Hot flushes in perimenopause: why they happen and what helps

A hot flush is a sudden wave of heat that spreads over your face, neck and chest, often with sweating and a pounding heart. It's the most common symptom of the menopause transition, and it often starts in perimenopause, while you still have periods.

In short

Up to 85% of women have hot flushes around menopause, and they can start before periods stop.
Most women have them for less than five years, but for some they last longer.
Cooling tricks and avoiding triggers help; effective hormonal and non-hormonal treatments exist.

What does a hot flush feel like?

Ireland's HSE describes a creeping feeling of heat that spreads through the body and face. Your skin may redden, you may sweat, and your heart may pound or race. A flush usually lasts a few minutes and can come at any time, day or night. At night, it's called a night sweat; read more in Night sweats in perimenopause.

Why do hot flushes happen?

The brain's temperature control centre is sensitive to estrogen. As estrogen levels swing and fall, it can misread your body as too hot and trigger a flush to cool you down: blood vessels widen, you sweat, and then you may feel chilly. Germany's IQWiG explains that falling estrogen is thought to upset the regulation of body temperature.

How long do hot flushes last?

According to the European Menopause and Andropause Society (EMAS), most women have hot flushes for less than five years, but some still have them beyond the age of 60.

What triggers hot flushes?

Common triggers listed by the HSE include spicy food, caffeine, alcohol, smoking, warm or bulky clothing, and stress. Triggers differ from woman to woman, so it helps to notice your own.

What helps with hot flushes?

Stay cool. Wear light layers you can take off, keep your bedroom cool, use a fan, sip cold drinks and choose lukewarm showers.
Notice your triggers and cut back on the ones that affect you.
Try CBT. The UK's NICE recommends menopause-specific cognitive behavioural therapy (CBT) as an option for hot flushes and night sweats. It doesn't stop flushes, but it can make them less bothersome.
Ask your doctor about treatment. Hormone therapy is the most effective treatment for hot flushes. EMAS also lists several non-hormonal prescription medicines for women who can't or don't want to take hormones. Your doctor can explain what suits you.

IQWiG notes that the evidence for herbal products such as soy, red clover or black cohosh is unclear.

When to see a doctor

Talk to your doctor if hot flushes disturb your sleep, work or daily life, or if self-help isn't enough. See a doctor sooner if flushes come with unexplained weight loss, diarrhoea, fever or feeling generally unwell, or if you think a medicine may be causing them.

Get urgent help if you have a racing heart with chest pain, breathlessness or fainting. More in Heart palpitations in perimenopause.

Noting when your flushes come and how often, on paper or in an app like Pausie, helps your doctor see the pattern and judge whether treatment is helping.

Frequently asked questions

Can you have hot flushes and still have periods?

Yes. EMAS notes that hot flushes may begin before periods stop.

Why are my hot flushes worse at night?

A warm bedroom and heavy bedding can trigger them, and you notice them more when they wake you.

Do hot flushes mean menopause is close?

Not necessarily. They can start years before the last period.

Does exercise help hot flushes?

Exercise is good for sleep, mood, bones and heart, but evidence that it reduces hot flushes is mixed.

One tap when it happens

Tap »Hot flash now« in Pausie the moment a flush starts. Over weeks you'll see when they come, how often, and what goes with them. No account, and your diary stays on your phone.

Get it onGoogle Play iPhone: join the waitlist →

This article is general information, not medical advice. Written by the Pausie team. Published and last reviewed 2 November 2026.