Why You Shouldn’t Put Up With Hot Flashes in Menopause

From waking up at 3 a.m. drenched in sweat to feeling heat spread across your face halfway through a meeting, hot flashes and night sweats are a very real part of menopause for some women. These symptoms can leave you exhausted, distracted, and worried about the next episode.

But relief is possible, and you don’t have to wait until symptoms become unbearable to ask for help. Here’s why hot flashes deserve a conversation with your doctor — and some treatment options that are worth discussing.

Why Do Hot Flashes Happen?

But their intensity — and how disruptive they are — will vary widely depending on the woman, says Monica Christmas, MD, an associate medical director of the Menopause Society and the chief of comprehensive gynecology at the University of Chicago.

“Everybody doesn't get them. And even in women who do get hot flashes, it's very variable in terms of the frequency and the bother,” Dr. Christmas says.

Changing estrogen levels play a key role. As estrogen declines, the brain’s temperature-control center — the hypothalamus — becomes more sensitive to small changes in body temperature, according to Robin Noble, MD, a Portland, Maine–based gynecologist and the chief medical adviser at the nonprofit Let’s Talk Menopause.

“What's actually happening is we think the thermoregulatory zone is shrinking,” Dr. Noble says.

The True Toll on Your Quality of Life

Hot flashes can interfere with every part of a woman’s life, says Sameena Rahman, MD, an obstetrician-gynecologist and the founder of GSM Collective, a medical concierge service in Chicago.

“Patients tell me they’re having them in the middle of a big lecture, while having sex, while trying to sleep, during exercise, while they’re leading teams. It can be a profound disruption,” Dr. Rahman says. “At night, it can be a great source of distress, leading to fatigue, irritability, brain fog, and inability to concentrate.”

These interruptions add up.

• In a study of 141 women with frequent hot flashes, those reporting four or more hot-flash-related awakenings per night spent an estimated 42 minutes awake after initially falling asleep.

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• In a survey of 619 women, 91 percent said their symptoms affected their sleep, and among this group, 83 percent said it affected their daytime productivity.

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• A study involving 4,440 women found that nearly 11 percent had missed work because of their symptoms.

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These symptoms often arrive during an already demanding chapter of life, Noble says. Women may be at the height of their careers, raising children, and caring for aging parents. “I find that some people don’t realize how much they were struggling until they feel better.”

“The loss of estrogen through the menopause transition can affect nearly every bodily system, not only our reproductive system, but also our brain, heart, bones, and more,” says Madeline Cohn, DO, a women’s health specialist at Cleveland Clinic in Ohio who focuses on menopause and hormone therapy.

That doesn’t mean hot flashes cause heart disease or that treating them prevents it, Christmas says. “Association and causation are two different things,” she says.

Many more health and lifestyle factors need to be considered, Christmas says. She calls midlife a “critical time point” to look at overall health alongside menopause symptoms. This includes discussing blood pressure, cholesterol, diabetes risk, and bone health with your doctor.

The Latest Treatment Options to Consider

You may have been told that hot flashes are a “natural” part of menopause, but that doesn’t mean you have to tough them out, Cohn says.

“Although menopause and hot flashes may be ‘normal’ or ‘common,’ that doesn’t mean that women have to suffer through them. If these symptoms are disruptive to your life, that’s a reason to seek treatment,” Cohn says.

And you get to decide what counts as disruptive. “I don’t get to be the boss of how severe their symptoms are,” Christmas says. Whether hot flashes interrupt your sleep, interfere with work, or simply make you uncomfortable, it’s worth discussing your treatment with your doctor. Here are some options to explore.

Talk to your doctor about whether HRT is appropriate for you. If you have a more complex medical history, such as diabetes, high blood pressure, or an increased risk of breast cancer or cardiovascular disease, Noble says it may be helpful to consult a menopause specialist.

Nonhormonal Medications For women who don't want hormones or aren't HRT candidates, there are effective nonhormonal options as well, Rahman says.

Behavioral and Lifestyle Approaches Try not to think of treatment in silos, Christmas says. Medication can be combined with tools, such as psychotherapy and lifestyle modifications.

Wearing layers, practicing good sleep hygiene, and using a fan and lighter bedding can make episodes more comfortable, but Rahman says these measures don’t address the underlying physiology causing the hot flash.

“We don't have to make women fail every lifestyle intervention before discussing medication,” Rahman says. “We have effective treatments.”

How to Advocate for Yourself With Your Doctor

Start by telling your doctor how hot flashes and night sweats are affecting your sleep and daily life. Are you waking up in the middle of the night, changing soaked sheets, or losing your train of thought at work?

Track your symptoms for a week or two, including frequency, severity, nighttime awakenings, and daytime effects. “Even a simple note on your phone for a couple of weeks can reveal patterns,” Rahman says.

Questions to bring to your appointment include:

• Could menopause explain my symptoms, or should we check for other causes?
• Am I a candidate for HRT?
• Could nonhormonal options help if I’m not a candidate for HRT or don’t want hormone therapy?
• When should we follow up to assess whether treatment is working?
• Are there any lifestyle modifications I should consider?

Noble says you can search for a Menopause Society certified practitioner in your area for a specialized approach.