Hot Flashes & Night Sweats

What a Hot Flash Actually Is

A hot flash begins in the brain. The hypothalamus—your body’s thermostat—becomes more sensitive to slight changes in body temperature during perimenopause and menopause. When estrogen fluctuates, the hypothalamus can misread normal body temperature as “too hot” and trigger a cooling response.

What happens next is rapid: blood vessels near the skin dilate to release heat, your heart rate increases, and sweat glands activate. The result is that sudden flush of warmth spreading across your chest, neck, and face—sometimes accompanied by visible redness and intense sweating.

The flash itself typically lasts between 30 seconds and 5 minutes. But the disruption—to your sleep, your confidence, your sense of being at home in your body—can feel much longer.

The Range of Experience

Not all hot flashes are created equal. Some women experience mild warmth a few times a week. Others have 20 or more intense episodes daily. The variation is enormous, and there’s no predicting where you’ll land.

Common patterns include:

Flashes that come primarily at night (night sweats)
Flashes triggered by stress, alcohol, caffeine, or spicy food
Flashes that wake you from deep sleep, drenched
Flashes preceded by a sense of pressure or anxiety
Flashes that arrive without warning at any time

For most women, hot flashes begin in perimenopause and continue for an average of 7-10 years. Some women experience them for much longer. A smaller percentage never have them at all.

Night Sweats and Sleep

When hot flashes happen during sleep, they become night sweats—and the impact on rest can be profound.

You may wake up with soaked sheets, heart racing, fully alert. Getting back to sleep becomes difficult. Over time, the accumulated sleep disruption affects mood, cognitive function, and overall wellbeing.

This is one reason why menopause symptoms can feel so interconnected: poor sleep from night sweats contributes to brain fog, irritability, and fatigue, which then makes everything harder to manage.

What’s Happening Hormonally

Estrogen helps regulate the hypothalamus. As estrogen levels become erratic during perimenopause—spiking and dropping unpredictably—the hypothalamus loses its calibration.

The narrowing of the “thermoneutral zone” (the range of temperatures your body considers comfortable) means even tiny fluctuations can trigger a full cooling response. Your body isn’t malfunctioning; it’s adapting to a new hormonal reality. But the adaptation process can be intense.

What Actually Helps

Hormone Therapy

For many women, estrogen therapy is the most effective treatment for hot flashes, reducing frequency and intensity by up to 75%. This is a conversation to have with your healthcare provider, weighing benefits against individual risk factors.

Lifestyle Adjustments

Temperature management:

Dress in layers you can easily remove
Keep your bedroom cool (65-68°F)
Use breathable, moisture-wicking fabrics
Keep cold water nearby

Trigger awareness:

Track what precedes your flashes (alcohol, caffeine, stress, spicy food)
Reduce or avoid identified triggers
Notice patterns in timing

Mind-Body Practices

Research shows that cognitive behavioral therapy, mindfulness, and clinical hypnosis can reduce both the frequency of hot flashes and how bothersome they feel. The brain plays a significant role—learning to shift your response to the sensation can genuinely help.

Movement

Regular physical activity is associated with fewer hot flashes, though intense exercise in heat can trigger them. Find what works for your body.

Reframing the Experience

Hot flashes are often treated as something to be eliminated—a symptom to suppress. But they’re also a sign that your body is in transition, doing the work of reorganizing itself for the next phase.

This doesn’t mean you have to suffer unnecessarily. Seek relief where you can find it. But also know that this intensity is temporary. Your body is learning a new way of regulating itself. The thermostat will eventually stabilize.

Go Deeper

These are the original writings this entry draws from: