frequent and intense hot flashes for 7 – 10 years, or would you rather have less frequent and intense hot flashes for 15 years?

What Do Hot Flashes Feel Like?

For me, a hot flash follows the same pattern.

1. First, I’ll get a sense of doom which I now can recognize that a hot flash is coming. Before, this feeling would freak me out, as if my intuition was trying to tell me something I wasn’t noticing. It would also up my anxiety, which is not something you want when you get a hot flash.

2. Then, I’ll get a prickly sensation like a chemical surge coursing through my veins.

3. I’ll get a little lightheaded, like a head rush.

4. I’ll break out into a sweat or have a feeling of heat.

5. Depending on the severity, I’ll get the chills after, but this mostly happened earlier in perimenopause for me.

I’ve also noticed that, in general, I sweat pretty easily. I often have a change of clothes with me when I go out in case I need to freshen up.

Other women have reported the following:

• General sense of being warmer than normal all of the time

• Pins and needles feeling

• Impending doom

• Profuse sweat in literally seconds

• A sudden rush of heat through body

• Head rush

• Redness

• Intense heat followed by chills and feeling soaked

• Warm rush down your legs

• Racing heartbeat

• Dizzyness

• Weakness

• Difficulty breathing

• Nausea

• Lightheadedness

• Wet ears (which I think is body heat “melting” ear wax or the ear canal sweating)²

Risk Factors

If 70 – 80% of Western women are getting hot flashes at some point, I don’t think risk factors are all that important to consider except for maybe their intensity of them. Other than how I used to manage stress (by ignoring it), I don’t have any of the risk factors for hot flashes, and yet I used to get them pretty intensely.

The risk factors are:

• Smoking

• Socioeconomic status/low education

• Obesity (for developing hot flashes earlier, but not a risk factor for later development post-menopause)

• Black/African American (in the U.S.)³

• Stress, anxiety, depression

• History of childhood abuse⁴

Why Do They Happen?

Scientists now know how hot flashes happen, but they still don’t know why. It’s very hard to study a female brain while the female is still alive.

The body’s temperature regulation system relies on estrogen. This system is located in a part of the brain called the hypothalamus, which is located in the part of the brain called the limbic system (which also controls emotion. This tidbit is important to know in a minute).

This part of the brain also controls our autonomic nervous system, which manages those things we can’t consciously control, like digestion and temperature regulation. If you’d like to better understand this system, read this section of this article.

You probably didn’t realize before that our body is constantly scanning the environment so that it can make changes within the autonomic nervous system to ensure our comfort. If our body notices that we’re getting too hot, it will sweat, and if it notices that it’s getting too cold, we’ll shiver.

This system can become a bit dysregulated during perimenopause/menopause and will think your body is overheating more often, causing the cascading effects of hot flashes. The system narrows the range of what your body should be comfortable within.

When a hot flash happens, the body intuitively knows how to expand the blood vessels near the skin to allow more blood to release body heat. This causes flushing and sweating which can be followed by chills after the body heat has been released.

Other things can cause hot flashes, so although they are a telltale sign of perimenopause and menopause, it’s best to get checked by a doctor for confirmation that nothing else is going on.

When Do They Happen?

I already mentioned a bit of this above, but I’ll also mention here that hot flash intensity can change depending on where you are in your menstrual cycle. My Menopause Society-certified GYN also says she’s seen a link between the seasons and hot flashes, so she wasn’t surprised when I said mine were getting bad again in the fall.

If you’ve already developed hot flashes, you may have noticed what triggers them, like alcohol, spicy foods, lack of sleep, stress, and caffeine.

They can happen throughout the day and night or only occasionally. Everyone is different.

Because hot flashes stem from the part of the brain that controls emotions, I always say, “Hot flashes are a physical manifestation of an emotion,” and that’s when I feel them the most. When I have a thought that triggers an emotion, it creates a response that gives me a hot flash.

