Hot Flashes: How to Get Relief Before, During, and After Menopause

[Originally published: Sept. 23, 2024. Updated: Dec. 18, 2024.]

The term “hot flash” may not fully capture the waves of sudden heat that an estimated 75% of women experience as they move through menopause, a life change marked by a full year without menstruation.

When hot flashes occur at night—also known as night sweats—they can be especially disruptive, says Hugh Taylor, MD, chair of Yale Medicine Obstetrics, Gynecology & Reproductive Sciences.

“If hot flashes happen throughout the night, they wake you up and disrupt your sleep. As a result, you’re tired all the time, and it can greatly impact your quality of life. In some women, hot flashes are accompanied by anxiety, heart racing, or palpitations, which can interfere with their jobs and relationships,” Dr. Taylor says. “We shouldn’t trivialize hot flashes. And I’m afraid that a term like hot flash makes it sound not as bad as the reality. For some women, these symptoms can be disabling.”

The average age of menopause in the United States is 51. But often, hot flashes begin in perimenopause, the phase before menopause that can last four to eight years. Studies show wide variability in how long hot flashes last, but the average is seven to nine years.

“We used to think that, for more than two-thirds of women, all hot flashes recede and eventually go away within five years of menopause onset,” says Lubna Pal, MBBS, MS, a Yale Medicine reproductive endocrinologist and infertility specialist. “We now have better clarity. For some women, hot flashes may continue into their 60s and 70s.”

Most importantly, women shouldn’t suffer silently through hot flashes or any menopausal symptoms, the doctors say. Medications, including nonhormonal options, can help. And for some women, lifestyle modifications might bring relief if their hot flashes are mild.

Below, we talk more with Drs. Taylor and Pal about hot flashes and how they can be managed.

Hot flash is the term used to describe a sudden and intense sensation of heat mainly involving the upper body—typically the chest, neck, and face. Hot flashes typically only last one to five minutes but can happen anywhere from one to 10 or more times a day. They may also be accompanied by clammy or flushed skin, a sense of anxiety, a fluttery or fast heartbeat, and sweating. “The sudden wave of heat is often followed by chills, which can be equally—if not more—bothersome than the flash of heat and sweating," adds Dr. Pal.

“The underlying causes and triggers of hot flashes are not completely understood, but we know that the hormone estrogen is relevant. The fluctuations in estrogen levels in perimenopause and the loss of ovarian estrogen at menopause play a role,” Dr. Pal says. “When the body has dropping estrogen levels, the temperature fluctuates more.”

That’s because estrogen directly affects the “conductor” of an “orchestra” that helps regulate the body’s inner temperature, Dr Pal adds. This conductor is made up of a small collection of brain cells that occupy a tiny area of the brain called the hypothalamus; these cells, in turn, help regulate the body's temperature control center, also located within the hypothalamus.

This temperature center is sensitive to the fluctuations and eventual drop in estrogen levels. The sudden and transient resetting of this temperature center results in a rise in core body temperature, triggering a hot flash. Soon after, the temperature center tries to set in motion mechanisms that cool the body down.

For example, blood vessels, particularly those near the surface of the skin, widen (dilate) to release heat, leading to the flushing and redness commonly associated with hot flashes. Sweat glands also become more active. (Sweating helps cool the body through evaporation.)

“Finally, if any of these mechanisms aimed at heat loss overshoot, it leads to a transient drop in inner body temperature, triggering shivers in an attempt to retain heat,” says Dr. Pal. “There may also be a temporary increase in heart rate as part of the body's effort to dissipate and retain heat.”

Dr. Taylor emphasizes how unpleasant such a change in body temperature can be. “For young women who have never had a hot flash or for men, it almost sounds like this pleasant feeling, like sitting by the fire on a cold winter night. But it is very uncomfortable and can come with this surge of adrenaline,” he says. “You can have heart-racing palpitations, you can sweat, and it can elicit anxiety.”

Medications to manage hot flashes come in two categories: hormonal and nonhormonal.

Hormonal medications: These are also known as menopausal hormone therapy (MHT). There are two different classes of MHT medications: “estrogen-only” formulations are available for women who do not have a uterus (for instance, a woman who has had a hysterectomy), whereas a combination of estrogen and a second hormone called progesterone is available for women who have a uterus. Both classes of MHT medications include formulations that contain natural (or bioidentical) and synthetic hormones. The strategy is to control the hot flashes that result from a loss of estrogen by supplementing the body with MHT.

MHT can also help with other menopausal symptoms, including poor sleep, as well as vaginal dryness and painful sex that can occur because of changes in the vaginal tissue resulting from estrogen loss. There are many hormonal medications that are approved by the Food and Drug Administration (FDA) for menopausal symptoms. MHT administration methods include pills, shots, transdermal patches (medicated adhesive patches), and creams. Studies have shown that oral MHT is highly effective at alleviating hot flashes and night sweats. “However, the vaginal route of hormone administration is a better approach to managing vaginal symptoms,” says Dr. Pal.

