Why do I get hot flushes at night?
Often menopause or perimenopause. Night sweats are hot flushes while you sleep. But in trials, flushes fell by more than half on dummy pills. A remedy that seems to work may not.
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Why do I get hot flushes at night?
Menopause is one of the most common reasons. A hot flush is when your face, neck and chest suddenly feel very hot or cold. The NHS says it can happen during the day or night (night sweats) and last for several minutes.
They can start in perimenopause, the years before your periods stop. Symptoms can happen during perimenopause and menopause, and after menopause too.
A flush can also make you sweat a lot, feel dizzy, or bring on palpitations or anxiety. Palpitations means a fast, pounding or noticeable heartbeat.
| Common reason | What it means |
|---|---|
| Menopause hot flushes | Sudden heat in your face, neck and chest, by day or night. |
| Anxiety | Feeling worried, tense or panicky. |
| Some medicines | Such as some antidepressants, steroids and painkillers. |
| Low blood sugar | Also called hypoglycaemia. |
| Alcohol or drug use | Drinking alcohol or taking drugs. |
| Hyperhidrosis | A harmless condition that makes you sweat when your body does not need to cool down. |
Sources: NHS: night sweats; NHS: menopause symptoms
Periods changing too? That’s usually one of the first signs of perimenopause.
Sometimes the cause is unknown. For the other causes, see blood tests for night sweats.
For a few weeks, note each night a sweat wakes you. It gives your GP the pattern.
How can I stop night sweats?
Start with the bedroom and the evening. These are the NHS tips for hot flushes and night sweats.
Six NHS changes to try
- Wear lightweight clothing to bed.
- Keep your bedroom cool at night.
- Keep a fan or a cold drink by the bed, or take a cool shower.
- Cut down on spicy food, caffeine, hot drinks, smoking and alcohol.
- Find ways to bring your stress level down.
- Exercise regularly and keep to a healthy weight.
Source: NHS: things you can do
The NHS calls these potential triggers. Your list may differ, so cut one at a time and see if your nights change.
Still waking up soaked? Then it’s time to look at treatment.
What is the best menopause night sweats treatment?
HRT. If you’re 40 or over, NICE says to offer HRT for hot flushes and night sweats linked to menopause. HRT replaces the hormones your body makes less of, mainly oestrogen.
NICE options for hot flushes and night sweats
- 1
HRT
Offered first. Tablets, patches, spray or gel.
- 2
CBT
A talking therapy. With HRT, or instead of it.
- 3
Fezolinetant
A non-hormonal tablet for moderate to severe flushes, if HRT is unsuitable.
- 4
Other tablets
Clonidine (a non-hormonal tablet) or some antidepressants. Not routinely first for flushes alone.
Sources: NICE NG23; NICE TA1143; NHS; NHS: other medicines
In 24 trials, HRT tablets cut how often flushes came by 75% compared with dummy pills. The NHS says symptoms should improve after a few days or weeks.
HRT may not be suitable if you’ve had breast, ovarian or womb cancer, blood clots, untreated high blood pressure or liver disease, or you’re pregnant. After a clot, patches or gels may be used instead of tablets.
Fezolinetant needs liver blood tests before you start and monthly for the first 3 months.
Ask your GP whether HRT suits you, and in which form. Never stop or change a prescribed medicine without your prescriber. More on blood tests before HRT.
Do natural remedies for night sweats work?
In the same trials, women on dummy pills saw their flushes fall by 57.7%. That’s the placebo effect. Symptoms may also come and go, and often ease after menopause.
It’s like a cold that clears up while you take a remedy. The remedy gets the credit either way. So a remedy needs testing against dummy pills, or a proven treatment, to show it works.
| Option | What the evidence says |
|---|---|
| CBT | Fewer night sweats at 6 and 26 weeks, in a UK trial of 140 women. |
| Isoflavones (plant compounds found in soya) or black cohosh (a herb) | NICE: some evidence they may help. Safety is uncertain. |
| Red clover and other herbs | NHS: very little evidence on how well they work, or how safe they are. |
Sources: Ayers 2012, Menopause; NICE NG23; NHS
CBT is a talking therapy. In that UK trial, a group course and guided self-help both worked. Ask your GP how to get menopause CBT.
Some herbs may cause serious side effects with other medicines, so talk to a doctor first. More in natural alternatives to HRT and menopause supplements.
How long do menopause night sweats last?
Menopause symptoms often last years. The NHS says they usually last for 7 to 9 years, sometimes longer, and change along the way. Night sweats may ease and give way to low mood or anxiety.
Women from a Black ethnic background are more likely to have hot flushes that are severe and continue longer.
Sleep problems may be worse if you have night sweats. So don’t wait it out if they wear you down. See also perimenopause symptoms.
When to speak to a GP
Book an appointment if:
- You have night sweats regularly that wake you up or worry you.
- You also have a very high temperature (or feel hot, cold or shivery), a cough or diarrhoea.
- You have night sweats and you’re losing weight for no reason.
- You’re under 45 and think you have menopause symptoms. It may be early menopause.
- You have palpitations, your periods are heavier than before, or you bleed after 12 months with no period.
On fezolinetant? Get medical help straight away for tiredness, itching or yellow skin or eyes. The same goes for dark pee, pale poo, feeling or being sick, loss of appetite or stomach pain.
For daytime flushes and their causes, see hot flushes and menopause.