You wake up in the middle of the night, drenched in sweat. Or you suddenly feel the urge to open a window, even though it’s a cold winter day. If you’re in your 40s or 50s and this sounds familiar, you could be in perimenopause.

Night sweats and hot flashes are two of the most common symptoms of perimenopause, the transition leading up to menopause. The good news is that treatments and lifestyle changes can help you manage these symptoms and feel more comfortable.

What Do Night Sweats and Hot Flashes Feel Like?

Perimenopause is different for everyone. Some women experience frequent or severe hot flashes over a period of seven to 10 years, while others have mild or infrequent episodes.

Hot flashes can cause:

• A sudden feeling of warmth or heat, often in the face, neck, or chest
• Flushed, reddened, or darkened skin
• Increased heart rate
• Anxiety
• Sweating or chills as the body cools down

Most hot flashes last for a few minutes, though some may last up to five minutes.

Night sweats are hot flashes that happen when you’re asleep. They can cause heavy sweating that soaks pajamas or bedding. They often wake you up and make it difficult to fall back asleep.

Night sweats and hot flashes can feel confusing and, at times, frustrating. You may feel intensely hot while people around you say the room feels comfortable or even chilly. But you are definitely not alone.

How Common Are Night Sweats and Hot Flashes?

Night sweats and hot flashes are very common during perimenopause. About 2 million women in the U.S. enter perimenopause each year. When looking at the entire menopause transition, from perimenopause to postmenopause, up to 80 percent of women experience hot flashes and night sweats. Women who start having them before menopause are more likely to continue having them for a longer time.

Hot flashes are most likely in the year after your last period, but the timing and severity can vary. Up to a third of women have several hot flashes daily during this phase.

What Causes Night Sweats and Hot Flashes?

Night sweats and hot flashes are vasomotor symptoms of menopause. Vasomotor means they’re related to the widening or narrowing of blood vessels.

Your body usually keeps its core temperature within a narrow range. If you get too hot, it sends more blood to the skin or triggers sweating to help you cool down. If you get too cold, it pulls blood away from the skin or causes shivering to generate heat and warm you up. Most of this is driven by a part of the brain called the hypothalamus.

Estrogen also plays an important role in regulating body temperature. During perimenopause, estrogen levels begin to decline, which may confuse the brain’s temperature-control system. As a result, the body may suddenly react as if it’s too hot, even when it isn’t. In response, blood vessels near the skin widen, leading to flushing and sweating.

In addition to hormonal changes, certain factors such as stress, alcohol, caffeine, or spicy foods can trigger or worsen hot flashes in some people.

How Do Vasomotor Symptoms Affect Quality of Life?

Vasomotor symptoms of menopause can significantly affect quality of life. For many women, these symptoms disrupt sleep, daily activities, and emotional well-being.

One woman told ThisIsMenopause, “I’ve lost so much sleep due to hot flashes, night sweats, and achy joints.” Another said, “The hot flashes are very real. I didn’t know that it meant that you would sweat so bad in a matter of seconds.”

What Women Are Saying About Hot Flashes

“I have massive hot flashes. I feel hot all the time.”

“I wish other people could experience hot flashes for a day just to see what it feels like.”

“I wish the hot flashes would go away so I can sleep more peacefully.”

“Put on a jacket and every blanket you own. Now take it off. Get cold and repeat until you die!”

While night sweats and hot flashes can affect your quality of life, help is available. Working with an OB-GYN, or another healthcare provider who is knowledgeable about menopause, can help you understand your symptoms and find effective treatment options.

Treatment Options

Night sweats and hot flashes are the menopausal symptoms for which women most often seek treatment. Medical treatment options include hormone therapy and nonhormonal medications.

Hormone Therapy

Menopause hormone therapy, also known as hormone replacement therapy (HRT), can be an effective treatment for night sweats and hot flashes. It works by providing some of the estrogen your ovaries produce less of as you approach menopause. Hormone therapy can also help relieve other menopause symptoms, including mood swings, vaginal dryness, and brain fog.

The U.S. Food and Drug Administration (FDA) has approved hormone therapy in several forms. These include pills, skin patches, gels, sprays, and vaginal products.

If you’ve had a hysterectomy, you may be able to take estrogen alone. If you still have your uterus, you also need progesterone to reduce the risk of uterine cancer.

Another treatment option combines estrogen with a medication called bazedoxifene. In addition to helping with vasomotor symptoms, this combination helps prevent osteoporosis, another condition linked to declining estrogen levels. This medication is ideal for postmenopausal women with a uterus who need hot flash treatment and prevention of bone loss.

While hormone therapy can be effective in relieving symptoms, it isn’t the right choice for everyone. Talk to your doctor about your personal risk factors and whether hormone therapy is appropriate for you.

Nonhormonal Medications

Several nonhormonal medications can also help reduce night sweats and hot flashes. These include medications that are specifically designed to treat hot flashes and other drugs that have many uses. Possible nonhormonal options include:

• Antidepressants — Certain selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs) can help regulate the brain signals involved in temperature control. One option is low-dose paroxetine, an SSRI approved by the FDA to treat vasomotor symptoms.
• Elinzanetant (Lynkuet) and fezolinetant (Veozah) — These medications are FDA approved for hot flashes and work by blocking molecules in the brain that cause hot flashes. Elinzanetant has also been studied on women with a history of breast cancer.
• Gabapentin — This anti-seizure medication can reduce nighttime symptoms for some people.
• Oxybutynin — This medication is also used to treat urinary conditions.

Both hormonal and nonhormonal medications can cause side effects. Always ask your healthcare provider about the risks and benefits of each treatment option.

Lifestyle Changes

Certain lifestyle changes may also help reduce the frequency or intensity of night sweats and hot flashes. There is limited scientific evidence on lifestyle changes for menopause symptoms. However, limiting stress and getting enough sleep, movement, and nutritious food can benefit your overall health and may make symptoms easier to manage.

Some women find that a combination of medication and lifestyle strategies works best for hot flashes and night sweats.

Consider these tips for hot flashes:

• Avoid spicy foods, caffeine, and alcohol, as these can trigger hot flashes for some women.
• Wear layers so you can easily adjust if you get too warm.
• Stay cool by sitting in a cold room when possible.
• Try relaxation exercises like yoga, tai chi, or stretching.
• Explore mindfulness meditation and deep breathing.
• Consider cognitive behavioral therapy (CBT) or another type of therapy to help manage stress.

Here are some practices that may help with night sweats:

• Keep your bedroom cool at night by setting the thermostat lower.
• Use fans to keep air moving, or open the windows if it’s safe.
• Try cooling sheets or a cooling mattress pad.
• Use a moisture-wicking blanket.
• Sip cold water if you wake up during the night.
• Keep a cold pack under your pillow, and flip your pillow as needed.

Some people try supplements and natural remedies like black cohosh, vitamin E, or evening primrose oil. However, there is limited evidence that these are effective treatments, and many supplements have side effects or interact with medications. Always talk to your doctor before trying any new product, even over-the-counter supplements.

Hot flashes and night sweats can be disruptive, but treatments are available. With the right care, support, and strategies, midlife can be the start of an exciting new chapter, one where you feel informed, supported, and comfortable in your body.