If you’re getting them and you can’t figure out your triggers or you don’t know why they keep happening, please don’t be hard on yourself. It’s not you. We can only control so much while these hormones are jumping all over the place in perimenopause. Even scientists haven’t figured out everything we need to know about hot flashes so I caution against using this as a weapon on yourself. It is what it is.

Hot flashes can last up to 5 minutes, but some are short, about a minute. Mine are about 2 minutes “all in” from the initial sense of doom and heat to the resolution. However, I’ve also had quick ones. Sometimes, I just have the anxiety of a hot flash without the full-on sweating, which I would classify as mild, but they still leave me feeling gross.

Some other questions you may have:

Can diet help? There’s no “compelling data” showing that a healthy diet helps prevent the onset of hot flashes; however, eating a healthy diet, especially at midlife, is always a good idea for better health overall. They used to think that Asian women had a lower incidence of hot flashes because they ate more soy, but that theory doesn’t have enough supporting science to make eating soy an official recommendation for hot flashes. However, I spoke with a nutrition researcher at the NIH’s Office of Research on Women’s Health at a menopause conference last year, and she felt that soybeans were helpful (as in whole soybeans, not soy-based products).

Does using GLP-1s like Wegovy or Ozempic help hot flashes? There is a risk factor of developing hot flashes earlier in perimenopause while being obese (as mentioned above). However, there is no data yet showing if GLP-1s help hot flashes or if because GLP-1s help weight loss that it could reduce the risk factor of hot flashes. This is something of interest to researchers, but there’s a long list and limited resources. It could be some time before we know.

What other things can cause more severe hot flashes? Researchers know that women who have had their ovaries removed pre-menopause have more intense hot flashes but are not as affected if they have their ovaries removed post-menopause. I heard one doctor say that women who have had their ovaries removed pre-menopausally can have a lifetime of hot flashes.

Medical menopause also can cause severe hot flashes. Developing premature ovarian insufficiency (a condition that can occur before age 40) has not been studied enough to know its effects on developing hot flashes.

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What’s Next?

There’s still so much that scientists don’t know about vasomotor symptoms of perimenopause and menopause, but the good news is that they are taking it seriously and keeping this at the forefront of menopause research.

“It is not yet fully known whether treating vasomotor symptoms will improve cardiovascular, bone, or neurocognitive health, but treating vasomotor symptoms may be critical to improving women’s mood, sleep, and overall functioning” during perimenopause and menopause. ⁵

This is not to say that hormone therapy can fix these things, but it’s possible that by reducing the unpleasantness of vasomotor systems, we can improve a woman’s life. This has become very important in women’s health research.

Need Help?

If you're looking to better understand hot flashes and explore some helpful lifestyle tips for managing them, as well as learn more from an educational perspective about treatment options available, consider scheduling an appointment with me to get all of your perimenopause questions answered. Click here to learn more about how I can help you reclaim hours of research on your own!

I'm currently booking sessions for February and March (there are a few slots still available in January; first come, first served).

Be well, stay cool….

Shelby Tutty, MHA
Certified Perimenopause Educator
Founder of The Periprofessional, LLC

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1. Thurston, Rebecca C. PhD, FABMR, FAPS. Basics of vasomotor symptoms. Menopause 31(12):p 1085-1086, December 2024. | DOI: 10.1097/GME.0000000000002479

2. I mentioned this yesterday on Threads and currently have over 100 comments from women talking about their wet ears, over 370 likes, and over 20,000 views on the post.

3. Based on The Study of Women’s Health Across the Nation (SWAN) which showed that this group has a higher risk of developing hot flashes that last longer and become more bothersome.

4. These risk factors were discussed in a member’s webinar with The Menopause Society, which was held on December 19, 2024.

5. Thurston, Rebecca C. PhD, FABMR, FAPS. Basics of vasomotor symptoms. Menopause 31(12):p 1085-1086, December 2024. | DOI: 10.1097/GME.0000000000002479