Hot Flushes and Night Sweats: Causes and What Helps

Hot flushes and night sweats are the menopause's defining symptom: the NHS says symptoms usually last 7 to 9 years, and in the SWAN cohort frequent flushes lasted a median 7.4 years. They are not the only cause of night sweats, so the other causes come first, then what NICE says the NHS offers and what the supplement trials measured.^{1, 2} One spoke of the Wellgard menopause guide.

Sources checked on 5 November 2026.

What causes hot flushes and night sweats?

Falling oestrogen. The NHS says the menopause "is caused by a fall in hormone levels", and describes a hot flush as when "your face, neck and chest suddenly feel very hot or cold"; it "can make you sweat a lot, cause palpitations or anxiety", lasts "for several minutes", and happens by day or, as a night sweat, in bed.^{1, 3} At 45 or over, NICE treats flushes or sweats that "have recently started", with any change in the cycle, as the mark of perimenopause itself, with no blood test; the first signs of perimenopause covers the stages.⁴

How long they last is the question behind most searches. In the SWAN cohort of 3,302 US women, frequent flushes or sweats (six or more days in two weeks) lasted a median 7.4 years and persisted a median 4.5 years after the final period; they ran longest, a median over 11.8 years, when they began before or early in the transition, and shortest, 3.4 years, when they began after the final period.² The NHS says symptoms "usually last for 7 to 9 years, sometimes longer", and that women from a Black ethnic background "are more likely to have hot flushes that are severe and continue longer".¹ A 2026 meta-analysis of 61 studies put the odds of flushes 1.65 times higher in Black women than in White women, and higher with smoking (1.63), obesity (1.35) and depression (2.36).⁵ They do not always stop at 60: of 921 women aged 60 or over attending one US menopause clinic, 41% reported moderate to severe flush bother, a clinic sample rather than a population one.⁶

What else can cause night sweats?

Five things sit beside the menopause on the NHS's own list, and two more belong with them. The NHS night sweats page (reviewed 9 November 2023) defines them as sweating so much that "your night clothes and bedding are soaking wet" in a cool room, and names the most common causes as menopause symptoms, anxiety, "medicines, such as some antidepressants, steroids and painkillers", low blood sugar, alcohol or drug use, and hyperhidrosis, a harmless tendency to sweat heavily at any hour; "Sometimes the cause of night sweats is unknown."⁷ The two others: An overactive thyroid: the NHS lists "sensitivity to heat", "warm skin and excessive sweating", palpitations and weight loss among its signs, and the NHS says a blood test can often tell whether a thyroid problem is the cause.⁸ And infection, which is why a very high temperature with the sweats is one of the NHS's reasons to see a GP.⁷

Alcohol earns its place twice: it is on the NHS list of causes, and it shortens the time to fall asleep, then disrupts the second half of the night, which is when a sweat surfaces you; why hangovers feel worse in your forties has the sleep recordings.^{7, 9} "Cold sweats" are the same event from the other end: the NHS's description of a flush is feeling "very hot or cold", and a sweat with feeling "hot, cold or shivery" and a very high temperature is a GP trigger.^{1, 7} Sweats in the days before a period are a common search; they are not on the NHS list, and in the forties the first question is whether the cycle itself has started to change.⁷ The waking itself, and what helps it, stays with perimenopause sleep problems.

Do hot flushes matter beyond comfort?

They can be a marker as well as a nuisance. In SWAN, 3,083 women aged 42 to 52 were followed for up to 22 years, with 231 cardiovascular events: women with frequent flushes at the start (six or more days in two weeks) had 1.51 times the rate of later events of women with none, and women whose frequent flushes persisted through follow-up 1.77 times, after adjustment for the usual risk factors.¹⁰ That is an association, not a cause; the authors call flushes a possible "female-specific" risk factor, and the route the Wellgard menopause guide gives for it is the GP's blood pressure, cholesterol and glucose checks, not a supplement.¹⁰ Weight runs the other way: among 154 overweight or obese women bothered by flushes inside a six-month weight-loss trial, the intensive programme gave 2.25 times the odds of improvement, and every 5 kg that came off raised the odds by 1.32.¹¹ The NHS list for flushes includes keeping "to a healthy weight".¹²

What does the NHS offer for hot flushes?

