Perimenopause night sweats: Causes, treatment & what they feel like

What are night sweats?

Night sweats are hot flashes (sometimes called hot flushes) that happen while you’re asleep. They are a common symptom of perimenopause through menopause and postmenopause. Both hot flashes and night sweats are sometimes called vasomotor symptoms. In Latin, “vaso-” refers to blood vessels and “motor-” means movement. So vasomotor symptoms involve the movement (constriction and dilation) of blood vessels [1].

There isn’t a universal definition for night sweats, but they generally refer to excessive sweating that happens because you get too hot while you sleep — and that isn’t necessarily caused by factors in your bedroom environment alone (i.e., too hot in the room, blanket too thick, etc.). They can happen suddenly and might be strong enough to soak through your clothes or sheets [2]. 

Most people’s sleep is disturbed enough that they wake up during night sweats, but it is possible to sleep through them [3].

What do night sweats feel like?

Often, a sensation of heat starts in the face, neck, chest, or upper body and then spreads. Your skin might turn red (looking flushed) or you might experience palpitations. You may also be asleep during the onset and just wake up feeling hot and sweaty. Like hot flashes, night sweats last a few minutes on average, but they can also be shorter or longer [4]. 

How common are night sweats around menopause?

Night sweats are a common complaint in perimenopause, which is the transition period leading up to menopause. Even though people often talk about menopause as a longer phase, it’s technically one day on the calendar — when it’s been 12 months since a woman’s last menstrual period (with no other medical cause). 

According to one study comparing women who did and did not experience menopausal symptoms, among those with symptoms, two-thirds reported night sweats [5] — but this can vary widely based on factors such as where you live, your cultural background, and ethnic origin [4]. The reason for this wide variation isn’t yet known.

Up to 80% of women will experience hot flashes or night sweats at some point in their menopause journey, but this often depends on how close someone is to their final menstrual period (FMP) [6]. 

According to one study, five to ten years before their FMP, only 20% of women reported hot flashes or night sweats, although 40% reported trouble sleeping. Four years before their FMP, 40% had night sweats and 60% had hot flashes [6]. 

Perhaps unsurprisingly, the research indicates that these symptoms are more commonly reported during the warmer months, particularly during the summer. The study also suggests that ambient temperature variation (not necessarily specific temperature levels) and variations in daylight exposure might contribute to these seasonal differences [6]. 

While night sweats can be merely uncomfortable and inconvenient for some, everyone’s experience is different. The International Menopause Society reports that for up to 25% of women, they can significantly lower quality of life “due to physical discomfort, social embarrassment, sleep disruption, mood changes, and associated stress” [7]. However, it’s important to note that the impact of menopausal symptoms can be often underestimated [4]. 

There can be a lot of stigma around talking about menopause and its symptoms, but it’s becoming more openly discussed. The more we can normalize the conversations around the perimenopause experience, the more likely it will be that women can get the help they need to thrive through this transition. 

What causes night sweats?

The short answer as to what causes night sweats in perimenopause is changes in the brain related to hormonal shifts that occur as the body transitions beyond its reproductive years. Estrogen levels generally decrease during this time — although it’s not a straight line and it can certainly feel like a roller coaster at times — but estrogen alone isn’t enough to explain it because different women can have very different experiences.

Temperature regulation in the brain

The exact mechanism is not yet fully understood, but part of the cause of night sweats appears to be related to how the brain controls body temperature. The hypothalamus, which regulates both body temperature and circadian rhythms, seems to play a crucial role in how menopausal symptoms are expressed [4]. 

Your brain likes to keep your core body temperature within a narrow range to keep everything running smoothly. This is called the thermoneutral zone (TNZ). It’s normal for your core temperature to vary within the TNZ throughout the day [1], and as long as you’re in the zone, your body is neutral. However, if your temperature rises above this zone, you sweat. If it dips below this zone, you shiver [4]. 

