One minute you're perfectly comfortable.
The next, someone appears to have switched on an internal furnace without asking permission.
Your face is hot. Your neck is hot. Your chest is hot. You're sweating. Perhaps your heart has decided to join the party with a few enthusiastic palpitations.
And then, several minutes later, it's over.
Welcome to the hot flush.
Hot flushes are one of the best-known symptoms of perimenopause and menopause, but knowing they're common doesn't make them any less annoying when you're removing your jumper in the middle of a meeting or waking up with your pyjamas stuck to you.
So why do hot flushes happen? How long can they last? And, crucially, what can you actually do about them?
Let's turn down the temperature on some of the confusion.
What is a hot flush?
Hot flushes, together with night sweats, are known medically as vasomotor symptoms, or VMS.
The NHS describes a hot flush as a sudden feeling of heat or cold around the face, neck and chest. It can be accompanied by heavy sweating, palpitations, anxiety or dizziness and may last for several minutes. [1]
When these episodes happen at night, they're generally referred to as night sweats.
Some people experience a mild warmth. Others suddenly feel as though they've been teleported into a sauna while fully dressed.
There may also be visible flushing of the skin, particularly around the face, neck and upper chest. And because sweating is the body's cooling mechanism, you might actually feel cold or shivery afterwards.
Hot. Sweaty. Cold.
All within a few minutes.
The human body does enjoy keeping things interesting.
Why do hot flushes happen during menopause?
This is where things get surprisingly fascinating.
Menopause happens as hormone levels change and ovarian function declines. In particular, levels of oestrogen fall.
Hot flushes aren't simply a case of "less oestrogen equals feeling hot", though. The biology is considerably more interesting than that.
Your brain contains a region called the hypothalamus, which plays an important role in regulating body temperature.
Think of it as your internal thermostat.
Research suggests that hormonal changes during the menopause transition affect the brain's temperature-regulating system, making the range of temperatures your body considers comfortable narrower. [2]
That means a relatively small change in core body temperature may be enough to trigger the body's cooling response.
Blood vessels near the skin dilate, increasing blood flow towards the surface. You feel suddenly hot and may look flushed. Your body starts sweating to lose heat.
Hence the sudden:
"IS ANYONE ELSE ABSOLUTELY BOILING?"
Followed by everyone else in the room looking slightly confused.
There's some interesting brain chemistry involved too
Our understanding of hot flushes has become considerably more sophisticated.
Researchers have identified a group of neurons in the hypothalamus often called KNDy neurons. These are involved in reproductive hormone signalling and temperature regulation.
One of the signalling molecules involved is neurokinin B.
Oestrogen normally helps regulate this system. When oestrogen levels decline during menopause, neurokinin B signalling changes and activity in these temperature-regulating pathways can increase. This is thought to contribute to the thermoregulatory instability behind hot flushes. [2]
Why does that matter?
Apart from being a cracking piece of menopause trivia, this research has helped scientists develop newer non-hormonal medicines that target the neurokinin pathway involved in vasomotor symptoms.
So no, hot flushes are not "all in your head".
But technically, quite a lot of the action is happening in your brain.
How common are hot flushes?
Very.
Hot flushes and night sweats are among the most common symptoms associated with the menopause transition.
A large US longitudinal study, the Study of Women's Health Across the Nation (SWAN), reported that more than half of midlife women experienced frequent vasomotor symptoms. [3]
But menopause isn't a standardised experience.
Some people have no hot flushes at all.
Some experience them occasionally.
Others have them repeatedly throughout the day and night, with a significant effect on sleep, work and everyday life.
The NHS emphasises that menopause symptoms vary considerably between individuals and can range from barely noticeable to having a major impact on daily life, relationships, social life, family life and work. [1]
In other words, your friend's menopause tells you precisely nothing about what yours "should" look like.
How long do hot flushes last?
Here's one menopause myth worth putting to bed: hot flushes don't necessarily disappear after a year or two.
The SWAN study followed women over many years and found that, among those experiencing frequent vasomotor symptoms, the median total duration was 7.4 years. [3]
Yes. Years.
The study also found that symptoms persisted for a median of 4.5 years after the final menstrual period.
People who first developed frequent vasomotor symptoms while they were premenopausal or in early perimenopause tended to experience them for longer. [3]
There were also differences between ethnic groups. In the SWAN study, African American women reported the longest median duration of vasomotor symptoms, while Chinese and Japanese women reported shorter durations. [3]
That doesn't mean your hot flushes will last 7.4 years. A median is a midpoint across a population, not a countdown timer for your individual menopause.
