Hot Flushes, Night Sweats and Palpitations

Hot flushes, Night sweats, Palpitations

Together these are called vasomotor symptoms.  Most women are aware of these and approximately 75% of women will experience these at some point in the menopause transition. However, they vary from woman to woman in their frequency, duration and intensity.

What is a hot flush?

This is described as a transient feeling if intense heat in the upper body, arms and face.  In some women this is accompanied by visible flushing and then profuse sweating.  These can cause considerable anxiety and distress when they occur in a public space and can be accompanied by palpitations.

What causes them?

The exact mechanism is not entirely understood.  It is believed that fluctuating estrogen levels in the perimenopause cause 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, this is the body’s natural way of losing heat.  However, this then reduces her temperature which falls below what the brain perceives to be normal, and she starts to shiver.  This is the on-off situation well known to women who have experienced hot flushes and night sweats.

Who gets them?

Any woman can be affected but these are often more common in women who smoke

How long will they last?

These may start before the periods stop but are most common in the first year after the final period. On average, if left untreated, these will last for 7-8 years although many women continue to have symptoms for decades.

Are there any health risks associated with vasomotor symptoms?

Studies have shown that women who experience hot flushes are at increased risk of a future heart attack or stroke, severity of the hot flushes being more important than frequency or duration.

In addition, women who have hot flushes have been shown to have worse memory.  This is felt to be due to several factors – the temporary disruption of blood flow to the brain that happens with a hot flush, the sleep deprivation caused by night sweats and the low mood that can result from these physical symptoms.

What can I do to help myself?

  • Avoid triggers.  Many women find that caffeine, hot drinks, alcohol and spicy foods trigger hot flushes
  • Stop smoking.  Smokers tend to experience more severe hot flushes and carry an increased risk of heart disease or stroke
  • Layer clothing and wear natural fibres or those that wick away moisture – cotton, linen, silk, wool and bamboo
  • Invest in a fan.  A desk fan can be useful in work and a bedside fan can be helpful to cool the skin at night.  By placing a bottle of frozen water in front of the fan, the air will cool as it comes across, this can be particularly useful in the summer months
  • Swap your duvet.  Two single duvets or a split-tog duvet will allow for you and your partner to have your own needs met.  Alternatively swap your duvet for sheets and blankets which can be easily thrown off…and layered on.
  • Stay calm.  A hot flush in a public place can increase anxiety which further exacerbates the hot flush.  Cognitive Behavioural Therapy is a talking therapy that has been shown to benefit women experiencing hot flushes.  This focuses on the link between our thoughts, feelings and how we behave.  Try to remember, each flush is only going to last a short time and will pass. If you feel CBT might help you can look for a therapist in your area at

What treatments are available?

  • Hormone Replacement Therapy (HRT) is recommended by the National Institute for Health and Care Excellence (NICE) as first line treatment for vasomotor symptoms in women with no contraindications to HRT
  • SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-norepinephrine reuptake inhibitors) are not recommended as first line treatment. Furthermore, they should not be used to alleviate low mood associated with the menopause in women who have not been diagnosed with depression. They are sometimes used in women who have a contraindication to HRT. Studies have shown a reduction in symptoms ranging from 20-50% reduction in hot flushes. However, an adverse effect on sexual function is common.
  • Clonidine. This was originally developed as medication for high blood pressure. It has been used for decades to reduce hot flushes but can be associated with side effects such as sleep disturbance, dry mouth, nausea and fatigue
  • Herbal medicines. At present there is insufficient evidence, inconclusive results or studies show no benefit from black cohosh, dong quai, St John’s Wort and evening primrose at helping hot flushes.

The most effective treatment for symptoms that result from a lack of estrogen is to replace the estrogen.  NICE guidelines state that for most women, the benefits of HRT outweigh the risks.  Estrogen delivered across the skin as a patch, gel or spray carries no increased risk of clot and when used at an appropriate dose, can relieve hot flushes and night sweats in weeks.

If you have ongoing symptoms that are negatively impacting your quality of life, find out more by reading the HRT leaflet.

Dr Alice Duffy

Last updated May 2021

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