Hot Flashes

by Christiane Northrup, M.D.


Hot flashes, or vasomotor flushes, are characterized by the feeling of heat and sweating, particularly around the head and neck. They are the most common menopausal symptom, affecting anywhere from 50 to 85 percent of women at some point during their climacteric years. Mainstream medicine considers hot flashes to be a result of declining estrogen levels at menopause. Indeed, hot flashes are seen in women with low estrogen; however, women with high estrogen levels or fluctuating estrogen levels also experience hot flashes. It is not uncommon for women to experience hot flashes during pregnancy, and also premenstrually.

Hot flashes often start just before or during the menstrual period during perimenopause. While hot flashes tend to go away a year or two after menopause, many women experience hot flashes post-menopausally. Depending on the intensity of a hot flash, some women may get accompanying headaches or feel dizzy, tired, weak, or lose sleep. Others experience heart palpitations or erratic heart beats. Many women flush, sweat and then become chilled afterward.

Night sweats are on a continuum with hot flashes. In Traditional Chinese Medicine, 3:00–4:00 A.M. is the most common time for night sweats, which may cause you to awaken, drenched with sweat. Solutions are the same as for hot flashes.

What Causes Hot Flashes?

Hot flashes occur when blood vessels in the skin of the head and neck open more widely than usual, allowing more blood to shift into the area, creating heat and redness. Researchers believe that this vascular shift is due to changes in neurotransmitter activity that are not full understood, occurring in response to erratic hormone levels.

Women with low progesterone but normal estrogen levels may experience hot flashes and night sweats. Other hormones may also play a role in causing hot flashes. Hot flashes also occur with low testosterone levels (even in men), high FSH (follicle stimulating hormone), surges of LH (luteinizing hormone), increased cortisol, increased stress hormones and low beta–endorphin levels. Even low levels of antioxidants in the body can contribute to hot flashes, which is another reason why a hormone-balancing diet rich in nutrients and low in refined carbohydrates is important to support the body during menopause.

Certain illnesses, such as anorexia nervosa, can cause hot flashes. Medications can also cause hot flashes. Over-the-counter medications for sinus and allergy trouble can have an adrenaline-like effect that can trigger hot flashes. Prior to menopause, I experienced hot flashes while taking GnRH to shrink my fibroid before having it surgically removed.

Listen to Your Body

While researches continue to look at the underlying causes of hot flashes, one thing is certain: Every woman can learn to stay cool by paying attention to her own individual triggers. What seems to trigger a hot flash for one woman, may give another woman no trouble at all. Learning your triggers may be all you need to control your hot flashes. Here are some common triggers that you may want to experiment with. Remember to keep a journal to record your individual findings.

  • Hot, spicy food. Many women find that spicy food aggravates or even triggers hot flashes. However, some researches now believe that hot peppers can be great for combating hot flashes, as women in South American and Mexico rarely experience them.
  • Hot drinks. Warm beverages can heat you up just enough to trigger a hot flash. If this is true for you, stick with cold or room-temperature drinks instead.
  • Caffeine. Eliminate all caffeine (even decaffeinated drinks) for one week to see if caffeine is a trigger for you.
  • Alcohol. Alcohol is a refined carbohydrate that acts like sugar in the body. It can cause an epinephrine release, which can trigger a hot flash. Red wine is particularly potent.
  • White sugar. Sugar has also caused heart palpitations in some of my patients.
  • Stress. Stress causes a hormonal chain reaction in the body that has been linked to increased number and severity of hot flashes. See Solutions for ways to combat stress.
  • Hot weather. You can’t control the weather, but you can set your thermostat at a comfortable level; 70 degrees during the day and 65 at night may help keep you cool.
  • Hot tubs and saunas. Hot tubs and saunas can cause your body temperature to rise and trigger a hot flash. It’s best to avoid these if you’re sensitive.
  • Tobacco.
  • Unexpressed anger. Keeping feelings of anger and shame bottled up can lead to a whole host of health problems. Identify the root of your anger and express it openly. You may want to keep a journal to help you uncover patterns.