Nonhormonal medications: There are currently two nonhormonal medications that are FDA-approved specifically for bothersome hot flashes.

• Paroxetine: Sold under the brand name Brisdelle®, paroxetine is a type of antidepressant medication—called a serotonin reuptake inhibitor (SSRI)—that is approved for moderate to severe hot flashes. SSRIs affect serotonin, a neurotransmitter involved in regulating body temperature. By stabilizing serotonin levels, paroxetine can reduce the frequency and severity of hot flashes. Brisdelle is taken once a day in pill form. It was approved for the treatment of hot flashes in 2014; studies showed it provided modest relief for hot flash symptoms.
• Fezolinetant: Sold under the brand name Veozah®, the FDA approved this medication for moderate to severe hot flashes in 2023. Veozah is a neurokinin 3 (NK3) receptor agonist that works by binding to and blocking the activities of the NK3 receptor, which helps regulate body temperature in the brain. Veozah is also taken once a day in pill form. According to studies, the medication significantly reduced the severity of hot flashes. In December 2024, the FDA placed a boxed warning (also known as a black box warning), its most serious cautionary labeling, on this drug because of its known risk of rare, but serious, liver injury.

There are also other nonhormonal medications that doctors prescribe “off label” for hot flashes and other menopause symptoms, which, while not FDA-approved for that purpose, are recognized to be effective against hot flashes, adds Dr. Pal. These include other SSRIs, such as citalopram (brand name: Celexa®), escitalopram (brand name: Lexapro®), and gabapentin (Neurontin®), a medication developed to treat seizures.

Medical experts say MHT is the most effective treatment for managing hot flashes, but there have not been any head-to-head trials comparing MHT with nonhormonal options.

“MHT almost always helps,” Dr. Taylor says. “It may not completely eliminate hot flashes, but we can adjust the dosage to get them under excellent control. Veozah is similar in efficacy and the first nonhormonal option to come close to estrogen. But none of the others, including paroxetine and SSRIs, are generally considered anywhere near as effective as hormones.”

If a woman’s hot flashes are mild and infrequent, she may not need medication, the doctors say. But if they are disrupting her life, there are certain factors to consider. For example, women who have had breast cancer shouldn’t take MHT because studies have shown breast cancer survivors are more likely to have new or recurrent breast cancer than those not taking hormones. Additionally, MHT is not recommended for women who are at higher risk of stroke or blood clots or are more than 10 years past menopause onset, Dr. Pal says.

For these women, nonhormonal options are safe. But even for women who don’t have reasons to avoid hormone therapy, many are still reluctant to treat menopause symptoms with hormones because of a much-publicized Women’s Health Initiative (WHI) study, which was stopped early in 2002. Data from that study suggested that older women who were more than 10 years from menopause onset who took hormones were at increased risk of breast cancer, heart disease, and other health issues.

Over time, limitations of this study have been brought to light, including that most of the women in the study were over 60 and, therefore, already at increased risk of many of the highlighted health problems.

Today, medical experts conclude that in perimenopausal and early menopausal women who are within 10 years of the onset of menopause, the potential for benefits from the use of MHT far exceeds the potential for harm compared to women ages 60 years or older, adds Dr. Pal.

For women considering initiating hormone therapy, it is advisable to use MHT at the lowest dose and for the shortest time possible, notes Dr. Pal.

Dr. Pal says choosing the right treatment involves considering the severity and the spectrum of symptoms and being attentive to the unique health risks of each woman; the goal is to identify the treatment that would maximize benefit with minimum risk. For example, if an otherwise healthy woman is experiencing hot flashes, as well as a loss of sexual desire and vaginal dryness early in the menopausal phase, then MHT as a patch, pill, or vaginal ring may be the first step to consider because systemic hormonal therapy will address all three symptoms.

“But, if her only issues relate to vaginal dryness and discomfort, without anything relating to hot flashes or sleep, then vaginal estrogen alone may be needed,” she says.

For some women, lifestyle changes can help lessen the discomfort of hot flashes. The National Institute on Aging offers these tips:

• Lower the temperature in your bedroom at night
• Try drinking a small amount of cold water before bed
• Layer your bedding so that it can be adjusted in the night
• Turn on a fan in the bedroom
• Carry a portable fan
• Consider mind-body practices such as cognitive behavioral therapy (CBT) and hypnosis

Or, if you share a bed with someone who doesn’t heat up at night, consider putting more blankets on the other side of the bed, or even an electric blanket for your unaffected bedmate.

While there aren’t rigorous studies that show any of the common-sense techniques, like dressing in layers, can alleviate hot flash symptoms, Dr. Taylor says he still recommends them.

“Even if we don’t have the evidence, they likely help, so I encourage women to try them,” he says. “Sometimes, just taking control and being proactive helps people cope with any medical condition.”