But it does demonstrate that vasomotor symptoms can be a long-term issue rather than a brief inconvenience.
Which is also why "just put up with it" isn't particularly helpful advice.
What can trigger a hot flush?
Sometimes a hot flush will simply arrive uninvited.
At other times, you might notice patterns.
The NHS lists several potential triggers that people experiencing hot flushes and night sweats can experiment with reducing or avoiding, including:
- Caffeine
- Alcohol
- Spicy food
- Hot drinks
- Smoking [4]
Stress may also play a role, and the NHS recommends finding ways to reduce stress as one strategy for managing hot flushes and night sweats. [4]
The key word here is potential.
Not everyone responds to the same things.
Your morning coffee may appear to have absolutely no relationship with your symptoms, while that glass of wine in the evening reliably turns bedtime into tropical night.
Or vice versa.
Keeping a simple symptom diary can help you spot patterns. Note when a flush happens and what was going on beforehand: what you ate or drank, how stressed you felt, whether you'd exercised, the room temperature and anything else that seems relevant.
You're looking for patterns, not conducting a clinical trial in your kitchen.
What can you do when hot flushes are getting seriously annoying?
Let's start with the simple stuff.
The NHS suggests several practical measures for easing hot flushes and night sweats, including wearing lightweight clothing, keeping your bedroom cool, having a cool shower, using a fan or having a cold drink. [4]
Layers can be particularly useful.
A beautifully chunky jumper may seem like an excellent idea at 8am.
At 8:17am, during a hot flush, you may have different feelings.
Layers give you options.
And during menopause, options are always welcome.
Look at your potential triggers
If hot flushes are frequent, consider whether there are obvious triggers you could experiment with.
That doesn't mean banning everything enjoyable from your life simultaneously.
You could try reducing caffeine for a couple of weeks and see what happens. Or switch your evening glass of wine. Choose a caffeine-free herbal infusion instead of a hot caffeinated drink later in the day.
Change one or two things and observe.
Your body may give you useful information.
Don't forget about night sweats
A hot flush at 2pm is irritating.
A hot flush at 2am can become a sleep problem too.
Night sweats can disturb sleep, and poor sleep can then leave you tired, irritable and struggling to concentrate the following day. The NHS specifically notes that sleep problems may be worse when night sweats are also present. [1]
Keeping your bedroom cooler, using lighter bedding and choosing breathable sleepwear may help you feel more comfortable.
If you're waking regularly with night sweats, however, you don't simply have to keep changing the sheets and getting on with it.
There are treatment options.
What treatments are available for hot flushes?
If hot flushes are interfering with your life, talk to a healthcare professional.
There is absolutely no medal for enduring them in silence.
Current NICE guidance recommends offering hormone replacement therapy (HRT) to people with vasomotor symptoms associated with menopause. [5]
HRT replaces hormones that decline around menopause and can be highly effective for symptoms including hot flushes and night sweats. Whether it's appropriate for you depends on your individual circumstances, preferences and medical history, and the benefits and risks should be discussed with a healthcare professional.
NICE also recommends considering menopause-specific cognitive behavioural therapy (CBT) as an option for vasomotor symptoms. It can be used alongside HRT, when HRT is contraindicated, or when someone prefers not to take HRT. [5]
Yes, CBT for hot flushes.
And no, that doesn't mean anyone thinks you're imagining them.
Menopause-specific CBT uses psychological and behavioural techniques to help people manage their responses to symptoms and reduce the impact those symptoms have on everyday life.
There are non-hormonal medicines too
HRT isn't suitable for everyone, and not everyone wants to take it.
Other treatment options are available.
NICE now recommends fezolinetant as an option for treating moderate to severe vasomotor symptoms associated with menopause when HRT is unsuitable. [6]
Fezolinetant is particularly interesting because it targets the neurokinin pathway involved in the brain's regulation of body temperature, rather than replacing hormones.
Other medicines may also be considered depending on individual circumstances.
The important point is that persistent or severe hot flushes aren't something you simply have to tolerate.
What about herbal remedies?
Herbal and complementary products are often marketed for menopause symptoms, but "natural" doesn't automatically mean effective or risk-free.
