--- title: 'What Causes Hot Flushes In Perimenopause And What Can Help Them?' slug: hot-flushes-perimenopause-what-causes-them-what-helps lifeStage: perimenopause category: Symptoms author: 'Samaira Farid' medicalReviewer: 'Dr Shree Datta, Consultant Obstetrician and Gynaecologist ' reviewerId: 'https://blog.bloume.com/perimenopause/medical-board.md#dr-shree-datta' lastUpdated: '2026-08-29' primarySource: 'Treatment for symptoms of the menopause' wordCount: 1224 readTimeInSeconds: 306 --- # What Causes Hot Flushes In Perimenopause And What Can Help Them? Hot flushes are one of the most familiar parts of perimenopause and menopause. That sudden wave of heat through your face, neck, and chest, often followed by sweating and a chill, comes down to hormonal changes affecting how your brain regulates body temperature. This article explains what is going on, sets out the main treatment options including Hormone Replacement Therapy (HRT), and covers the everyday factors that can change how often and how strongly the flushes come. **Q: Why do hot flushes happen during perimenopause?** A: Hot flushes trace back to oestrogen rising, falling, and then dropping over perimenopause, which affects your hypothalamus, the part of your brain that regulates body temperature. With oestrogen less steady, your hypothalamus becomes oversensitive and reacts to small temperature changes with an outsized cooling response, including flushing, sweating, and sometimes a chill afterwards. 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. ## 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. 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. ## 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. 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. 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. > **INFO**: If you are thinking about HRT, talk it through with your GP. The decision weighs up benefits and risks specific to your health history, and your GP can help you understand which type and form may suit you best. ## 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. 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. 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. ## 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. ## 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. 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. 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. 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. 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. --- **Q: Why do hot flushes happen during perimenopause?** Hot flushes trace back to oestrogen rising, falling, and then dropping over perimenopause, which affects your hypothalamus, the part of your brain that regulates body temperature. With oestrogen less steady, your hypothalamus becomes oversensitive and reacts to small temperature changes with an outsized cooling response, including flushing, sweating, and sometimes a chill afterwards. **Q: Is HRT the only treatment for hot flushes?** HRT is the most effective treatment for hot flushes and night sweats, though it is not your only route. Non-hormonal prescription medicines, including certain antidepressants (SSRIs and SNRIs), clonidine, and gabapentin (used off-label and as a controlled drug), can reduce symptoms. Menopause-specific CBT is also recommended in UK clinical guidance. Lifestyle changes, like easing back on known triggers and moving more, can add further benefit. Any prescription option is worth discussing with your GP. **Q: Can lifestyle changes genuinely reduce hot flushes?** Lifestyle changes can make a real difference, though how much varies. Cutting back on caffeine, alcohol, and spicy food can lower how often triggers hit. Regular aerobic exercise and stress-calming practices such as yoga or meditation may help too. These work best alongside appropriate clinical treatment where that suits you. **Q: When should you speak to a GP about hot flushes?** If hot flushes are affecting your sleep, your mood, or your day, it is worth raising at your next GP appointment. Your GP can talk through the full range of options, including HRT and non-hormonal alternatives, and help you weigh up what fits your own health history. ### Clinical Sources - [Treatment for symptoms of the menopause](https://www.rcog.org.uk/for-the-public/browse-our-patient-information/treatment-for-symptoms-of-the-menopause/) - [Symptoms of menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/) - [Hot flushes explained](https://www.drlouisenewson.co.uk/knowledge/hot-flushes-explained) - [A Guide to Menopause and Vasomotor Symptoms, Including Hot Flashes and Night Sweats](https://www.everydayhealth.com/menopause/vasomotor-signs/guide/) - [Menopause: diagnosis and management](https://www.nice.org.uk/guidance/ng23/resources/menopause-identification-and-management-pdf-1837330217413) - [Types of hormone replacement therapy (HRT)](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/) - [About hormone replacement therapy (HRT)](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/) - [Recommendations | Menopause: diagnosis and management](https://www.nice.org.uk/guidance/ng23/chapter/recommendations) - [Alternatives to hormone replacement therapy (HRT)](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/alternatives-to-hormone-replacement-therapy-hrt/lifestyle-changes-to-make-if-youre-unable-to-take-hrt/) - [BMS consensus statement: Non-hormonal based treatments for menopausal symptoms](https://thebms.org.uk/wp-content/uploads/2025/11/04-BMS-ConsensusStatement-Non-hormonal-based-treatments-for-menopausal-symptoms-NOV2025-C.pdf) - [Recommendations | Menopause: diagnosis and management](https://www.nice.org.uk/guidance/ng23/chapter/recommendations) - [Things you can do to help menopause and perimenopause symptoms](https://www.nhs.uk/conditions/menopause-and-perimenopause/things-you-can-do/) - [Things you can do to help menopause and perimenopause symptoms](https://www.nhs.uk/conditions/menopause-and-perimenopause/things-you-can-do/) - [Menopause: a healthy lifestyle guide](https://www.cuh.nhs.uk/patient-information/menopause-a-healthy-lifestyle-guide/) - [Things you can do to help menopause and perimenopause symptoms](https://www.nhs.uk/conditions/menopause-and-perimenopause/things-you-can-do/) --- Reviewed by Dr Shree Datta, Consultant Obstetrician and Gynaecologist | [Medical Board](https://blog.bloume.com/perimenopause/medical-board.md) | August 2026