Mastering the Hot Flash: Why They Happen & How to Stop Them

It happens without warning. You’re in a meeting, or standing in line at the grocery store, and suddenly, an intense heat starts in your chest. It rushes up your neck to your face. You feel yourself turning beet red. Beads of sweat form on your upper lip. You feel a sudden spike of anxiety—a "fight or flight" sensation—right before you want to strip off your layers right there in public.

Welcome to the Hot Flash.

If you are nodding your head, you are in the majority. Up to 75% of women experience vasomotor symptoms (hot flashes and night sweats) during the menopause transition.

But just because they are "common" doesn't mean you have to suffer through them. Here is exactly why your internal thermostat is broken, and the toolkit you need to fix it.

To treat hot flashes, you have to understand where they come from. They don't start in your skin; they start in your brain.

Your body has a thermostat located in the hypothalamus. Its job is to keep your body temperature within a specific "comfort zone."

The Problem: Estrogen helps regulate this thermostat. When estrogen levels fluctuate wildly in perimenopause and drop in menopause, the "comfort zone" narrows drastically.

• The Glitch: Your brain misinterprets a tiny rise in temperature (like walking into a warm room or drinking hot coffee) as a "dangerously high" fever.

• The Reaction: To save you, the brain triggers an emergency cooling response. It dilates your blood vessels (the flush) and activates sweat glands to cool you down immediately.

Essentially, your brain thinks you are standing on the sun, even when you are just sitting on the couch.

Both caffeine and alcohol are vasodilators—they widen blood vessels, which mimics the start of a hot flash.

• Try This: If you notice flashes are worse in the morning, switch to half-caff. If night sweats are ruining your sleep, skip the evening glass of wine for a week and see if the sheets stay dry.

A sudden spike (and subsequent crash) in blood sugar can trigger a flash. Keeping glucose stable with protein-rich meals often helps "cool" the system.

Research shows that slow, deep abdominal breathing can reduce the severity of a hot flash.

1. Inhale slowly through your nose for a count of 5 (expand your belly).

2. Exhale slowly through your mouth for a count of 5.

3. Repeat for 2–3 minutes. This calms the sympathetic nervous system (fight or flight) that makes the flash feel like a panic attack.

Don't just fan your face. Apply cold (ice water, a cold pack, or a wet paper towel) to the back of your neck or your wrists. These are pulse points where blood vessels are close to the surface, helping to cool your entire body faster.

Night sweats are simply severe hot flashes that happen while you sleep. They are particularly damaging because they disrupt your sleep cycles, leading to brain fog and irritability the next day.

• Bedroom Temp: Keep it at 65°F (18°C) or lower. Your body needs to drop its core temperature to enter deep sleep.

• Bamboo is Best: Swap cotton or synthetic sheets for Bamboo or Eucalyptus Lyocell. These fabrics are moisture-wicking and temperature regulating.

• The "3 AM" Reset: If you wake up soaked, do not lie there in damp sheets. Get up, towel off, change into dry clothes, and sip cool water. Lying in wet clothes can cause a chill (the "cold flash") that keeps you awake longer.

• Black Cohosh: One of the most studied herbs for hot flashes. Results are mixed, but many women find relief. (Note: Avoid if you have liver issues).

• Vitamin E & Evening Primrose Oil: Anecdotal evidence suggests these may help mild symptoms.

• Acupuncture: Several studies indicate that regular acupuncture can reduce the frequency of flashes.

• HRT (Hormone Replacement Therapy): This is the "Gold Standard." By topping up your estrogen levels, you widen the thermostat's comfort zone back to normal. For most healthy women under 60, the benefits usually outweigh the risks.

  • Read more in our Guide to HRT Safety.

• Veozah (Fezolinetant): A game-changer. This is a new, FDA-approved non-hormonal drug that specifically targets the neurons in the brain that cause hot flashes. It is ideal for women who cannot or do not want to take hormones.

• Other Non-Hormonals: Low-dose antidepressants (SSRIs) and Gabapentin are also commonly prescribed to help manage vasomotor symptoms.

Hot flashes are a biological signal that your body is changing. They are not a punishment, and suffering through them is not a badge of honor.

Start by tracking your triggers for one week. If that doesn't work, talk to your doctor about Veozah or HRT. You deserve to get through a meeting without sweating, and you certainly deserve a good night's sleep.

• Waking up at 3 AM? Read The Menopause Insomnia Guide.

• Confused about treatment options? Check out Navigating Menopause Treatments.