Spiritual and Holistic Options

Hot flashes are most common in Western cultures. Some researches are quick to excuse the low incidence of hot flashes and other menopausal symptoms in non-Western cultures, such as Japan, to a diet typically high in soy foods. However, other non-Western cultures such as Hong Kong, Pakistan, and Mexico also report, on average, that only 10 percent or less of menopausal women have hot flashes.

In our culture 70 to 85 percent of women suffer from hot flashes, sometimes severely. I believe that this is, in part, because we have been led to believe that issues that arise premenstrually and perimenopausally are just hormonal, or that they exist in a universe that is completely separate from the rest of our lives. GuthrieThis is simply not true. By reducing our bodies’ signals to physical symptoms, we are “buying in” to the belief system that pervades Western medicine. If we don’t pay attention to the emotional issues that arise premenstrually and perimenopausally, our symptoms will continue to escalate until we pay attention to the signals our bodies are sending. These signals are usually related to a larger need that is not getting met.

While I am not discounting the direct physical effect of changing hormones, it is important to understand that uncomfortable symptoms, such as hot flashes, will be magnified and prolonged if a woman is carrying heavy emotional baggage. In general, women with a history of anxiety, panic attacks or depression are more troubled by hot flashes than women without these experiences.

Hot Flash Solutions

If you’re hot and bothered, there are a number of ways you can control the severity and frequency of your hot flashes.

  • Try estrogen replacement. Estrogen replacement is highly effective in cooling hot flashes, and is considered the “gold standard.” I recommend only bioidentical estrogen at individualized doses. You may want to have your hormone levels tested before you begin using estrogen.
  • Try natural progesterone cream. Two-percent bioidentical progesterone cream has been shown to decrease hot flashes in many women at a dose of one-quarter teaspoon per day on skin. I recommend one-quarter teaspoon once or twice per day, at least three weeks per month, or daily if periods have stopped. Leonetti2

    NOTE: Bioidentical progesterone is entirely different biochemically from the synthetic progesterone found in most conventional hormone replacement regimens and in birth control pills. It has far fewer side effects compared to the synthetic varieties.

  • Learn stress reduction techniques. Dr. Herbert Benson, author of the famous Relaxation Response and founding president of The Mind/Body Medical Institute has successfully taught women relaxation techniques and cognitive behavioral skills to help them ease the transition to menopause. His studies show that relaxation-based techniques help cool hot flashes in 90 percent of women without any hormonal therapy at all.

    I recommend that you read Minding the Body, Mending the Mind, by Dr. Joan Borysenko and Healing Mind, Healthy Woman, by Alice Domar, PhD and Henry Dreher.

  • Improve your diet. Many women also find relief when they improve their diets. (See The Wisdom of Menopause, Chapter 7, “The Menopause Food Plan.”) Soy foods (a total of 45–160 mg of soy isoflavones per day) provide relief.
  • Try herbal therapies. There are a wide variety of herbs used on their own or in combination with other helpful traditional herbs, including Angelica (Dong Quoi), burdock, chasteberry, motherwort, and licorice.

    I recommend black cohosh, 40 mg, twice per day. Formulas that contain high quality wild-crafted Dong Quoi, burdock, chasteberry, black cohosh, motherwort, and licorice can be very helpful, as can Traditional Chinese herbs. (These approaches are detailed in The Wisdom of Menopause, Chapter 6, “Foods and Supplements to Support the Change.”)

