Hot Flashes at Night Respond Best to Hormone Therapy

What Helps Hot Flashes at Night

Hormone therapy works best for hot flashes at night, and nonhormonal prescriptions and mind-body therapies come next. Bedroom cooling adds comfort but has no strong evidence as a treatment. The 2023 nonhormone therapy position statement ranks hormone therapy as the most effective treatment.

1. Hormone therapy: the first choice for women under 60 or within 10 years of menopause who have no contraindications.
2. Fezolinetant (Veozah) or elinzanetant (Lynkuet): nonhormonal pills approved for moderate to severe hot flashes, each with liver testing.
3. Low-dose paroxetine (7.5 mg at bedtime) or another SSRI or SNRI: antidepressant-class drugs that cut hot flashes by 25% to 69% in trials.
4. Gabapentin at bedtime: an off-label option whose drowsiness can help when hot flashes break up sleep.
5. Cognitive behavioral therapy (CBT) or clinical hypnosis: both rated Level I by The Menopause Society.
6. A cool bedroom and fewer triggers: worth doing for comfort while treatment starts.

SSRI means selective serotonin reuptake inhibitor, and SNRI means serotonin-norepinephrine reuptake inhibitor. Our hot flashes treatment guide covers every option in more depth, including the ones that work less well.

Why Hot Flashes Are Worse at Night

Hot flashes feel worse at night because they cluster in the first half of sleep and often wake you up. In a 2006 sleep-lab study by Freedman and Roehrs, women with hot flashes woke more often in the first half of the night. Most of their hot flashes came just before those awakenings.

Later in the night, rapid eye movement (REM) sleep suppressed both the hot flashes and the awakenings. Small rises in core body temperature can set off a hot flash, so a warm room or heavy duvet can trigger one during sleep.

Night sweats can last for years. In the Study of Women's Health Across the Nation (SWAN), frequent hot flashes and night sweats lasted a median 7.4 years. They lasted more than 11.8 years when they began before or early in perimenopause.

Menopause is one cause, and the NHS also lists anxiety, low blood sugar, alcohol or drug use, and medicines such as some antidepressants, steroids and painkillers. Men with night sweats should read hot flashes in men, since the causes differ.

How Night Sweats Affect Sleep

Night sweats break sleep into pieces, but they are often not the only thing waking you. In a 2007 study of 102 women aged 44 to 56 with poor sleep, 53% had sleep apnea, restless legs or both.

The authors concluded that treating hot flashes may ease sleep complaints without fixing those separate sleep disorders. If you keep waking up tired after your hot flashes improve, ask about a sleep study.

Some treatments help both problems. The 2023 statement reports that low-dose paroxetine improved sleep disruption, without weight gain or loss of libido. For waking that continues on its own, see our guides to perimenopause insomnia and the sleep and recovery hub.

Bedroom Changes for Hot Flashes at Night

A cooler bedroom reduces hot flashes at night a little and makes the ones you get easier to sleep through. In the 2006 Freedman study, an 18 C (about 64 F) room cut first-half-night hot flashes from 2.2 to 1.5 compared with warmer rooms.

The NHS suggests these changes for hot flushes and night sweats.

• Keep the bedroom cool at night and use a fan.
• Wear lightweight clothing to bed.
• Take a cool shower or have a cold drink when a flush hits.
• Cut back on spicy food, caffeine, hot drinks, smoking and alcohol, especially in the evening.

Do not expect these steps to replace treatment. The Menopause Society found no strong evidence that cooling or avoiding triggers improves hot flashes. A 39-woman trial of a nighttime cooling device found no objective drop in night sweats.

We would move bedroom cooling higher on the list if a larger sham-controlled trial showed it reduced nighttime hot flashes.

Hormone Therapy for Night Sweats

Hormone therapy is the most effective treatment for night sweats, and its benefits outweigh its risks for most healthy women under 60 or within 10 years of menopause. That is the finding of The Menopause Society's 2022 hormone therapy statement, which also credits it with preventing bone loss and fracture.

Starting after 60, or more than 10 years after menopause, carries greater absolute risks of coronary heart disease, stroke, blood clots and dementia. The risks also depend on the type, dose, route, length of use and whether a progestogen is included.

Hormone therapy is a poor fit if you have an estrogen-dependent cancer or cardiovascular disease, and the nonhormonal drugs below are the alternative. Our menopause hub explains the forms and how to start.

Nonhormonal Medicines for Night Sweats

Four nonhormonal medicines are the main prescription choices for night sweats, and three of them carry FDA approval for menopausal hot flashes. Each comes with a different safety check, so the right one depends on your liver, your other medicines and whether you want help falling asleep.

The fezolinetant label lists known cirrhosis, severe kidney disease and CYP1A2 inhibitors as reasons not to take it. Stop it and get liver tests if you develop tiredness, nausea, itching, yellow skin or eyes, pale stools, dark urine or belly pain. Gabapentin is FDA approved as an antiepileptic, and The Menopause Society notes its short half-life makes bedtime dosing a good choice for sleep-disrupting hot flashes.

When Night Sweats Need a Doctor

Night sweats need a doctor when they soak your sheets regularly or come with fever, shivering, a cough, diarrhea or weight loss you cannot explain. Those are the warning signs the NHS lists, and they call for checks beyond menopause.

Sweating at night is normal when the room or bedding is too warm, so rule that out first. If your night sweats fit menopause and have no warning signs, book a visit. Ask about hormone therapy or one of the nonhormonal medicines for hot flashes at night.

How to test your hormones at home

You don't need a lab appointment to check your own hormones — a few at-home kits mail you a collection kit and return physician-reviewed results online within days:

Everlywell At-Home Metabolism and Stress Hormone Test Kit - Measures Cortisol and Other Hormones - CLIA-Certified Lab Results Within Days - for Men and Women Ages 18 Plus

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Everlywell At-Home Women's Health Collection Kit, Measures 11 Biomarkers for Hormonal Wellness, including Cortisol, Progesterone & TSH - CLIA-Certified Lab Results Within Days - for Women Ages 18 Plus

Everlywell

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Prefer to order direct? The Everlywell Men's or Women's Health hormone test uses a CLIA-certified lab, physician-reviewed results, and prepaid return shipping.