How To Manage Hot Flashes and Night Sweats

What Can You Do?

1. Monitor Your Health

As women, we are good at monitoring the health of our loved ones, we tend to however, only focus on ourselves if there is a big health scare. Hot flashes and night sweats can be an indication of other health concerns and not actually menopause. This includes:

• Thyroid conditions

• Diabetes

• Sleep apnea

• Anxiety

• Excessive alcohol

• Medication side effects

• Cancer

• Tuberculosis

In particular if you have moderate to severe VMS make sure you know and assess indicators for heart disease such as blood pressure, and engage in health behaviors to reduce risks such as exercise and nutrition.

2. Start Tracking

Create a log (we are working on this for you!) that tracks time of day, duration, intensity. In addition, record factors such as sleep, stress, exercise, trigger foods or beverages, etc.

Minimizing the Impact of VMS

One of the things that makes me roll my eyes through this perimenopause adventure is advice I like to call ‘thanks tips’. This is advice that is annoying because it does not solve any problem and it is common sense. Some of the items below may seem common sense but we still have to share it, just in case it provides some support and you may not have had the time to think of it. 

Room Temperature. Drop your room temperature lower than you usually do, this will help keep your body temperature low. Some suggest to sleep next to a fan (roll your eyes with me on this one). 

Avoid Stress. This one is the best, I love when you are told to reduce your stress. I know some of us have work to do on mindset and stress so ok, let’s work on this, but we don’t really seek out stress do we? We can take stock of things we think we are ‘handling well’ like Anya and her divorce (see story above) and work to reduce and manage these stressors with various techniques such as cognitive behavioral therapy, meditation, etc.. 

Clothing. Dress in layers. Anyone in an office where the winter office temperature is already hot and the summer temp is so cold that we have heaters at our feet have already mastered this one. There are some clothing designers with fabrics or designs that support VMS. You will still get the hot flash but breathable fabrics will help with the heat. It doesn’t matter what fabric your pajamas are made of however, you are still getting the night sweat and you will still be soaked-save your money on “special pajamas' unless they make you feel good and happy (e.g. Lusome Eva Sleepshirt).

Accessories. Some women carry small fans with them to help dissipate heat. There are cooler packs for your bras you can purchase. Joylux (US)  and Issviva (UK) are two providers.  Stripes also makes ‘The Cool Factor’ a face mist you can keep in the fridge and spray. It feels and smells great but may play a bit of havoc with your make up in the office. There are also other product companies producing this such as State of Cool, Womaness, Venn, and many others. 

Food & Drinks. Carry a water container to keep ice cold beverages with you. Avoid hot beverages and caffeine which can trigger VMS. Also avoid spicy foods as they can be a trigger as well. As stated above, it appears a little alcohol may help with VMS however, heavy drinking is likely to worsen VMS.

Mental Health Strategies

Paced Breathing & Mindfulness. Deep breathing techniques can help during a hot flash. The 4-7-8 technique is ‘hot’ (ha ha!) right now. This is where you breath in for a count of four, hold your breath for seven, and exhale for a count of eight. It allows you to replenish oxygen and creates a state of deep relaxation. There is some research supporting paced breathing and mindfulness stress reduction however, more research is required. While exercise and yoga are great no matter what, research has not yet shown a positive impact on VMS.

Cognitive Behavioral Therapy (CBT-I). Level 1 Some evidence shows cognitive behavioral therapy and clinical hypnosis are efficacious in reducing vasomotor symptoms. However, MsFLASH, a research network performed multiple trials and did not find CBT-I benefited VMS (6). 

Acupuncture. Several randomized controlled trials (RCTs) have investigated the efficacy of acupuncture in alleviating menopausal symptoms, particularly vasomotor symptoms such as hot flashes.  A pragmatic RCT demonstrated that acupuncture significantly reduced the frequency of hot flashes and other vasomotor symptoms in menopausal women.
nccih.nih.gov

Technology

There are some devices on market now that are leveraging technology to help you with your hot flashes. 

Hand held devices. Menopod for example is a small hand held device that you place on the back of your neck, it sends sensations to the brain to cool your body temperature. 

Bed technology. There are devices intended to keep you cool in bed such as BedJet, with research claiming to relieve night sweats and hot flashes by 85%. In addition, certain mattresses, bed pads and gel cooling foams are available.

Neck devices. Spice of Life has a cooling fan that looks like headphones worn around the neck. There is also ‘neck cooling gel’, also worn around the neck (CoolTimeUSA).