Sweating is one of the body’s main mechanisms for cooling itself when it’s too hot. In people who are more symptomatic, it seems that the TNZ is narrower than in people who aren’t. Basically, the brain becomes extra sensitive to smaller temperature changes, so it’s easier to cross the threshold for your body to start producing sweat. This means that things that might have caused a slight temperature rise that stayed within the TNZ before, suddenly are enough to push your body out of the zone and cause sweating [4]. 

Triggers for night sweats (and hot flashes) can include:

• Stress [4]
• Alcohol
• Caffeine
• Spicy foods
• Smoking
• Certain foods, particularly ultra-processed [8]
• Too little, or too vigorous, activity [9, 10]
• Bedroom, bedding, or pajamas that are too hot
• Sudden ambient temperature change [10]

Estrogen and temperature

Another contributing factor is the role that estrogen plays in lowering body temperature [11]. This is part of why your temperature is lower in the follicular phase, when estrogen levels are higher compared to post-ovulation in the luteal phase, when more progesterone contributes to a slightly elevated temperature. As estrogen levels generally decrease toward menopause, this could be one explanation for why the body gets warmer.

Night sweats unrelated to menopause 

Since night sweats can be caused by shifting hormone levels, they can also occur in other phases besides peri- and post-menopause. They can happen in the first and third trimesters of pregnancy, and may continue for a while postpartum as hormones readjust [12]. Night sweats can also be caused by illness, infection, or certain medications [2]. If you’re experiencing night sweats and they’re disruptive — regardless of the reason —  it’s a good idea to reach out to your healthcare provider.

Treatment for perimenopausal night sweats

Night sweats aren’t just an inconvenience at nighttime. Sleep disruption from night sweats can cause fatigue, worsen mood, cause individuals to withdraw socially, make it harder to concentrate, and generally interfere with daily life. So they are definitely worth treating! There are many options available — some medical, and some you can try on your own. Everyone is different, so it might be worth experimenting a bit to see what gives you the best results. 

Remember that if your symptoms are disrupting your life, you should contact your healthcare provider to talk about your options. It can be helpful to record your symptoms to facilitate a productive discussion.

Environmental changes can help manage perimenopausal night sweats

Keep the bedroom cool: Use an air conditioner, fan, or open window to ensure a steady stream of cool air at night.

Put an ice pack under your pillow: If you wake up hot, you can flip your pillow over and rest your head on the cooled side.

Wear light pajamas: Natural fibers often breathe better than synthetic, so try materials like linen, cotton, lightweight merino wool, etc. 

Sleep with layers: Try having more lightweight layers of bedding instead of one thick blanket, so it’s easier to adjust if you feel your temperature change during the night. 

Have clean pajamas nearby: If you have an extra pair of pajamas next to the bed, it’s easier to change quickly without having to get up all the way in the middle of the night.

Try a cooling mattress topper: Some mattress pads are made out of materials that stay cooler, which can help your body not overheat. 

Have ice water on hand: Keeping a thermos of ice water on your bedside table can help you cool down quickly.

Lifestyle changes can reduce the likelihood of hot flashes and night sweats

Limit alcohol and caffeine intake: These can make hot flashes and night sweats more likely.

Reduce consumption of foods that trigger symptoms: For some, ultra-processed and spicy foods tend to make symptoms worse [13]. One study of over 6000 women showed that diets high in fat and sugar increased the risk of vasomotor symptoms, while fruit and Mediterranean-style diets were associated with fewer symptoms [14]. 

Maintain a healthy weight: While managing weight during perimenopause poses its own set of challenges due to the natural hormonal shifts, it’s worth being aware that overweight and obese people may experience hot flashes or night sweats that are more frequent and severe [4, 13].

Avoid smoking or try to quit: Stopping smoking is associated with many health benefits, including the easing of menopausal symptoms [13]. Smoking is a risk factor for more severe vasomotor symptoms in menopause [4].