  • Check your emotional baggage. Determine what your hot flashes mean to you. Tapping into your body’s wisdom can help ease your symptoms significantly. Many women experience hot flashes when they are angry, especially if they don’t let their anger out. Vicki Noble, author of Shakti Woman: Feeling Our Fire, Healing Our World suggests that hot flashes are the body’s way of naturally cleansing what it no longer needs. If you have any doubts about your emotions, one of the best ways to figure out just how you feel about things is through keeping a journal.
  • Establish a peer support network. Studies show that women benefit both mentally and physically from mutual support. Talking with other women about your experience can help alleviate some of the anxiety often associated with menopausal symptoms.

Learn More — Additional Resources


  1. Guthrie, J., et al., 1996. Hot flushes, menstrual status, and hormone levels in a population-based sample of midlife women. Obstetrics & Gynecology, 88, 437–442.
  2. Leonetti, H., et al., 1999. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstetrics & Gynecology, 94, 227–228.
Christiane Northrup, M.D.

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


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  1. Sheila
    3 weeks ago

    Hi! In the book Wisdom of Menopause, Dr Northrup says that some women break open prometrium capsules and apply it topically on skin. I normally take 100mg orally but want to try the topical route. How much of the capsule content applied topically/transdermally be equivalent to 100mg taken orally? Thanks. Sheila

  2. Darlene Armenta
    2 months ago

    Add makeup to that list. I realized that when I use Almay foundation for acne control I sweat like crazy.

    1. Darlene Armenta
      2 months ago

      It comes in waves like hot flashes until I wash my face at night.

  3. Deb
    2 months ago

    I now understand that the red wine/alcohol that I drink at night is most probably the reason for my hot flashes during the night, but why do I wake just seconds before one hits ? Meaning I am constantly woken all night from about midnight on and unable to go back to sleep for an hour or two leaving me very tired in the morning.

  4. helen
    3 months ago

    Hi I have had had hot flushes for the last 10 years, periods stoped a year ago, cant go on hrt because of fibroid history, I tend to wake up too early with the flushes what can I do I am sick of not getting enough sleep.

    1. Erin
      2 weeks ago

      I hear you about waking up before they come on and I was getting them throughout night. I have history in family of ovarian cancer, so not a candidate for HRT. My gyn though told me to go on the birth control pill, which I’d been off for several years. I just started back up four nights ago and last night was first night I found relief, so they’re kicking in. She also told me to lay off red wine which is hard because it’s my vice and I love glass every night. I stopped drinking wine two nights ago and really helped. So if you can, birth control pills and reduction or elimination of alcohol consumption may totally help you, as it did me.

    2. Kristin Jagelski
      1 week ago

      I keep OTC glucose in bed. The moment the palpitations start, I bite just a tiny piece og g a glucose tablet. It stops the attack in its tracks immediately.

      My doctor said I’m wrong, but he’s wrong because this works great. I feel I can go back to sleep. It is empowering.

      If it works for you, would you let me know?

    3. Kristin Jagelski
      1 week ago

      A teeny immediate piece of glucose tablet works for me.

  5. Deb Taylor
    4 months ago

    I went on HRT, the Patch, about 15 years ago, for I had hot flashes every hour and this took them away. I also had a total hysterectomy 9 years ago. My question is, they say you can have hot flashes for 14 years….and the only reason I did not have them is the HRT, now that I am off hormones for the past 6 months, I have hot flashes again…does the time I was on the hormones count as time. Since I had hot flashes before I started HRT? For if so, I should get over them quickly, just may positive thinking….?
    Thanks! Deborah

  6. Deb Taylor
    4 months ago

    I had a total hysterectomy in 2006 and have been on HRT for the past 15 years. I stopped the HRT, the patch, this past December. I am having horrible hot flashes every 60 to 120 minutes. Taking Black Cohosh, 400 mg at night and in morning. Then, Evening Primrose Oil at lunchtime. Tying to cut out rice, pasta, bread and sugars, almost successful. Thinking my one cup of coffee needs to go, for had 2 hot flashes within 30 minutes of drinking the cup. The tower fan is what works best, for I am sweat from head to toe. Any additional information would be helpful, will not go on hormones again.
    Thanks! Deborah

    1. Erin
      2 weeks ago

      Can you go on birth control? Also do you drink red wine? Eliminating wine helped me, as did the pill. Stopped having hot flashes.

