Hot flashes and night sweats

Hot flashes — hot flushes, if you learned the word in Britain — are the symptom most people picture when they think of menopause, and for good reason. They are the most common change of the whole transition, and for a lot of women they are the first thing that makes it undeniable. The clinical name is vasomotor symptoms, which just means symptoms to do with the widening and narrowing of blood vessels.

What a hot flash actually is

Your body keeps its core temperature inside a narrow comfortable band. As estrogen rises and falls less predictably in perimenopause, that band seems to get narrower, so a small change in temperature that you would once have ignored now trips the alarm. The brain’s temperature centre reacts as if you are overheating and does what it would do on a hot day: it opens the blood vessels near the skin and switches on sweating to dump heat fast. That is the flush, the racing heart, and then the chill as the sweat evaporates.

None of it is in your head, and none of it means anything is wrong with you. The SWAN study — the Study of Women’s Health Across the Nation, which followed thousands of women through the transition for years — found that vasomotor symptoms are not only common but often last far longer than the “year or two” women are led to expect. For many they run for several years, and for some longer than that.

Why the night ones are the worst

A night sweat is the same event in the dark. It wakes you, often around the same early hour, and the problem is rarely the heat itself — it is that you are now awake, damp, and running the day ahead. This is why hot flashes and broken sleep travel together, and why fixing the nights matters as much as the days. If that early wake is your real complaint, start with the 3 a.m. wake.

What genuinely helps

There is a lot of noise here, so it is worth separating the small levers from the two things with the strongest evidence behind them.

• The small levers: layers you can shed, a cooler bedroom, and noticing your own triggers — for many people alcohol, caffeine, a hot room or a spike of stress. These help at the edges.
• Hormone therapy is the most effective treatment for hot flashes and night sweats. The Menopause Society’s 2022 position statement is clear that for healthy women within about ten years of menopause, its benefits generally outweigh its risks. It is worth an honest conversation, not a flat no left over from an old scare — see hormone therapy after the scare.
• Cognitive behavioural therapy has real randomized-trial support here. The work of Hunter and Smith showed that CBT reduces how much hot flashes and night sweats disrupt your life and how distressing they feel, even when it changes the raw number of them less. How you meet a flush changes the flush.

How Still Me helps

Still Me is a coach, not a clinic, so it will not prescribe. What it does is meet the moment and help you get seen. Its Right now page has a short wind-down for a flush — slow the breath, drop the story, let the wave pass — instead of lying there bracing against it. Because the coach remembers, it can notice the pattern you would not spot yourself, the way your worst nights follow the wine or the late email. And when it is time to ask for more, the doctor-prep session turns all of that into one page you can hand over, so you are describing a record instead of trying to remember in the room.

Grounded in the SWAN study (Study of Women’s Health Across the Nation); the CBT-for-hot-flushes trials of Myra Hunter and Melanie Smith; Jen Gunter, The Menopause Manifesto; and The Menopause Society’s 2022 Hormone Therapy Position Statement.