Find your optimal activity level: Research has shown sedentary time can lead to an increase in hot flashes [15]. However, there is also research that correlates moderate to vigorous activity with worse or more frequent hot flashes — possibly because intense activity can increase body temperature [9, 10]. To reduce night sweats, it could help to do your higher intensity activities earlier in the day. 

Like many topics in women’s health, more research is needed, but for now we can say that staying active with light-intensity activities, such as walking or gentle yoga, are likely to be beneficial compared to sitting still for long periods during perimenopause. However, we also know that physical activity is important for maintaining body composition as women age. Aerobic exercise helps regulate fat mass and BMI in younger women, while resistance training seems to be particularly important for preserving lean muscle mass in older women postmenopause [16]. Everyone’s experience is different, so you should experiment to find a balance that works for you to promote overall health and symptoms.

Reduce stress: Symptomatic women often have higher levels of stress markers in their nervous system [4]. Mindfulness practices, such as paced respiration (deep slow breathing) and hypnotherapy, promote relaxation and have been shown to reduce the frequency and perhaps intensity of hot flashes [10]. Cognitive behavior therapy (CBT) can also be beneficial in treating symptoms [4]. 

Acupuncture: The research on acupuncture for relieving menopausal hot flashes is limited, and evidence for its effectiveness isn’t clear yet. Some research has shown no difference between acupuncture and simulated acupuncture. However, other research has shown that acupuncture is more effective than no acupuncture [17, 18]. 

Avoid your triggers: Keep track of the behaviors that seem to correlate with your night sweats or hot flashes and do your best to limit them. 

Limit exposure to endocrine-disrupting chemicals (EDCs): While more research is still needed, there is evidence that suggests that exposure to certain types of chemicals (including phthalates and parabens, found in many consumer goods) is linked to worsening of some symptoms of menopause, including hot flashes [19]. These chemicals mimic hormones like estrogen in the body, so they can disrupt natural processes. There are a lot of EDCs and exposure to them is more or less inevitable in modern society, but it is possible to reduce exposure and observe how your body reacts.

Dietary supplements 

If you search for foods, herbs, and supplements to relieve menopausal symptoms, the internet has a lot of advice. However, most of these have not been thoroughly studied, so evidence is lacking and we can’t reach any clear conclusions about their effectiveness based on the available science [4, 18, 20]. Always talk to your doctor before taking new supplements.

Medication can be an effective form of symptom management

Hormone replacement therapy (HRT)/Menopause hormone therapy (MHT): Treatments that provide estrogen are currently the most effective for reducing the frequency and severity of night sweats/hot flashes and other perimenopausal symptoms [4]. If you’re interested in trying this option, work with your healthcare provider to find the right type of medication and dosage for you. 

Non-hormonal medication: Certain anti-depressants, such as SSRIs and SNRIs, as well as gabapentin, have been found to help with hot flashes and can be prescribed for those who can’t take hormones, or who prefer to avoid them [21, 22].

When to See a Doctor

If your night sweats or hot flashes are interfering with your quality of life, you don’t have to suffer through it and there is help available. Reach out to your healthcare provider to talk about your options. 

While night sweats are a common symptom of perimenopause, they can also be caused by medications, infections, or underlying health issues [2]. If you have other symptoms that don’t make sense with perimenopause, it’s a good idea to consult your healthcare provider.

Learn more about your body with Natural Cycles

Perimenopause is a unique journey for everyone, and there will be lots of changes during this transition. Natural Cycles is a temperature-based app that is FDA Cleared as non-hormonal birth control, but it can also help you spot changes to your cycle. The app can identify if you’re still ovulating, and you’ll be able to download a record of cycle symptoms that you can use to facilitate productive discussions with your healthcare provider as you navigate potential treatment options. Want to start tracking cycle symptoms today? Find out if Natural Cycles can work for you!