Hot flashes and night sweats, why they happen and what helps
What a hot flash is, why falling estrogen sets one off, how long they last, the triggers and cooling habits that make them easier to live with, what supplements do and do not do, and the prescription options worth asking about.
By the Wet Betty editors · Published Oct 17, 2026
Fact checked against FDA 510(k) filings, WHO guidance and the sources listed below. How we review
Hot flashes are sudden waves of heat in the face, neck and chest, often with sweating, caused mainly by falling estrogen around menopause. Night sweats are the same thing during sleep. Cooling habits ease them, supplements have weak evidence, and hormone therapy is the most effective treatment. Nonhormonal prescriptions such as fezolinetant are worth asking a clinician about.
What a hot flash is.
A hot flash starts as a sudden feeling of heat that spreads through the chest, neck and face. Skin can look flushed or blotchy, the heart can race, and sweat follows, mostly on the upper body. As it passes, many people feel chilled, because the body has just dumped heat it did not need to lose. Some feel a spike of anxiety with it.
Mayo Clinic says a single hot flash may last 1 to 5 minutes, and that most people who have them have them daily. Night sweats are hot flashes during sleep. They are the version that does the most damage, because they wake you, soak the sheets and add up to weeks of short sleep.
Hot flashes are the most common symptom of the menopause transition. They can start in perimenopause, while periods are still coming, and on average they continue for more than seven years. Some people have them for more than ten. The National Institute on Aging notes that African American and Hispanic women tend to have them for more years than white and Asian women.
Why they happen.
The leading explanation involves the hypothalamus, the part of the brain that acts as the body's thermostat. As estrogen falls, that thermostat becomes oversensitive. A tiny rise in core temperature that it used to ignore now reads as overheating, and it triggers the cooling response all at once: blood vessels in the skin open, sweat starts, the heart speeds up. That is the flash.
The newer prescription drugs work on exactly this circuit. Fezolinetant blocks a brain signal, neurokinin B, that helps drive the thermostat's overreaction. That is why it can reduce hot flashes without being a hormone.
Other causes. Not every hot flash is menopause. Mayo Clinic lists medicine side effects, thyroid problems, some cancers and cancer treatment. Smoking and a higher body weight are linked with having more of them.
Common triggers.
The National Institute on Aging suggests noting what sets yours off, and names alcohol, spicy foods and caffeine as common culprits. Hot rooms, hot drinks, stress and tight or heavy clothing are others people report. A two week log of each flash, the time, and what came before it is the fastest way to find your own pattern, and it is useful to bring to an appointment.
Cooling habits that help.
These do not change how often hot flashes happen, and the Menopause Society did not find evidence that cooling techniques work as a treatment. They do make each one easier to sit through, which is why NIA recommends them as a first step.
- Keep the bedroom cool and run a fan at night.
- Layer your bedding so you can throw off a layer without waking fully.
- Sip cold water before bed and keep some by the bed.
- Dress in layers you can remove at the first sign of a flash.
- Carry a small fan for work and travel.
- Quit smoking, and work toward a healthy weight if that is a goal for you. The Menopause Society lists weight loss among options with some evidence.
Mind and body approaches with evidence.
Two nondrug approaches made the Menopause Society's recommended list with its strongest evidence grade: cognitive behavioral therapy and clinical hypnosis. Both are structured programs with a trained therapist, not relaxation apps. They are worth asking about if you prefer not to take a medicine. The same statement did not recommend paced breathing, yoga, exercise, acupuncture or mindfulness as hot flash treatments, though several have other health benefits.
Supplements for hot flashes.
The Menopause Society 2023 statement does not recommend supplements or herbal remedies for hot flashes. NIA warns that black cohosh, DHEA and soy isoflavones are not proven effective and some carry risks such as liver damage. Supplements are not approved by the FDA to treat menopause.
Two ingredients have cleaner small trials than the rest. ERr 731 rhubarb extract, the only active ingredient in Estroven Complete, reduced hot flashes versus placebo in a 12 week trial of 109 women. A Swedish flower pollen extract, sold as Bonafide Relizen, had more responders than placebo in a trial of 64 women. If you try one, try one at a time, follow the label and your clinician, and judge it at 12 weeks.
Our take. The drugstore way to get ERr 731 rhapontic rhubarb extract, the menopause botanical with the cleanest placebo controlled trial.