Wrist devices. Embr Wave 2 Thermal wrist band is worn on your wrist, and when you feel overly warm, you push the button on the side to release thermal sensations that will help cool your entire body. It connects to an app with different sensations to select from. A small study shows some improvement. 

Medical Treatments

• Hormone Replacement Therapy (HRT). HRT is the gold standard for treating VSM. Women taking HRT show higher core temperature sweating threshold and reduced frequency of hot flashes compared to placebo (7).The most effective treatment for severe hot flashes and night sweats is estrogen. Unless you no longer have a uterus, you'll likely need to take a progestogen. Progestogens (progestin) can add to the effects of low-dose estrogen and may be a good option for women who cannot take estrogen. 

• Low Does Birth Control Pill. If you need contraception, you can take low-dose birth control pills until menopause. Another advantage of these pills is that they regulate your menses and suppress the erratic hormonal ups and downs of perimenopause.

• Veoza (fezolinetant). Approved by the US FDA in May 2023, this is the first drug created specifically for VMS. It works by blocking a brain protein called neurokinin-3 that plays a unique role in regulating body temperature in menopausal women (8-10).

• Elinzanetant. Under FDA review in the USA currently.

• Anti-Depressants (SSRIs) and SNRIs. Selective Serotonin Reuptake Inhibitors (SSRIs). Women who don't want or can't take a hormonal therapy can potentially get relief from antidepressant SSRIs including Brisdelle or Paxil (paroxetine), Lexapro (escitalopram), Celexa (citalopram), Prozac (fluoxetine) 

• Selective-Norepinephrine Reuptake Inhibitors (SNRIs) including Effexor (venlafaxine) and desvenlafaxine have been shown to improve VMS compared to placebo and low doses of estradiol (11,12)

• Clonidine. This is a medication for blood pressure but has been shown to improve VSM (13).

• Gabapentin. Gabapentin has been shown in random control trials to benefit VMS when compared to placebo (14). 

Always be aware of potential side effects of any medication and potential complications. For example, some SSRIs can interfere with the metabolism of tamoxifen in certain women.

Botanical & Herbal Supplements

There has not been a lot of clinical grade research done on herbal supplements to determine if they have a true positive impact on VMS. In addition, the space is unregulated meaning, the quality and doses are not validated with companies. For example, one study found 25% of black cohosh supplements did not contain any black cohosh. Here are some popular items used and what we know. Be wary of the ‘hot flash' cocktail supplements on-line that claim to help with all things menopause including VMS. 

• Omega-3 Supplementation. No significant impact on VMS.

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• Phytoestrogen. These include a variety of plants such as soy, flaxseed, red clover, dried fruits, sesame seeds. Phytoestrogens mimic the effects of estrogen in the body. Because of this estrogen-like activity, some believe these foods can help with VMS.

  • Soy has received the most focus in research but has not proven to work for VMS. Some research shows a moderate reduction (20-30%) however, results are inconsistent. Benefit appears greater among women who are equol producers (gut microbiota convert isoflavones into equol). 

    • Dose appears to be >50mg/day for at least 12 weeks before a noticeable improvement.

  • Red Clover. A meta-analysis published in 2019 in Climacteric examined 14 RCTs evaluating the efficacy of red clover supplements for menopausal symptoms. The analysis found no significant difference between red clover and a placebo in reducing hot flash frequency or severity.

  • Flaxseed: Modest improvements. Results inconsistent.

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• Vitamin E. Some studies suggest that vitamin E may offer modest benefits for reducing hot flashes, the evidence is not conclusive, and more high-quality research is needed to establish its effectiveness definitively. Additionally, the optimal dosage, duration of treatment, and specific populations that may benefit from vitamin E supplementation remain unclear.

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• Cannabis. Research on the effects of cannabis, including both THC (tetrahydrocannabinol) and CBD (cannabidiol), on menopausal symptoms such as hot flashes is still in its early stages, and there is limited scientific evidence available. Some anecdotal reports and preliminary studies suggest that cannabis may offer some relief for menopausal symptoms, including hot flashes, due to its potential effects on the endocannabinoid system, which plays a role in regulating various physiological functions, including temperature regulation and mood. One study published in 2020 in the Journal of Women's Health for example, examined the use of cannabis for menopause symptom relief using data from a large survey of menopausal women. The study found that women who reported using cannabis had lower odds of experiencing hot flashes and night sweats compared to non-users. However, this study relied on self-reported data, which may be subject to bias.

