You feel trapped in a small space, and the heat is to its highest setting. Then, suddenly, you feel chilled.

You wake up suddenly in the middle of the night from a deep sleep, drenched in sweat and with a racing heart.

It feels like something is crawling under your skin and is spreading to every limb. Do these scenarios sound familiar to you?

Hot flashes and night sweats are episodes of feeling a sudden and profuse spreading sensation of heat in the upper part of the body; sweating and flushing often immediately follow close behind. Vasomotor symptoms announce loudly and clearly that your body is going through a major hormonal transition, typically into menopause. Three out of four women experience hot flashes in menopause, usually starting about 1-2 years before the onset of menopause (i.e., one year of no menses), and then persisting for six months to five years, depending on the person and contributing factors.

hot flash

Hot flashes and night sweats can dramatically disrupt women’s lives, interfering with sleep, social interaction, work, travel, exercise, sex — and much more. Apart from the inconvenience they cause, night sweats, in particular, can affect your overall health because the resulting disruption of sleep can lead to a whole host of mental and physical concerns. Perhaps the most frustrating aspect of hot flashes and night sweats is the sense of powerlessness they can give you over your own body.

Finding a solution can also be frustrating! Healthcare practitioners frequently prescribe antidepressants or HRT, which, for various reasons, many women don’t want. Progesterone creams, soy, and herbal remedies for menopause symptoms, like black cohosh or red clover, are widely available, but it can take a while to figure out what dose is effective, and the quality of products varies tremendously across companies.

In our experience, women get the best results using a combination approach tailored to their individual needs. Whether you are going through perimenopause, menopause, or weaning off hormone replacement therapy (HRT), your body is naturally equipped to handle the transition. Given adequate support, you can regain comfort — and trust — in your body! Let’s take a closer look at some causes and natural solutions for hot flashes and night sweats, so you can determine the approach that works best for you.

Symptoms associated with hot flashes and night sweats

Hot flashes and night sweats are also called vasomotor symptoms because they involve nerves and muscles that cause blood vessels to constrict or dilate. These symptoms can be accompanied by many other sensations:

  • Feeling of intense heat in the chest, neck, face and sometimes upper limbs
  • Increased heart rate/palpitations/fluttering
  • Dizziness
  • Nausea
  • Headache
  • Perspiration
  • Weakness
  • Anxiety
  • Feeling trapped or suffocated
  • A creepy-crawly, or tingling sensation of the skin (“formication”)
  • Flushed appearance or blotchy skin

We aren’t truly overheating — the brain just thinks we are

Even though ‘hot flash’ physiology has been studied for about 4-5 decades, scientists are still in the process of fully understanding what causes them. The prevailing theory is that menopausal hot flashes and night sweats are the result of mixed-up signaling between the body’s hormones and the brain.

The body’s thermoregulatory center (internal thermostat), located in the brain’s hypothalamus, determines the temperature at which our body’s heat-loss mechanisms should activate to cool us down. In women experiencing hot flashes, it appears that the natural decrease in ovarian estrogen output narrows this ‘temperature-tolerance zone.’ As a result, only tiny fluctuations in core body temperature can now launch an all-out perspiration and blood-vessel-dilating reaction (a hot flash!). In simple terms, we might think of this as a ‘bump-down’ in your thermostat. The drop in estrogen appears to be more important than the actual circulating level of estrogen (or of related hormones, such as follicle-stimulating hormone and luteinizing hormone). We know this partly from the fact that younger women can have severe hot flashes immediately after their ovaries are removed (“surgical menopause”), and that women who were born without functioning ovaries (hence low estrogen) tend to not experience hot flashes. Also, a woman who never had hot flashes, uses HRT for awhile and then stops, will often experience hot flashes for the first time.

It is thought that one way that estrogen therapy reduces hot flashes is by widening this temperature-tolerance zone. Other factors involved in vasomotor symptoms include neurotransmitters like serotonin, epinephrine (adrenalin) and norepinephrine, and adrenal imbalances, but scientists are still figuring these out.

