Hot flushes and night sweats are some of most commonly recognised symptoms of menopause. Together with palpitations, they are collectively termed vasomotor symptoms and 75% of women will experience one or more of these at some point in their menopause transition. However, they vary greatly from woman to woman in frequency, duration and intensity.
What is a hot flush?
This is described as a passing feeling of intense heat in the upper body, arms and face. In some women this is accompanied by visible flushing and then profuse sweating. It can last for a few seconds or minutes and only happen occasionally or up to several times a day.
What is a night sweat?
It is normal to sweat at night if your room temperature is warm or you’re under too many layers. However, a night sweat as a symptom of peri/menopause is when you sweat so much that your night clothes and bedding are soaking wet, even though your sleeping environment is cool.
What are palpitations?
A palpitation is when your heartbeat becomes more noticeable.
Your heartbeat may feel like it is:
- racing or beating very fast
- irregular, with missed or extra beats
- pounding or thumping
- fluttering
Heart palpitations can last for a few seconds, minutes or longer.
Some common reasons for palpitations are:
- strenuous exercise
- lack of sleep
- stress and anxiety
- medication
- alcohol, caffeine, nicotine and recreational drugs
And some women experience palpitations as a result of hormone changes such as in peri/menopause or in pregnancy.
Palpitations can be common in perimenopause and menopause but if they are associated with any chest pain, dizziness, nausea, or breathlessness, talk to your doctor about this.
Everyday impact of symptoms
Hot flushes, night sweats and palpitations can cause considerable anxiety and distress for women going through perimenopause and menopause. Having a hot flush in public can be embarrassing for some women and night sweats inconvenient when they necessitate a complete change of bed clothes and/or bedding in the middle of the night.
Palpitations can also be worrying to experience, especially if you’ve never had them before. Many women assume there is something wrong with their heart function and can even end up seeing heart specialist doctors because of these symptoms.
What causes vasomotor symptoms?
The exact mechanism is not entirely understood. It is believed that fluctuating estrogen levels in perimenopause causes the area of the brain that controls temperature (the hypothalamus) to reset, narrowing the normal body temperature range. This means it only takes a slight increase in body temperature for a woman to sweat – which is the body’s natural way of losing heat. The sweating then reduces her temperature which in turn falls below what the brain perceives to be normal, and she may start to shiver – the body’s attempt to warm up. This is the on-off scenario well known to women who experience hot flushes and night sweats.
Any woman can be affected by vasomotor symptoms once in perimenopause and menopause however, they are more common in women who smoke.
How long do women have vasomotor symptoms?
You may notice these symptoms before your periods stop but they are most common in the first year after the final period. On average, if left untreated, these types of symptoms will last for approximately 7-8 years, and some women continue to have them for decades after finishing periods.
Are there any health risks associated with having vasomotor symptoms?
Studies have shown that women who experience hot flushes are at increased risk of a future heart attack or stroke. And it is thought that the severity of the hot flushes are more of a risk factor than how often they occur or for how long.
In addition, women who have hot flushes have been shown to have worse memory. This is felt to be due to a combination of these factors:
- when having a hot flush, there is a temporary disruption of blood flow to the brain, which over time can affect brain function
- night sweats can significantly disrupt sleep and poor sleep is known to contribute to worsening memory
- experiencing vasomotor symptoms can lower your mood, which in turn can affect cognitive functions like memory.
How can I help my vasomotor symptoms?
If you smoke, it is important to stop altogether. Smoking is known to make these symptoms worse, as well as raise your risk of many diseases of the heart, lungs and risk of cancer or stroke.
Avoid triggers and work out which of these could be exacerbating your symptoms:
- caffeine
- hot drinks
- alcohol
- spicy foods
Maintain a cool bedroom temperature and consider separate duvets to your partner if you share your bed. You may want to use a sheet and top layer so you can vary what covers you according to your internal thermostat as it varies during the night.
Consider what you wear in the day and night, layers will be your friend, and stick to natural fibres or those that wick away moisture like cotton, linen, or wool.
Invest in a fan or three! You may want one by your bed, in the lounge and where you work. In summer months, if you’re extra hot, try placing a bottle of frozen water in front of the fan, the air will cool as it comes across you like DIY air conditioning!
Stay calm. A hot flush in a public place can increase anxiety which further exacerbates the hot flush. Practice some breathing or grounding techniques so you have them well practiced and at your disposal when the heat and feelings of panic come on.
Cognitive Behavioural Therapy is a talking therapy that has been shown to benefit women experiencing hot flushes. The therapy focuses on the link between your thoughts, feelings and behaviour. Try to remember, each flush is only going to last a short time and it will pass. If you feel CBT might help, you can look for a therapist here.
What treatments are available for vasomotor symptoms?
The most effective treatment for symptoms that result from a lack of estrogen is to replace the estrogen. Hormone Replacement Therapy (HRT) is recommended by the National Institute for Health and Care Excellence (NICE) as first line treatment for vasomotor symptoms for most women, as the benefits of HRT outweigh any risks.
Estrogen delivered across the skin via a patch, gel or spray, when used at an appropriate dose, can relieve hot flushes, night sweats and palpitations in weeks for most women.
In recent years, a new group of drugs have been successfully trialled and licensed to directly target the process that causes the onset of vasomotor symptoms. These are especially important for women who have been told HRT is not recommended for them, or those who choose not to use HRT.
Neurons in the brain called KNDy become overactive when estrogen levels drop and they release substances called kisspeptin and neurokinin B (NKB) which can trigger hot flushes and night sweats. Medication has been developed to block NKB, known as NK antagonists, which calms the overactive neurons and reduces vasomotor symptoms. A drug called Fezolinetant (brand name Veoza) is available on private prescription or on the NHS if HRT is not indicated as the best option for a woman. The other medication is Elinzanetant (brand name Lynkuet), which may not only reduce hot flushes but also improve sleep problems.
Some menopause specialist doctors prescribe a medication called Oxybutynin in low doses for vasomotor symptoms for women who cannot take HRT. This is normally used as a treatment for an overactive bladder so it is prescribed ‘off-license’ for improving vasomotor symptoms. It might be dispensed as generic oxybutynin or under brand names, such as Ditropan, Aspire, or Kentera (a transdermal skin patch). The drug affects the body’s internal thermostat in two ways: it blocks acetylcholine receptors in the brain’s hypothalamus, which helps stabilise the body’s core temperature set-point. And it blocks the nerve signals that stimulate the eccrine sweat glands, preventing the body from sweating excessively. Women can experience side effects when taking oxybutynin such as dry mouth and dry eyes, constipation and stomach pain, blurred vision or mild dizziness.
Antidepressants known as SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-norepinephrine reuptake inhibitors) are not recommended as first line treatment. These medications should also not be used for low mood associated with peri/menopause unless there is a separate diagnosis of depression. These medications are sometimes used for hot flushes in women who have a contraindication to HRT. Some studies have shown a reduction in symptoms ranging from 20-50% reduction in hot flushes for example, but side effects relating to decreased sexual function are common.
At present there is insufficient evidence, inconclusive results or studies that show no benefit from taking herbal medicines for hot flushes including: black cohosh, dong quai, St John’s Wort and evening primrose.
If hot flushes, night sweats or palpitations are bothering you, contact our team to discuss improving your symptoms.
Last updated: July 2026