The NHS notes that there is very little evidence showing how well some complementary remedies marketed for menopause work or how safe they are. Herbal products can also interact with medicines. [7]
NICE notes that there is some evidence that isoflavones or black cohosh may relieve vasomotor symptoms, but also emphasises uncertainties around safety, variation between preparations and possible interactions with medicines. [5]
So if you're considering a herbal supplement specifically to manage hot flushes, particularly if you take medication or have a health condition, speak to an appropriately qualified healthcare professional.
A comforting herbal menopause tea is one thing.
Treating a medical symptom is another.
When should you speak to a doctor?
If you think you're experiencing perimenopause or menopause symptoms and want to discuss your options, contacting your GP is the best option.
You should also seek advice if symptoms are significantly affecting your daily life.
And remember that sweating isn't always menopause.
Seek help from a GP if you regularly experience night sweats that wake you or worry you, particularly if they occur alongside symptoms such as an unexplained high temperature, cough, diarrhoea or unexplained weight loss. [8]
If something feels unusual for you, get it checked rather than automatically putting everything into the enormous "probably menopause" bucket.
The bottom line
Hot flushes are one of the most recognisable symptoms of perimenopause and menopause, but there's much more going on than simply "feeling a bit warm".
Changes in oestrogen influence sophisticated temperature-regulating pathways in the brain, making the body's internal thermostat more sensitive.
For some people, hot flushes are occasional and manageable.
For others, they're frequent, disruptive and seriously annoying.
Practical changes such as keeping cool, dressing in layers and identifying personal triggers can help you manage them. And if hot flushes are having a significant impact on your life, effective treatment options including HRT, menopause-specific CBT and, in appropriate circumstances, non-hormonal medication are available.
Most importantly, you don't have to prove you're suffering enough before asking for help.
Menopause is a normal life transition.
Being absolutely fed up with sweating through your favourite top is also perfectly reasonable.
References
1. NHS. Symptoms of menopause and perimenopause.
NHS guidance covering common menopause symptoms, including hot flushes, night sweats, palpitations, sleep problems and their potential impact on everyday life.
NHS: Symptoms of menopause and perimenopause
2. Baker FC, et al. Effects of menopause on temperature regulation.
Review of current evidence on thermoregulation during menopause, including the relationship between declining oestrogen, hypothalamic temperature regulation and neurokinin B pathways involved in vasomotor symptoms.
3. Avis NE, Crawford SL, Greendale G, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Internal Medicine. 2015;175(4):531–539.
The SWAN study examined 1,449 women experiencing frequent vasomotor symptoms and found a median total duration of 7.4 years and median persistence of 4.5 years after the final menstrual period.
JAMA Internal Medicine: Duration of Menopausal Vasomotor Symptoms
4. NHS. Things you can do to help menopause and perimenopause symptoms.
NHS advice includes lightweight clothing, keeping the bedroom cool, cool showers, fans and cold drinks, reducing stress and experimenting with reducing potential triggers including caffeine, alcohol, hot drinks, spicy food and smoking.
NHS: Things you can do to help menopause symptoms
5. National Institute for Health and Care Excellence (NICE). Menopause: identification and management. NG23.
Current NICE guidance recommends HRT for vasomotor symptoms and menopause-specific CBT as an additional or alternative management option in appropriate circumstances. NICE also discusses the evidence and uncertainties surrounding complementary therapies including isoflavones and black cohosh. The guideline was most recently updated in April 2026.
NICE: Menopause identification and management
6. National Institute for Health and Care Excellence (NICE). Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause. TA1143. 2026.
NICE recommends fezolinetant as an option for moderate to severe vasomotor symptoms associated with menopause when HRT is unsuitable.
NICE: Fezolinetant for vasomotor symptoms
7. NHS. Treatment for menopause and perimenopause.
NHS guidance discusses HRT, non-hormonal treatments and the limitations and potential interactions associated with herbal remedies and complementary medicines marketed for menopause symptoms.
NHS: Treatment for menopause and perimenopause
8. NHS. Night sweats.
NHS guidance explains when recurrent night sweats should be discussed with a GP and highlights symptoms that warrant medical assessment.
NHS: Night sweats
This article is intended for general educational purposes and does not replace personalised medical advice. If your symptoms are affecting your daily life, you're unsure whether they are related to menopause, or you have concerns about your health, speak to an appropriately qualified healthcare professional.
