What do hot flashes feel like during perimenopause?

What do hot flashes feel like? 

There are so many different ways that women experience this common perimenopause symptom. Here are a few examples; 

• A sudden ‘flare’ of heat that spreads through your body and face
• A red flush spreading across your chest, neck, face and head
• Sweating (often on the upper body but sometimes ‘drenching’ the whole body)
• Faster heartbeat or feeling that the heart is beating harder 
• Feeling the need to fling open all the windows to cool down, even if no one else is hot 
• Feeling very cold after the hot flash – this is because of the sudden loss of heat through the skin

As well as the physical symptoms, some women describe that a hot flash also causes changes to their mood. Some women describe losing concentration, and feeling very anxious whilst the hot flash is going on. Some women find that they withdraw from the social scene because they feel embarrassed about their symptoms. This is all very understandable if you are feeling continually hot under the collar!

Although hot flashes are a common perimenopause symptom, there are also a wide variety of other symptoms (at least 40!), and everyone’s experience differs. If you are not sure whether your hot flashes are a signal that you are in the perimenopause period, you could use our menopause symptom checker. 

As you can see, it can be difficult to fully explain exactly what does a hot flash feels like in perimenopause, as it is likely to be very unique to you, may happen alongside lots of other symptoms, and can come and go. 

Hopefully, understanding why hot flashes happen and how you can improve things might help keep you cool and collected.

What actually is a hot flash?

Perimenopause is the time during your life before menopause. During this time, the amount of hormones produced by your ovaries changes, leading to a fluctuation and overall reduction in oestrogen  and progesterone levels – which are the 2 main female hormones. 

Perimenopause (and the symptoms that go with it), mostly often start in your mid 40-s and symptoms tend to last between 4 and 8 years. 

The reason hot flashes happen is not fully understood. It may be due to the reduced levels of oestrogen^1,2, and its effect on the female brain. 

• The ‘heat manager’ (also called the hypothalamus) in the brain, responds more quickly  to small changes in body temperature as oestrogen levels fall^2,3 _.Basically, it’s over-reacting!
• When the heat manager thinks that the body is too warm, it kicks off a hot flash to cool the body down. 
• This causes small blood vessels in the skin to open up and cause heat loss through the skin, which is what causes sweating and flushing – classic symptoms of a ‘hot flash’.
• The ‘hot flash’ (or night sweat, if happening overnight) can last anywhere from a few seconds to around 10 minutes. An average is around 4 minutes⁴. How often the hot flashes happen is very variable but may be from every hour to a couple of times per week⁴. 

The average length of time that women going through perimenopause experience hot flashes (sometimes called ‘vasomotor symptoms’ by doctors) for is around 7 years. In some cases they can go on for more than 10 years^5,6. 

Often hot flashes stop once perimenopause is over (medically, this is when you have not had a period for a year). Unfortunately, for some women they can hang around even after menopause. However, if you are suffering, don’t despair…there are lots of treatments that can be used to help. 

Remember that although hot flashes are a very common symptom in perimenopause, there are a number of medical conditions (such as an overactive thyroid gland, and certain infections) and medications that can also cause them. If you are experiencing hot flashes, speak to your doctor for some advice. Blood tests can usually help determine if there is another cause.

How can I reduce hot flashes?

There are some tips and tricks you can use to manage hot flushes, which might make the symptoms more manageable ^7,8;

• Avoid alcohol, caffeine and spicy foods – these are a very common trigger. 
• Wear fabrics that are light and breathable; cotton and silk are good options. This is also really important when it comes to your nightwear. 
• Keep your bedroom cool and use a few different layers of bedding, so that you can remove layers if you get too hot at night. Again, natural fabrics may help.
• Shower using lukewarm water rather than super-hot water. 
• Keep a fan or a cooling spray on hand to help reduce hot flashes when they strike.
• Regular exercise may help control symptoms; As well as being good for your overall health, if you are overweight, exercise may help you reduce the kilos and improve any hot flashes. Exercise also helps reduce stress, which is another common hot-flash trigger. 
• Cognitive Behaviour Therapy (CBT); CBT, developed specifically for menopausal symptoms, can help women to manage hot flushes and night sweats and evidence shows that there can be some additional benefits to quality of life⁹.
• Supplements and herbal remedies 
• Although the evidence for some of these therapies is limited, there are a few different supplements that you can buy over the counter which may help reduce hot flashes.

Hot flashes are a common reason for sleep disturbance in perimenopause, as clearly if you are waking up overnight with your nightwear soaked, you won’t sleep well! See our article on improving sleep in perimenopause for some further tips on improving your sleep. 

There are also medical treatments for hot flashes, including by replacing the oestrogen that is naturally lost in perimenopause and menopause. This can be done in a few ways including combined hormonal contraception and hormone replacement therapy (HRT). 

The choice of how to replenish your oestrogen levels depends on other factors about your health and whether you still need contraception (yes, you can still potentially get pregnant even if you are in the perimenopause period). Speak to your doctor to explore your options and what might suit you best.

If hormonal treatments are not suitable for you, there are some other drugs which may help¹⁰. Examples include clonidine, some types of antidepressant (e.g citalopram or fluoxetine) and gabapentin⁹. You should speak to your doctor to decide if these  might be suitable for you. 

Hot flashes can leave you exhausted and embarrassed, and have a significant impact on day to day life. Hopefully understanding what causes them and how to stave them off may help you, but if you are struggling, speak to a doctor.