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• Black Cohosh (Actaea racemosa). One of the most researched herbs for menopausal symptoms, including hot flashes. It's believed to help regulate hormonal fluctuations. Some studies have shown promising results, indicating that black cohosh could help reduce the frequency and severity of hot flashes in menopausal women. However, other studies have failed to find significant benefits compared to a placebo (15). One of the challenges in assessing the effectiveness of black cohosh is the variability in study designs, dosages, and formulations used in different research studies. Additionally, the mechanisms by which black cohosh may work to alleviate hot flashes are not fully understood. While black cohosh is generally considered safe for short-term use in most women, it may not be suitable for everyone. Some women may experience side effects such as gastrointestinal upset, headaches, or allergic reactions. There have been rare reports of liver toxicity associated with black cohosh, although the causal relationship is not well-established. For more information on black cohosh, check out our blog.

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• Sage (Salvia officinalis). Some research suggests that sage may have potential benefits for reducing the frequency and severity of hot flashes in menopausal women. A few small-scale studies have shown promising results, indicating that sage supplementation could lead to a reduction in the frequency and intensity of hot flashes compared to a placebo. For example, a study published in 2011 in Advances in Therapy found that women who took a sage extract supplement experienced a significant reduction in the number and severity of hot flashes compared to those who received a placebo. However, more extensive and high-quality research is needed to confirm these findings and establish the effectiveness of sage for managing hot flashes.

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• Dong Quai (Angelica sinensis). Commonly used in traditional Chinese medicine, dong quai is believed to help balance hormone levels and reduce hot flashes and other menopausal symptoms. A review published in 2019 in the Journal of Ethnopharmacology examined the effects of dong quai on menopausal symptoms. The review found some evidence suggesting potential benefits, but noted that most studies were of low quality and lacked rigorous methodology.

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• Ginseng (Panax ginseng): Ginseng may help alleviate symptoms of menopause, including hot flashes, by supporting overall hormonal balance and reducing stress. There is some evidence to suggest that ginseng may offer benefits for reducing hot flashes, however, the research is not conclusive, and more high-quality studies are needed to better understand its effectiveness. Additionally, the optimal dosage, duration of treatment, and specific types of ginseng that may be most effective for managing hot flashes remain unclear.

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• Evening Primrose Oil (Oenothera biennis). Evening primrose oil contains gamma-linolenic acid (GLA), which may help regulate hormonal fluctuations and reduce the severity of hot flashes. A systematic review published in 2013 in the Cochrane Database of Systematic Reviews analyzed several randomized controlled trials evaluating the effects of evening primrose oil on menopausal symptoms. The review concluded that there was insufficient evidence to support the use of evening primrose oil for managing hot flashes or other menopausal symptoms.

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• Chasteberry (Vitex agnus-castus). Also known as vitex, chasteberry is believed to help regulate hormone levels, particularly by influencing levels of prolactin and progesterone, which may help reduce hot flashes. A systematic review published in 2014 in the journal Climacteric evaluated the efficacy of chaste tree berry for menopausal symptoms. The review concluded that while some studies reported beneficial effects, the overall evidence was limited by methodological flaws and inconsistencies, and further research is needed to confirm its effectiveness.

It's important to note that the effectiveness of these herbs can vary from person to person, and they may interact with medications or have side effects. It's always best to consult with a healthcare professional before starting any herbal supplements, especially if you have underlying health conditions or are taking medications. Additionally, while some herbs may provide relief for hot flashes, they may not eliminate them entirely.

🔬 Research Evidence on Exercise & Hot Flashes

1. Aerobic Exercise

• Several RCTs suggest regular aerobic exercise (brisk walking, cycling, jogging) may reduce hot flash frequency and severity.

• Example: A 2012 RCT (Menopause) found 16 weeks of aerobic training significantly reduced hot flash frequency compared to controls.

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• Mechanism: Improves thermoregulation (how your body manages temperature) and reduces stress reactivity.

2. Resistance Training (Strength Training)

• Limited direct evidence on hot flashes, but studies show resistance training improves body composition, insulin sensitivity, sleep, and mood, all of which can indirectly reduce symptom burden.

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• A 2019 study (Climacteric) suggested women who strength trained regularly reported better quality of life and fewer bothersome symptoms overall, though hot flash-specific data is less strong.

3. Yoga & Mind-Body Exercise

• Multiple trials show yoga, tai chi, and mindfulness-based movement improve sleep, mood, and stress — which can lessen the perception of hot flash severity.

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• A 2014 systematic review found yoga reduced vasomotor symptoms (hot flashes, night sweats) modestly, but evidence quality was moderate.

