Symptoms
Understanding Hot Flushes
Why they happen, what makes them worse and treatment options.
Hot flushes and night sweats are caused by changes in the brain's thermostat. HRT is the most effective treatment, with strong evidence-based alternatives if HRT isn't right.
Hot flushes and night sweats — together known as vasomotor symptoms — affect around 75% of women through the menopause transition. They're driven by changes in the brain's temperature-regulating thermostat (the hypothalamus) as oestrogen fluctuates and falls, not by the body actually being hot. Understanding this shifts what helps: cooling the skin brings relief in the moment, but calming the brain's overreaction is what reduces flushes long term.
What a flush actually is
- A sudden feeling of intense heat spreading from the chest to the neck and face, often with flushing, sweating, palpitations and a wave of anxiety.
- Typically lasts 1–5 minutes, followed by a chill as the body over-cools.
- Night sweats are the same physiological event happening during sleep, and are the biggest driver of menopausal insomnia.
- Frequency varies from a few a week to 20+ a day; for around a third of women they continue into their 60s if untreated.
Common triggers to identify (and moderate)
- Alcohol, especially red wine — one of the most consistent triggers.
- Caffeine, spicy food and very hot drinks.
- Stress, anxiety, held breath and shallow chest breathing.
- Warm rooms, tight synthetic clothing, heavy duvets and hot showers before bed.
- Sleep deprivation itself lowers the flush threshold, creating a vicious cycle.
First-line treatment: HRT
- HRT reduces flush frequency and severity by around 75–90% within 4–8 weeks.
- Transdermal oestrogen (patch, gel or spray) is the preferred route for most women — no increase in clot or stroke risk.
- Micronised progesterone (Utrogestan) is added if you still have a uterus, or the Mirena coil can be used.
- Doses are titrated over 8–12 weeks — flushes that persist usually mean the oestrogen dose needs adjusting, not that HRT isn't working.
Non-hormonal medical options
- Fezolinetant (Veoza) — a neurokinin-3 receptor antagonist licensed in the UK in 2024, specifically for moderate-to-severe flushes.
- SSRIs/SNRIs (venlafaxine, paroxetine, escitalopram) — helpful particularly where mood is also affected.
- Gabapentin — useful when night sweats dominate.
- Oxybutynin and clonidine — older options, still occasionally used.
- CBT specifically for menopausal symptoms has strong NICE-recognised evidence.
Practical daily tools that genuinely help
- Layered natural-fibre clothing (cotton, linen, bamboo, merino).
- A bedside water bottle, a small fan and cooling pillow.
- Cotton or bamboo bedding and a lower bedroom temperature (16–18°C).
- Paced breathing (6 slow breaths per minute) at the first sign of a flush — reduces intensity within seconds.
- Regular exercise reduces flush frequency; strength training in particular improves sleep and mood.
When to see a specialist
- Flushes are affecting sleep, work, driving or relationships.
- You've tried HRT but flushes persist — often a dose, route or preparation adjustment is needed.
- You cannot take HRT (personal history of certain cancers or clots) and want to review non-hormonal options.
- Night sweats are new or one-sided, or accompanied by weight loss — these need investigation beyond menopause.
Key takeaway
Hot flushes are a brain symptom, not a skin symptom — and they respond exceptionally well to treatment. Most women see 75–90% improvement within 8 weeks of the right regimen.
How Dr Awal approaches this in clinic
Every consultation starts with your full story — symptoms, cycle, medical history, family history and what you've already tried. From there we look at whether hormonal treatment, non-hormonal options, lifestyle changes or a combination will give you the best result, and we tailor the plan to your age, risk factors and preferences.
- A detailed 60 minute first appointment — no rushed 10-minute slots.
- Evidence-based recommendations aligned with NICE NG23 and BMS guidance.
- Body-identical HRT considered first-line where appropriate.
- Shared-care letters sent to your NHS GP so treatment can continue affordably.
- Follow-up at 3 months to fine-tune your regimen and address side effects.
- Ongoing annual reviews so your plan evolves with you.
Common questions we hear about this
Do I need to be at a certain age to be seen?
No. We see women in early perimenopause (often late 30s and 40s), through post-menopause and beyond. Age alone doesn't decide whether treatment is right — symptoms, health history and goals do.
Will my GP continue the prescription?
In most cases yes. After your consultation we send a detailed shared-care letter with the diagnosis, treatment plan and rationale so your NHS GP can prescribe on the NHS. Not every practice accepts shared care — we'll discuss this in your appointment.
What if I've tried HRT before and it didn't suit me?
Very common — often the type, dose or route wasn't right rather than HRT itself. We review what you've tried, why it didn't work, and adjust accordingly. Many women who thought HRT wasn't for them do well on a different preparation.
How long will I need to stay on treatment?
There is no set upper time limit for HRT. Current BMS and NICE guidance supports continuing HRT for as long as the benefits outweigh the risks for you personally. We review this together every year so you stay in control of the decision.
Where do you see patients?
All consultations at Pause and Co Healthcare are conducted securely via video, allowing us to support patients anywhere in the UK. Prescriptions and shared care arrangements are managed in the same way, regardless of your location.
About the author
Dr Nadira Awal is a British Menopause Society Advanced Menopause Specialist with 15+ years' NHS and private experience. She holds the BMS Advanced Certificate in Menopause Care, sits on the BMS Programme Planning Group, and advises the UK Government Menopause Strategy Group. Read her full profile.
Sources & further reading
General information only — not a substitute for personalised medical advice. Always speak to your GP or a menopause specialist about your own situation.
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