The sudden heat that rises through your face, neck, and chest, sometimes with a racing heartbeat, a film of sweat, and an anxious edge, then leaves you feeling cold, is one of the most familiar parts of perimenopause. Hot flushes and night sweats are known together as vasomotor symptoms, and most people going through perimenopause and menopause feel them at some point. They can start before your periods stop, so understanding what is behind them matters from early in the transition.2
What is happening in the body during a hot flush
The heat itself traces back to the way oestrogen rises, falls, and then drops across perimenopause. Your hypothalamus, the part of your brain that keeps your body temperature steady, is sensitive to oestrogen. As those levels shift, it becomes less precise about reading temperature.3
The result is a narrower comfort zone. Where your hypothalamus once tolerated a reasonable range before cooling you down, it now reacts to a much smaller change. A slight rise in your core temperature can read as overheating, even when you are fine. Your brain responds by widening the blood vessels near your skin, which is the flushing and redness you feel, and by switching on your sweat glands. When the wave passes, the cooling from that sweat can leave you with a chill. When the same thing happens overnight, it is a night sweat.4
HRT for hot flushes and night sweats
Hormone Replacement Therapy (HRT) is often recommended as the most effective treatment for hot flushes and night sweats. It works by bringing oestrogen back to steadier levels, which lets your hypothalamus regulate temperature more accurately again. UK clinical guidance supports offering HRT for these symptoms, after a conversation with your GP about the benefits and risks for your own health.5
HRT comes in two main forms. If you still have your womb, you will usually be offered combined HRT, which contains both oestrogen and a progestogen. The progestogen protects the lining of your womb. If you have had a hysterectomy, oestrogen-only HRT is used. Your GP will work out which type fits you.6
HRT comes as tablets, skin patches, gels, or sprays. Treatment usually starts at a low dose, which your GP can adjust over time depending on how your symptoms respond. The form and the dose are worked out with your GP rather than chosen on your own.7
Non-hormonal prescription options
If you cannot take HRT, or would rather not, a few prescription medicines can help bring hot flushes down. None of these should be started, stopped, or changed without guidance from your GP.
Certain antidepressants, the types known as SSRIs and SNRIs, can ease your hot flushes. UK clinical guidance is clear that these are not a first-line treatment for hot flushes on their own, and they need a GP prescription.8
Clonidine is a non-hormonal medicine licensed in the UK specifically for hot flushes. It is available on prescription and can cause side effects like drowsiness and a dry mouth. Your GP can talk through whether it suits you.9
Gabapentin, a medicine mainly licensed for epilepsy, can reduce hot flushes, and it may help most when night sweats are breaking up your sleep, since it can improve sleep quality too. In the UK it is a Schedule 3 controlled drug and prescription-only. Using it for hot flushes is off-label, meaning it is not licensed for this specific use. It should only be taken under GP supervision, and your GP can assess whether it fits your full health picture.10
Cognitive Behavioural Therapy for hot flushes
Menopause-specific Cognitive Behavioural Therapy (CBT), a structured talking therapy, is recommended in UK clinical guidance for managing hot flushes and night sweats. CBT for menopause works on your response to the flushes rather than the flushes themselves, which can lower the distress around them and help you cope. It sits alongside clinical treatment where that is appropriate. A referral from your GP may be needed to access CBT.11
Lifestyle factors that can reduce hot flushes
Alongside medical and therapeutic options, a handful of everyday factors shape how often and how strongly hot flushes hit. Common triggers include caffeine, alcohol, spicy food, and stress. Working out which ones apply to you, and easing back on them, can change how often the flushes come.12
Regular aerobic exercise, such as walking or running, can help reduce hot flushes, while muscle-strengthening activities like weight training help maintain bone density and muscle mass. Aiming for at least 150 minutes of moderate activity a week alongside strength exercises twice a week sits in line with general health guidance, though how much it relieves symptoms varies from person to person.113
Keeping to a healthy weight can also support how you manage symptoms. There is some limited evidence that foods with phytoestrogens, like soya and lentils, may ease your hot flushes. The evidence here is not strong, and clinical guidance does not make a firm recommendation on them. If you are taking tamoxifen or another hormone-sensitive treatment, check with your GP before you increase phytoestrogen-rich foods.14
Because stress can set off a flush, calming practices like yoga, tai chi, or meditation may help bring the frequency down. If you smoke, stopping is worth considering, as smoking tends to make hot flushes more frequent and more severe.15
If you are navigating hot flushes and want to understand more about what is happening in your body, talking to your GP is the best place to start. The British Menopause Society and Menopause Matters are also reliable sources of information and support.