4. High-Intensity vs. Moderate Exercise

• Some studies suggest moderate-intensity aerobic activity is most beneficial for hot flashes.

• Very high intensity can sometimes trigger hot flashes temporarily due to heat load, though long-term training improves thermoregulation.

⚖️ Summary

• Aerobic exercise (150 min/week, moderate intensity) has the best evidence for reducing hot flashes.

• Strength training = excellent for overall menopause health, indirectly supportive.

• Yoga/mind-body = helps with perception, sleep, and stress, improving symptom experience.

• Not a cure-all: Exercise won’t eliminate hot flashes for everyone, but it improves resilience and reduces overall menopause symptom burden.

As you navigate through the warmth of the night and the intensity of each flash, remember that within every challenge lies an opportunity for growth and transformation. Keep pressing forward with courage, knowing that with each step, you're drawing closer to a life filled with balance, vitality, and endless possibilities. Remember, PAUZ Health is here to help you!

👉 Join PAUZ Health

 References.

1. Col NF, Guthrie JR, Politi M, Dennerstein L. Duration of vasomotor symptoms in middle-aged women: a longitudinal study. Menopause. 2009;16(3)453-457.

2. Politi MC, Schleinitz MD, Col NF: Revisiting the duration of vasomotor symptoms in menopause: a meta-analysis. J Gen Intern Med. 2008;23(9):1507-1513.

3. Avis NE, Crawford SL, Greendale G, et al.; Study of Women’s Health Across the Nation. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539.

4. Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 2014;142:115-120.

5. https://www.menopause.org/docs/default-source/press-release/hot-flashes-and-nights-sweats-on-depression-and-stress-release.pdf

6. Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and management options. 2021;106(1):1-15.

7. Freedman, RR, Blacker CM. Estrogen raises the sweating threshold in postmenopausal women with hot flashes. Fertil Steril. 2002;77(3):487-490.

8. Depypere H, Timmerman D, Donders G, et al. Treatment of menopausal vasomotor symptoms with fezolinetant, a neurokinin 3 receptor antagonist: a phase 2a trial. J Clin Endocrinol Metab 2019;104:5893-5905.  

9. Fraser GL, Lederman S, Waldbaum A, et al. A phase 2b, randomized, placebocontrolled, double-blind, dose-ranging study of the neurokinin 3 receptor antagonist fezolinetant for vasomotor symptoms associated with menopause. Menopause 2020;27:382-392. 

10. Fraser GL, Ramael S, Hoveyda HR, Gheyle L, Combalbert J. The NK3 receptor antagonist ESN364 suppresses sex hormones in men and women. J Clin Endocrinol Metab 2016:101:417-426. 

    Prague JK, Roberts RE, Comninos AN, et al. Neurokinin 3 receptor antagonism as a novel treatment for menopausal hot flushes: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet 2017;389:1809-1820. 

11. Trower M, Anderson RA, Ballantyne E, Joffe H, Kerr M, Pawsey S. Effects of NT-814, a dual neurokinin 1 and 3 receptor antagonist, on vasomotor symptoms in postmenopausal women: a placebo-controlled, randomized trial. Menopause 2020;27:498-505Joffe H, Guthrie KA, LaCroix AZ, et al. Low-dose estradiol and the sertonin-norepinephrine reuptake inhibitor venlaxafine for vasomotor symptoms: a randomized clinical trial. JAMA Intern Med. 2014;174(7):1058-1066.

12. Pinkerton JV, Constantine G, Hwang E, Cheng RF; Study 3353 Investigators. Desvenlafaxine compared with placebo for treatment of menopausal vasomotor symptoms: a 12-week, multi-center, parallel-group, randomized, double-blind, placebo-controlled efficacy trial. Menopause.2013;20(1):28-37.

13. Laufer LR, Erlik Y, Meldrum DR, Judd HL. Effect of clonidine on hot flashes in postmenopausal women. Obstet Gynecol. 1982;60(5):583-586.

14. Butt Da, Lock M, Lewis JE, Ross S, Moineddin R. Gabapentin for the treatment of menopausal hot flashes: a randomized controlled trial. Menopause. 2008;15(2):310-318.

15. 

     McCurry SM, Guthrie KA, Morin CM, et al. Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: a MsFLASH randomized clinical trial. JAMA Intern Med. 2016;176(7):913-920
    
    Black Cohosh: Usefulness and Safety

16. Newton KM, Reed SD, Guthrie KA, et al. Efficacy of yoga for vasomotor symptoms: a randomized controlled trial. Menopause. 2014;21(4):330-338.