Pros
- One active ingredient, ERr 731 rhapontic rhubarb extract, 4 mg per caplet
- One caplet a day
- Hormone free and sold in most drugstores
Cons
- No published trial of the Estroven product itself, only of the extract
- Coating contains titanium dioxide
| Category | Format |
|---|---|
| Supplement | 28 caplets, one a day |
Our take. A Swedish flower pollen extract that works without plant estrogens, backed by small placebo controlled trials.
Pros
- Purified pollen extract (Serelys), no plant estrogens
- Bonafide cites three placebo controlled trials
- Two tablets once a day
Cons
- One of the pricier options per month
- The brand says best results take about three months
| Category | Format |
|---|---|
| Supplement | 1 month supply, two tablets a day |
Our full ranking is best menopause supplements, and the most common herb gets its own page in black cohosh for menopause.
Prescription options to ask about.
These are not instructions. They are the names to bring to an appointment, so the conversation starts in the right place. We give no doses; that depends on your history and is a prescriber's call.
| Option | What it is | What to know |
|---|---|---|
| Hormone therapy | Estrogen, with a progestogen if you have a uterus | The Menopause Society calls it the most effective treatment, and suggests considering it within 10 years of the final period |
| Fezolinetant (Veozah) | Nonhormonal pill, neurokinin 3 receptor blocker | FDA approved in 2023; the label calls for liver blood tests before and during the first months |
| Elinzanetant (Lynkuet) | Nonhormonal pill, neurokinin 1 and 3 receptor blocker | FDA approved in 2025 |
| SSRIs and SNRIs | Antidepressant classes used at hot flash doses | Paroxetine (Brisdelle) is FDA approved for hot flashes |
| Gabapentin | Nerve pain and seizure medicine | Recommended by the Menopause Society |
| Oxybutynin | Bladder medicine | Recommended by the Menopause Society |
Who usually asks about nonhormonal options. People with a history of breast cancer or other estrogen sensitive cancers, blood clots, stroke or heart disease, and anyone who would rather not use hormones. The Menopause Society notes it is important for clinicians to know these options for exactly that group.
Hot flashes and the rest of menopause.
Hot flashes rarely travel alone. Falling estrogen also thins vaginal tissue, which brings dryness, burning and painful sex, and it can make urinary symptoms and UTIs more common. Those do not improve with hot flash treatment alone. See vaginal atrophy, vaginal moisturizer vs lube, lube for menopause dryness, how to treat vaginal dryness and vaginal dryness causes. Night sweats plus dryness is also a common reason to pick a silicone lube, covered in best silicone lube.
When to see a clinician.
See a clinician if hot flashes or night sweats disrupt your sleep, work or mood, if they start well before the usual age for menopause, or if they come with fever, unexplained weight loss, a racing heart at rest or other new symptoms. Get any bleeding after menopause checked. If you have had breast cancer, ask your oncologist before trying any supplement. Bring your hot flash log and ask directly about hormone therapy and nonhormonal prescriptions. This page is general information, not medical advice.
Frequently asked questions.
What causes hot flashes?
Usually the drop in estrogen around menopause, which makes the brain's temperature control center react to tiny changes in body heat as if you were overheating. Less often, medicines, thyroid problems, some cancers and cancer treatment cause them.
How long do hot flashes last?
A single hot flash usually lasts 1 to 5 minutes. Mayo Clinic notes that people who have them do so for more than seven years on average, and some for more than ten.
How do you stop a hot flash fast?
You cannot switch one off, but you can shorten the discomfort. Strip a layer, use a fan, sip cold water and breathe slowly. If they come often, the fix is a treatment plan, not a trick in the moment.
What is the best treatment for hot flashes?
The Menopause Society calls hormone therapy the most effective treatment. For people who cannot or do not want to use hormones, prescription options include fezolinetant, certain SSRIs and SNRIs, gabapentin and oxybutynin. Which one fits depends on your history, so it is a clinician decision.
Why are night sweats worse than daytime hot flashes?
They break sleep. Mayo Clinic notes night sweats can cause long term sleep loss, which then makes fatigue and mood worse. A cool bedroom, layered bedding and a fan help, and they are a good reason to ask about treatment.
Can hot flashes be something other than menopause?
Yes. Mayo Clinic lists medicine side effects, thyroid problems, some cancers and cancer treatment as other causes. Night sweats with fever, weight loss or at a young age need a checkup.
What is the best hot flash relief?
The Menopause Society calls hormone therapy the most effective treatment, and prescription nonhormonal options include fezolinetant (Veozah) and elinzanetant (Lynkuet). It does not recommend supplements. For everyday menopause relief, layers, a cool bedroom, a fan and noting your own triggers help, and a clinician can tell you which prescription fits.