  7. Bronwyn Pease
    5 months ago

    Morning; I am trying to find a reason for my periods of feeling very hot at different times during the night, only, not during the day. I am 57, and presume I have gone through Menapause (I had a Hysterectomy 8 years ago). For the past 2 years I have been using Oestrogen Pessaries, to treat Vaginal Dryness/Vulval Irritaton, with slight bleeding after Intecourse, prescribed by my Gynaecologist, who had treated me for nearly 25 years (both as Obset and then gynae….so knew all my history)….I am taking some other medications for Fibromyalgia/ME and Osteo (all formally diagnosed)….and yes, I know that without a Thorough work through of of all medications, and probs, it’s hard to tell, but these hot periods at night, are also adding to my restless sleep at night….one minute cold, then hot….becoming frustrating and exhausting….Thankyou

  8. Christine M
    5 months ago

    I understand how we get Hot Flashes, but can anyone explain why?
    The body always seems to have a reason for the biochemical actions and reactions it goes through. Why does the body heat up, sweat and get vasomotor flushes?
    Is the body trying to clear or burn off overabundant hormones?
    It is such an amazing powerful process. There must be a purpose for them, other than waking me up out of sound sleep! Thanks

  9. Kim
    6 months ago

    I have been told I think to much. I over think things and worry about them.
    I am having trouble figuring out how to just feel and do. It is a life long habit to change. It is affecting my health that i keep things in.
    How do I heal and let emotions come out so get through menopause and feel good.
    I have been told to journal. Is that all there is i just dont get what to do.

  10. Caterina
    7 months ago

    Hi, thanks for this site. I’m 46 years old, recently was told I’m post menopausal due to a FHL level of 49 and a LH level of 36. I had a period about four months ago. I’ve been having hot flashes, weight gain, fatigue and headaches on and off for about 2 years, but the past year they were almost hourly. I researched bioidenticals and had lab work done.

    I am taking 20mg of Estriol and 100 mg of progesterone (both bio identicals from a compound pharmacy). I live in Istanbul, Turkey so it’s a very new concept in the country. I didn’t want to take the E1 estrogen out of fear of becoming estrogen dominate. I’ve been on the bio ident. homones for 2 weeks now. When will the hot flashes stop? What’s normal? Due to language issues here in Turkey it’s hard to find different opinions on treatment. I’d like to hear your ideas. I know you can’t give me specific absolutes, but ranges and norms would be great. Thanks in advance.

    1. Louise
      5 months ago

      FSH levels fluctuate during perimenopause. I had a FSH measurement of 48, then a month later it was 9. The only true way of knowing you are post menopausal is if you go 12 months without a period. “The Wisdom of Menopause” by Christiane Northrope is a really good source of information.

  11. […] Fewer menopausal symptoms. Numerous staples of a healthy vegetarian diet, such asflaxseeds and soybeans, are rich in phytoestrogens—natural substances that may help minimize vaginal dryness, hot […]

  12. Susan
    7 months ago

    Thank you for reminding me that the recent hot flashes might be due to my doctor’s recommendation to reduce my projesterone levels. I use bio-identical hormones. They have been fantastic. But, you do need to have your hormone levels checked by a blood test to stay on track. Hormones are tricky things!


  13. mamamuzic
    9 months ago

    How is the bioidentical estrogen given? And how are one’s hormone levels accurately tested?

  14. Anne Bishop
    6 years ago

    This is exactly what is going on with me. I’m starting to want me back in the picture. I’m starting to feel resentmant tword my husband. i keep trying to put myself first and then backsliding. Then I blame him for getting in the way. Breaking the cycle of putting myself far down on the “to do list” is so hard!

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