Hot flashes: why they happen and what really helps

Heat rises to your face and neck, you break into a sweat, then you may feel chilly. At night the same thing wakes you, and in the morning it feels as if you have not slept at all. Hot flashes are one of the most common signs of perimenopause and menopause. The good news: a lot is known about them, and some familiar advice works while some does not. Let's sort out which is which.

Why the body suddenly overheats

Each of us has a "thermal comfort zone" — a range in which the body does not try either to cool down or to warm up. When oestrogen falls during the transition, this zone narrows. Now even a very small rise in temperature is enough for the body to decide it must cool down urgently: blood vessels widen, the skin flushes, sweat appears.

Hot flashes usually come together with night sweats, broken sleep, dryness, aching joints and "brain fog". This is one picture, not a set of separate problems. If you wear a ring or watch, you can often see sharp jumps in skin temperature at night together with awakenings.

Why nights are the worst

Most night-time hot flashes coincide with waking up. The night breaks into pieces, and in the morning you have no energy, your mood is worse and sugar cravings are stronger. So anything that reduces night-time awakenings helps not only with hot flashes but with the whole day.

What helps — ranked by strength of evidence

Strength training twice a week. This is the strongest lever without medication. In the best study, hot flashes roughly halved, and mood improved even before strength and weight had changed. This is where to start, not something to leave "for later".

Cognitive behavioural therapy and clinical hypnosis. These are the only non-drug methods with strong support specifically for hot flashes. After CBT, hot flashes are less bothersome and interfere less with life; hypnosis also reduces how often they happen. There are group, online and self-help book formats; they are led by a psychologist or psychotherapist with this experience.

A cool, dark bedroom. Around 16–19 °C, breathable fabrics, clothing and bedding in layers so you can easily take something off at night. To be honest: cooling does not restore the "comfort zone", but it noticeably reduces awakenings and discomfort.

Less alcohol and caffeine. Alcohol makes hot flashes worse even in small amounts and breaks up the second half of the night. Coffee and strong tea before 2 pm.

What doesn't help with hot flashes, though it is often recommended

• Breathing practices, yoga, meditation do not reduce hot flashes better than a placebo. But they help with calm and sleep — and that is a good reason to do them.
• Soy, tofu and ground flaxseed did not reduce hot flashes in studies. They are good as food — protein and fibre — but not as a "hot flash remedy".
• Herbs — black cohosh, red clover, dong quai, chasteberry — are no better than a placebo for hot flashes in good-quality studies, and they can interact with medication. If you want to try them, discuss it with a specialist first.
• Omega-3 is good for the heart and blood vessels, but in studies it does not help with hot flashes.

No over-the-counter supplement has convincing evidence for hot flashes.

When to see a doctor

If hot flashes often wake you at night or get in the way of work and life, that is a reason to see a doctor, not to put up with it. The most effective options here are prescription ones: there are both hormonal and non-hormonal choices. This is a fully valid option, not a "failure of the natural way"; nutrition and habits remain a support, not a replacement.

And one more reason to tell your doctor about hot flashes: severe, long-lasting hot flashes and night sweats are not just discomfort. Doctors take them into account when assessing the heart and blood vessels — and after menopause this is especially important.

What to try this week

• Keep the bedroom cool and dark; bedding and nightwear in breathable fabrics, in layers.
• Two strength sessions of 30–40 minutes on different days; the basics are squats, pulls and presses, without pain.
• Coffee and strong tea only before 2 pm, and no alcohol in the evening.

Log your hot flashes every day in VIA-L: in two or three weeks you will see which of these works for you.

This is general information, not a prescription. The dose and treatment plan are chosen by a doctor.