HRT first, then menopause-specific CBT, then named non-hormonal medicines, all through a GP. The NHS says to talk to "a doctor, nurse or pharmacist about HRT and other options available", and that oestrogen, the main type of HRT, "can help manage your symptoms".¹³ NICE's recommendation 1.5.1 is one line: "Offer HRT to people with vasomotor symptoms associated with menopause."⁴ In the HALT trial in the table below, hormone therapy cut flushes and sweats by about four a day against placebo over a year, the size of effect everything else is measured against.¹⁴

CBT. NICE says to consider menopause-specific cognitive behavioural therapy for flushes "in addition to HRT", "for people for whom HRT is contraindicated" or "for those who prefer not to take HRT" (1.5.2).⁴ The trials are in the next section.

Fezolinetant. Since 31 March 2026 NICE has recommended this prescription medicine, a non-hormonal neurokinin 3 receptor antagonist, "as an option for treating moderate to severe vasomotor symptoms associated with menopause when HRT is unsuitable" (1.5.3, TA1143).^{4, 15} In one of its two 12-week phase 3 trials, in women aged 40 to 65 with at least seven moderate to severe flushes a day, the two doses cut daily flushes by 1.9 and 2.5 more than placebo at week 12.¹⁶ Whether it suits you is the prescriber's conversation.

Antidepressants and clonidine. NICE says SSRIs, SNRIs and clonidine are not to be offered "routinely" as "first-line treatment for vasomotor symptoms alone" (1.5.4); the NHS says CBT may be offered for flushes and, if that does not help, "a doctor may suggest clonidine, or an antidepressant".^{4, 13} Pooled across 11 trials and 2,069 women, SSRIs cut flushes by 0.93 a day more than placebo; adverse events in the pooled trials did not differ from placebo, though the authors note the usual SSRI side-effect profile.¹⁷ Doses and choices are the GP's; alternatives to HRT, as the NHS and NICE describe them, follow in this series.

Does CBT, hypnosis or exercise help?

CBT changes how much flushes bother you, measurably; hypnosis cut their number in one large trial; exercise has not been shown to reduce them. In the UK MENOS 2 trial, 140 women with ten or more problematic flushes or sweats a week had group CBT, guided self-help CBT or no treatment: on a one-to-ten problem rating, group CBT scored 2.12 points lower than no treatment at six weeks and self-help 2.08, with 1.33 and 1.19 still showing at 26 weeks, and both formats reduced night sweat frequency.¹⁸ After breast cancer, where HRT is usually off the table, six weekly group sessions cut the problem rating by 1.67 points at nine weeks in 96 women, and a nurse-led version in 130 women cut it 46% against 15% with usual care.^{19, 20} Counts are a different matter: in the MsFLASH trial of CBT for insomnia in 106 women with flushes, sleep improved and daily hot flush counts did not differ.²¹ NICE has recommended menopause-specific CBT since 2024, and for low mood and anxiety the NHS says "you can refer yourself to NHS talking therapies without speaking to a GP".^{4, 22}

Hypnosis. In one US trial, 187 postmenopausal women with at least seven flushes a day had five weekly sessions of clinical hypnosis or a structured-attention control: self-reported flushes fell 74% against 17% by week 12, and physiologically recorded flushes 57% against 10%.²³ It is a single trial and a practitioner's skill, not something on a shelf.

