The Menopause

Hot flushes and hot flashes: why they happen and how to treat them

Hot flushes (also known as hot flashes) are one of the most common symptoms of the menopause, thought to affect up to 80% of women. You might recognise them by a sudden feeling of heat that comes on quickly. It spreads throughout the body and can last for several minutes. You may also experience flushing of the face and sweating.

Though commonly associated with the menopause, women may experience hot flushes while still having periods. This is because hormone levels fluctuate and fall many months and years before the final period. This time is called the perimenopause. Hot flushes can hit day and night (night sweats) and can seriously impact wellbeing. They can disrupt much-needed sleep at night and hamper self-confidence during the day.

Some people also experience hot flushes that aren’t related to menopause. They can be triggered by pregnancy, a thyroid problem, certain medications, food and drink or even stress. A GP should be able to diagnose the root cause of hot flushes — whether it’s menopausal or something else altogether.

Read on to discover what causes hot flushes during the menopause, along with the most effective treatments, natural remedies and lifestyle tweaks.

What causes hot flushes during the menopause?

The cause isn’t known, but researchers suspect it relates to several factors. As our estrogen levels decline, a hormone called norepinephrine also declines. Low levels of norepinephrine are thought to increase body temperature, triggering hot flushes.

Changes to the body during the menopause are also thought to affect the body’s thermostat (known as the hypothalamus). This becomes more sensitive to changes in body temperature.

What are the risk factors?

Not all women will experience hot flushes during the perimenopause and beyond. Factors that may increase our likelihood of hot flashes include smoking cigarettes, having a high BMI and certain ethnicities. More African-American women report hot flashes than European women, for instance. Similarly, hot flushes are less common in Asian women than in white, European women.

How to treat hot flushes?

The Truth About HRT Liz EarleThe most effective treatment is Hormone Replacement Therapy (HRT), which stops hot flushes completely in most cases. It’s available from a GP and can be prescribed in tablet, patch or gel form. As well as relieving symptoms of the menopause, HRT significantly helps to protect women against osteoporosis and heart disease as they age.

For more information about HRT, download Liz’s bestselling e-book – The Truth About HRT. 

How to stop hot flushes without HRT?

While hot flushes can’t be entirely stopped without HRT, there are natural remedies and lifestyle changes that can help to ease the symptoms. It’s worth noting, however, that these remedies won’t protect against osteoporosis and heart disease in the way HRT can.

Alternative treatments and natural remedies for hot flushes:


If HRT isn’t an option, your GP may offer other medications. While there’s no evidence to suggest that antidepressants can improve low mood associated with the menopause, they can help to treat hot flushes and night sweats. Studies show a reduction in symptoms by just over 50% on average.

Gabapentin is a drug with a license for managing fits and seizures for those with epilepsy. Studies show it can also reduce hot flushes in menopausal women. In trials, gabapentin reduced the frequency by 50%. It was also shown to reduce the severity and duration.


Some women have reported that acupuncture helps with their hot flushes and night sweats.  In fact, a small study that compared acupuncture with an antidepressant called venlafaxine showed the treatments to be equally effective at treating hot flushes. We need more large scale studies to be certain of its effectiveness, however.

Listen to our podcast with acupuncturist and fertility expert, Emma Cannon, to learn more about acupuncture. 


menotea loaf menopause loaf good menopause guideMany women report that spicy foods can trigger hot flushes. Similarly, alcohol and caffeine are likely to make hot flashes worse. Avoiding these substances becomes particularly pressing at night as night sweats can disturb a good night’s sleep.

Eating a diet rich in soy is believed to be part of the reason why Asian women experience fewer hot flushes than white and African-American women. This is because of the naturally occurring phytoestrogens (also found in oats, flaxseeds and lentils), which are thought to relieve menopausal symptoms by mimicking estrogen in the body. Research shows that women would have to eat a lot of these phytoestrogens to impact symptoms, however (i.e. large portions with every meal and not all of us are able to process phytoestrogens in the way needed to help. 

Read more about foods to eat during the menopause.  

Try Liz’s Super Menopause Tea Loaf recipe. Not only a tasty treat, it’s also rich in phytoestrogens.

Black cohosh

Black cohosh is a well-known natural remedy for menopausal symptoms. Like soy, researchers think it mimics the effects of estrogen in the body. Evidence is scant and the results are mixed – some studies show it to be effective and others do not. There are also concerns that black cohosh can cause liver damage and failure in high concentrations.

If you decide to manage menopausal symptoms with alternative remedies look for the Traditional Herbal Registration (THR) logo. Spotting this means the product has been regulated.


Cognitive Behavioural Therapy (CBT) can help to manage stress and anxiety, which we know can trigger hot flushes. It’s a talking therapy available on the NHS that focuses on helping us understand how thought patterns contribute to stress and anxiety so we can better calm the body and mind. Studies have shown it can help to reduce hot flushes and improve sleep.


A recent study by Dr. Rosanne Woods has shown that women who have a higher lean body mass (more muscle than fat) have an average of 70% less hot flashes. The best way to build lean body mass is strength training. Lifting heavy weights often has the added benefit of strengthening bones which can weaken during the menopause.

Listen to Liz’s podcast about strength-training during the menopause with Amanda Thebe.

In need of some exercise inspiration? Get Liz’s best-selling at-home exercise plan, A Stronger, Slimmer You.

Lifestyle changes

Indoor heating is often thought to trigger hot flushes. Turn on the air conditioning at work, keep the windows open and get a handheld or electric fan.  A cooling face spritz or cold gel pack (found at most pharmacies) can also be helpful. Wearing loose layers of light clothing makes it easy to remove clothing if we do overheat.

Staying cool at night will also help avoid sleep-disturbing night sweats. Choose lightweight bedding made from low thread count cotton, linen or bamboo. Loose, lightweight nightwear made from natural fibres can also help keep you cool. You may also choose to invest in a timed bedroom fan to keep hot flushes and night sweats at bay while you sleep.

Try making your own cooling lavender face spritz that can double up as a sleep-inducing pillow spray at night.

Read more features about menopause