Vasomotor symptoms: hot flushes and night sweats in menopause and perimenopause

Vasomotor symptoms are the symptoms linked to the body’s temperature control, mainly hot flushes and night sweats. The NHS describes hot flushes as when your face, neck and chest suddenly feel very hot or cold, which can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy. It can happen during the day or night, when it is called night sweats, and last for several minutes.

The NHS places them within the wider picture of perimenopause and menopause. Perimenopause is the lead-up to menopause, menopause is when you have not had a period for 12 months, and after this it is called postmenopause. Symptoms can happen during perimenopause and menopause, and can also happen after your menopause has ended.

It stresses that perimenopause and menopause are different for everyone. Some people have symptoms that have a big impact on their daily life, including relationships, social life, family life and work, while others have hardly any symptoms at all.

Hot flushes and night sweats rarely occur alone. The NHS lists a range of other symptoms of menopause and perimenopause. Night sweats can make the sleep problems worse, and poor sleep in turn can make the mood and memory symptoms feel worse.

The NHS says symptoms usually last 7 to 9 years, sometimes longer, and during this time they can change. For example, you may get hot flushes and night sweats for a while, but they may improve and be replaced by other symptoms such as low mood and anxiety. Some symptoms, such as joint pain and vaginal dryness, can continue after menopause.

Hormonal contraception can make it harder to tell whether you have reached perimenopause or menopause, because it affects your periods. The NHS says it is possible to get pregnant during perimenopause and that you still need contraception for 1 year after your final period if you are 50 or over, and for 2 years after your final period if you are aged 40 to 49.

The NHS lists practical measures for hot flushes and night sweats. Several of them are about avoiding triggers and keeping cool, and they are inexpensive to try before or alongside medical treatment.

• Wear lightweight clothing and keep your bedroom cool at night.

• Take a cool shower, use a fan or have a cold drink.

• Find ways to reduce your stress level.

• Avoid or reduce triggers such as spicy food, caffeine, hot drinks, smoking and alcohol.

• Exercise regularly and keep to a healthy weight.

• Try cognitive behavioural therapy (CBT), which can help manage hot flushes and can also help with low mood and sleep problems.

The NHS says that if you have symptoms of perimenopause or menopause you should talk to a doctor, nurse or pharmacist about HRT and other options. The type of HRT depends on whether you still have periods or have had your womb removed. Oestrogen is the main type and can be taken as tablets, patches, spray or gel; if you have not had a hysterectomy you also need progestogen to protect the womb, as tablets, part of a combined patch or the hormonal coil.

If HRT does not work, you cannot take it or you do not want to, other treatments are available. For hot flushes and night sweats, the NHS says you may be offered CBT, or if that does not help a doctor may suggest clonidine or an antidepressant. If you have low mood, depression or anxiety caused by perimenopause or menopause you may be offered antidepressants.

HRT can have side effects. The NHS says it is common to have none or only mild ones, which usually improve over time, so it suggests continuing for at least 3 months if possible, and that a GP might change the dose, type or how you take it. Irregular bleeding or spotting is common in the first months and usually settles within 6 months. HRT has been associated with a small increase in the risk of blood clots and breast cancer.

The NHS advises contacting your GP if you think you have symptoms of menopause or perimenopause and want to know your options, if you have symptoms like a fast heartbeat (palpitations), if you still have periods but your bleeding pattern has changed and you are bleeding more, not less, than before, or if you have not had a period for 12 months or more and have any vaginal bleeding.

It singles out postmenopausal bleeding: if you have not had a period for more than 12 months and get any vaginal bleeding, even once or only a small amount, you should see a GP. It says it is not usually serious but can be a sign of cancer, which may be easier to treat if found early. Early advice can help reduce the effects of menopause and perimenopause on your health, relationships and work.

The NHS encourages talking to other people going through the same thing, including family, friends or colleagues, and relaxing activities such as yoga, tai chi or meditation. It advises talking to a doctor before taking herbal supplements or complementary medicines.

The NHS says to talk to a doctor, nurse or pharmacist about the options, and some treatments such as testosterone may be available from a menopause specialist. Private menopause clinics also exist in general terms, but HRT and non-hormonal treatments use the same medicines. Protecting your bones is also part of long-term care, with the NHS recommending regular weight-bearing exercise, calcium-rich food, sunlight or vitamin D supplements, not smoking and cutting down on alcohol.