Exercise, acupuncture and breathing. In the Cochrane review of five trials, 733 women, exercise against no active treatment showed no evidence of a difference in flush frequency or intensity (three trials, 454 women, low-quality evidence); the NHS lists regular exercise among the things to try for flushes, and its firmer case at the menopause is bone, strength and mood.^{12, 24} Acupuncture against sham acupuncture: 1.13 fewer flushes a day, not significant, across eight trials and 414 women.²⁵ Paced breathing: no difference from a control breathing pattern or usual care at 8 or 16 weeks in 218 women.²⁶ The US Menopause Society's 2023 statement lists CBT, clinical hypnosis, SSRIs and SNRIs and fezolinetant among the options it recommends for flushes, and does not recommend paced breathing, exercise, acupuncture or supplements and herbal remedies; NICE says there is "some evidence" for isoflavones and black cohosh.^{4, 27} The two bodies weigh the same small, inconsistent trials with different thresholds.

Do supplements or foods reduce hot flushes? The trials, as counts

No food or supplement may claim to, and the trials below are why the question stays open. No food or supplement holds a GB authorised health claim for any menopause symptom;²⁸ the MHRA's guidance on what counts as a medicine says that "claims for the relief of menopause symptoms, either direct or implied, are medicinal claims", including "claims for hot flushes, night sweats, headaches, and anxiety", and are not permitted for products that are not authorised medicines;²⁹ and the advertising code's guidance of 7 August 2026 treats claims to treat or help menopause symptoms as unlikely to be acceptable for foods and supplements.³⁰ The NHS says to "talk to a doctor before taking herbal supplements or complementary medicines".¹² So what follows is a count: who was studied, what they took, for how long, what changed against placebo, and who paid. Three things to hold while reading it. Nothing in it works quickly: a model fitted to 16 soy isoflavone trials found they took 13.4 weeks to reach half their maximum effect, against 3.09 weeks for oestradiol, and 48 weeks to reach 80% of it.³¹ Placebo works unusually well on flushes: in the Cochrane review, placebo arms cut flush frequency by anything from 1% to 59%.³² And a pooled result and a single trial can disagree, as the soy and red clover rows show.

The herbal rows come with their safety lines. NICE says "there is some evidence that isoflavones or black cohosh may relieve vasomotor symptoms", with the caveats that preparations vary, their safety is uncertain and interactions with other medicines have been reported (1.4.7), and that St John's wort, for women with a history of breast cancer, carries "potential serious interactions", including with tamoxifen, anticoagulants and anticonvulsants (1.4.8).⁴ The NHS says St John's wort "may stop HRT tablets and capsules from working as well", and that "it's not possible to say that other herbal remedies and supplements are safe to take with HRT".⁵⁵ In 2006 the MHRA asked for warnings about rare liver reactions on black cohosh products.⁵⁶ Black cohosh, sage and St John's wort are also sold in the UK as registered traditional herbal medicines: 15 of the 155 registrations on the MHRA's list dated 29 October 2026 carry a menopause indication, nine of them black cohosh, three of those combined with St John's wort.⁵⁷ The black cohosh wording is "for the relief of symptoms of the menopause, such as hot flushes, night sweats, and temporary changes in mood", the sage wording "for the relief of excessive sweating associated with menopausal hot flushes, including night sweats", and each is "based on traditional use only", which a food supplement containing the same herb cannot borrow.⁵⁷ The supplement-by-supplement review, with ashwagandha, collagen and the bone case, is which menopause supplements have evidence; magnesium's roles and forms are on what magnesium is good for, and omega-3's on what is omega-3.

What can I do tonight?

The NHS list, in its words: "wearing lightweight clothing", "keeping your bedroom cool at night", "taking a cool shower, using a fan or having a cold drink", and avoiding "potential triggers, such as spicy food, caffeine, hot drinks, smoking and alcohol".¹² It adds not smoking, because smoking "can make menopause symptoms worse", and keeping alcohol within the limit.¹² None of it is a treatment; it is what you control between now and the GP appointment. For the waking that follows a sweat, and the alcohol and caffeine timing, perimenopause sleep problems and why do I wake up at 3am have the detail.

When should I see a GP?

