In short
A hot flush is a sudden wave of heat, usually in the face, neck and chest, often with sweating and a racing heart. Most are caused by the hormone changes of perimenopause and menopause. They can continue for seven years or more. Hormone therapy is the most effective treatment, and non-hormonal options and CBT also help.
On this page
What is a hot flush?
A hot flush is a sudden feeling of intense heat that spreads through the face, neck and chest. Your skin may redden, you may sweat, and your heart may race. It usually passes within a few minutes and can leave you chilled afterwards. Hot flushes that happen at night are called night sweats.7
Some women have one or two a week. Others have several an hour.
Why do hot flushes happen?
Hot flushes are the body’s cooling system firing when it doesn’t need to. Falling oestrogen changes the activity of a group of nerve cells in the brain’s temperature control centre, which makes the brain react to tiny rises in body temperature by opening blood vessels in the skin and triggering sweating.2
That is why they are so common around perimenopause and menopause. They can also follow surgery that removes the ovaries or treatments that lower oestrogen.
Symptoms getting in the way of your day?
Talk it through with an Australian doctor online. No referral needed.
How long do hot flushes last?
Longer than most women are told. In a study that tracked women through the menopause transition, frequent hot flushes and night sweats lasted more than seven years for over half of the women who had them. Women whose flushes began before their periods stopped had them the longest.1
Common triggers
Many women notice that flushes are set off by alcohol, hot drinks, spicy food, warm rooms, stress or smoking. Dressing in layers, keeping the bedroom cool and using a fan are sensible steps. They haven’t been properly tested in trials, so think of them as comfort measures, not treatment.4
What helps hot flushes
- Menopausal hormone therapy. The most effective treatment. For most healthy women under 60, or within ten years of their final period, expert bodies consider the benefits outweigh the risks. Your doctor will weigh it against your own health history3,4
- Non-hormonal prescription medicines. Several are recommended for women who can’t take hormones, such as some women who have had breast cancer, or who prefer not to4,10
- Cognitive behavioural therapy (CBT). CBT doesn’t stop flushes, but in a randomised trial it made them much less of a problem, cut night sweats, and improved mood. A self-help version worked about as well as group sessions5
- Clinical hypnosis and weight loss. Both are supported by an expert review of non-hormonal options4
What doesn’t have good evidence
An expert review of non-hormonal treatments advised against relying on supplements and herbal products for hot flushes, because trials have been small, inconsistent or negative. The same review found that cooling techniques, avoiding triggers, yoga and exercise don’t reliably reduce flushes.4
A Cochrane review reached the same conclusion on exercise: there isn’t enough evidence that it treats hot flushes. It is still worth doing for your heart, bones, sleep and mood.6
Other causes of flushing and sweating
Not every flush is menopause. An overactive thyroid, infections, some medicines, alcohol, anxiety and, rarely, other medical conditions can cause flushing or drenching sweats. Other causes are more likely if you are under 45, or if the sweats come with fever, weight loss or feeling unwell.7,8
When to see a doctor
- Hot flushes that disrupt your sleep, work or daily life
- Flushes or night sweats before age 45
- Sweats with fever, unexplained weight loss, a cough that won’t go away or swollen glands
- Any vaginal bleeding after menopause
Many women put up with hot flushes for years. In an Australian study, most women with moderate to severe symptoms weren’t using any effective treatment.9
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-9.
- Rance NE, Dacks PA, Mittelman-Smith MA, et al. Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: a novel hypothesis on the mechanism of hot flushes. Front Neuroendocrinol. 2013;34(3):211-27.
- “The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
- New Collective Author. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
- Ayers B, Smith M, Hellier J, et al. Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause. 2012;19(7):749-59.
- Daley A, Stokes-Lampard H, Thomas A, et al. Exercise for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2014;2014(11):CD006108.
- healthdirect. Hot flushes due to menopause.
- Bryce C. Persistent Night Sweats: Diagnostic Evaluation. Am Fam Physician. 2020;102(7):427-433.
- Worsley R, Bell RJ, Gartoulla P, et al. Low use of effective and safe therapies for moderate to severe menopausal symptoms: a cross-sectional community study of Australian women. Menopause. 2016;23(1):11-7.
- Jean Hailes for Women’s Health. Treatments for menopause.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.