For night sweats, the NHS says to see a GP if "you have night sweats regularly that wake you up or worry you", if you also have "a very high temperature (or feel hot, cold or shivery), a cough or diarrhoea", or if "you're losing weight for no reason"; the GP "will want to check if you have any other symptoms", and may change a medicine that could be causing them.⁷ For flushes, the NHS says to contact a GP if you "want to know what your options are", and for palpitations: a 2022 review of 37 studies found no treatment for menopausal palpitations that could be recommended, isoflavones and sage included, so a new fast or irregular heartbeat is a GP check in its own right.^{1, 58} Flushes and sweats that start years after the menopause get the same check: they troubled 41% of the over-60s in one menopause clinic, and the list of other causes applies at any age.^{6, 7}

And the bleeding rule, on every page in this series. For any bleeding a year or more after your last period, bleeding after sex, or bleeding that is heavier or more frequent than before. About one in ten women with bleeding after the menopause has womb cancer, and nine in ten womb cancers present that way.⁵⁹ The NHS says to see a GP for postmenopausal bleeding even if "it's only happened once" or "there's only a small amount of blood, spotting, or pink or brown discharge"; it "is not usually serious but can be a sign of cancer".¹ When to see a GP about sleep has the 111 and 999 lines.

What we don't know

• Whether any food supplement reliably eases flushes: soy isoflavone extracts beat placebo in one pooled analysis of 17 trials, a Cochrane review of 43 trials found no conclusive evidence for phytoestrogens, and black cohosh did no better than placebo; the 2024 and 2025 soy poolings and the 2026 red clover pooling pull in opposite directions again.^{32, 33, 34, 35, 37, 38}
• Whether frequent flushes raise heart risk or only mark it: SWAN found the association after adjusting for the usual risk factors, and an observational cohort cannot say which.¹⁰
• Whether CBT lowers the count or the bother: MENOS 2 reduced night sweat frequency; the MsFLASH insomnia trial improved sleep without changing daily flush counts.^{18, 21}

Frequently asked questions

How long do hot flushes last?

A median 7.4 years in SWAN, 4.5 of them after the final period; longer when they start early in the transition, and still troubling 41% of women over 60 in one menopause clinic.^{2, 6} The NHS says symptoms "usually last for 7 to 9 years, sometimes longer".¹

What can be mistaken for a hot flush?

Anxiety, some antidepressants, steroids and painkillers, low blood sugar, alcohol and hyperhidrosis, all on the NHS night sweats list; infection, which sits behind the NHS's "very high temperature" trigger; and an overactive thyroid, which brings heat sensitivity, sweating and palpitations and is found by a blood test.^{7, 8}

What helps hot flushes if I cannot take HRT?

NICE names menopause-specific CBT "for people for whom HRT is contraindicated" and fezolinetant "when HRT is unsuitable"; the NHS adds clonidine or an antidepressant if CBT does not help.^{4, 13} That is a GP conversation. No supplement is an alternative to HRT, and none may claim to be.^{29, 30}

Does magnesium stop night sweats?

In a 289-woman trial, eight weeks of magnesium oxide did not change hot flush scores; magnesium contributes to normal muscle function and the maintenance of normal bones.⁵¹ The trial counted flushes and their severity from a diary and did not report night sweats separately.⁵¹

Why are my night sweats worse after drinking?

Alcohol is on the NHS list of causes of night sweats in its own right, and it breaks up the second half of the night, which is when a sweat wakes you (see the causes section above).^{7, 9} The NHS asks women at the menopause to keep within the alcohol limit because "it may affect your symptoms".¹²

Sources

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Spotted something out of date? Email support@wellgard.co.uk with the page address and the sentence.

This article is general information, not medical advice. Hot flushes and night sweats that affect your life deserve a GP appointment, where HRT, menopause-specific CBT and the non-hormonal medicines can be discussed; tell your pharmacist or GP about every supplement if you take HRT, tamoxifen, an antidepressant or a blood thinner, and women with a history of breast cancer should ask their oncologist before taking isoflavones or any menopause supplement.