Hot flash and night sweat trigger #1: stress

There are many known triggers for hot flashes and night sweats; however stress — emotional or physical — is usually involved in all of them. Poor nutrition is a form of physical stress easily overlooked during hormonal transitions like menopause. To help explain how it can make such a huge difference we’ve dedicated a whole page to nutrition and hot flashes. A study of more than 3,000 women found anxiety to be the most consistent psychological factor associated with hot flashes. Assuming you’re a woman experiencing hot flashes, have you sometimes been feeling quite comfortable until the very second you realize you forgot an important appointment, or you run into someone you’d rather avoid, and a raging hot flash erupts? I remember this happening to me when I suddenly realized that the romantic email I’d just sent to my partner was misdirected to the CEO. I’m relieved that emotional stress is being increasingly recognized as a major cause of women’s hot flashes and night sweats, because the Women’s Health Network has been making this connection with women for years. Studies have shown improvements in hot flashes using counseling, cognitive-behavioral training, relaxation, mindfulness-based stress reduction, and hypnosis. All of these findings confirm the notion that stress is a major trigger. In a study at Indiana University called “Breathe for Hot Flashes,” researchers are also investigating how women being treated for breast cancer can better manage their hot flashes uses breathing techniques.

There are many different types of stress, any of which can lead to increased levels of stress hormones in the same way that fear and anxiety can. Some physical stressors that increase hot flashes include insulin resistance and smoking. Obesity is a mixed bag, in that it appears to increase risk of hot flashes in younger women, but reduce them in older women. (at least in younger women). In terms of emotional stressors, hot flashes are more frequent in women who are depressed, or in a lower socioeconomic position in life, or who were abused or neglected in early life. Emotions are not faucets we can easily turn off and on at will, but they do always have something to teach us. Whatever your hot flash triggers, I encourage you to explore the possibility of an emotional component.

Common hot flash triggers

Aside from the larger contributors discussed above, the following factors can often trigger a hot flash:

  • Sugar and foods high in refined (or simple) carbohydrates
  • Caffeine, nicotine, and stimulants, in general
  • Alcohol (even one glass of wine)
  • Hot drinks or foods — spicy or temperature-wise
  • Hot spaces, such as saunas, hot tubs, showers, and warm, stuffy bedrooms
  • Crowded rooms
  • Poor air quality or lack of fresh air
  • Intensive exercise — or any type of activity that heats the body up without allowing adequate cool-down time

What about herbs for hot flashes and night sweats?

For decades, synthetic and equine forms of estrogen (e.g., Premarin) were the therapy of choice for hot flashes in menopausal and perimenopausal women. Although they often work well to relieve hot flashes, many women are wanting for a more natural approach, especially after the reported risks associated with HRT. We’ve developed an alternative, combination approach that delivers excellent results while also optimizing a woman’s long-term health. Central to the success of this approach is phytotherapy — the use of plants for healing purposes, both in whole-food form and as standardized extracts.

You may have read negative articles about herbal remedies. This often relates to the modern cultural expectation that popping a pill should deliver instant results. The intimate healing relationship between the female mind-body-spirit and the plant kingdom is thousands of years old. Compared to HRT or other prescription medications, phytotherapy typically requires more time for results to become obvious. Just as women have differing responses to drug therapy, not all women respond alike to plant therapies. But through the years we have determined a particular combination of phytotherapeutic herbs that offers synergistic benefits for most women.

The benefit to using herbs for hot flash relief is that they work with your neuroendocrine system to assist hormonal messaging between your brain, nervous system, and endocrine organs. Plant-based therapy can help increase or decrease cellular responses depending on what your unique body needs. We call this an adaptogenic effect, and it probably works because we evolved alongside the plant world. Within your cells, the responses taking place that originate from the plant world are called phytocrine responses. Phytocrines are the bioactive molecules in plants that share features with our own hormones and can directly connect with your endocrine system. By either encouraging the body to make more of a certain hormone, mimicking the body’s hormones, or stimulating the same response in the body as a natural hormone, plants can help the body maintain hormonal balance completely naturally and without the side effects often present with prescription medications.

The following plants have been used by generations of women for hot flashes, night sweats, and other menopausal symptoms:
Soy isoflavones (Glycine max)Kudzu (Pueraria lobata)
Black cohosh (Actaea racemosa, formerly Cimicifuga racemosa)Passionflower (Passiflora incarnata)
Red clover (Trifolium pratense)Ashwagandha (Withania somnifera)
Chastetree (Vitex agnus-castus)Wild yam (Dioscorea villosa)

Together, these plant species form the basis of our phytotherapeutic treatment protocol for hormonal imbalance. In the practice of integrative medicine, herbal options are used together with a foundation of healthy lifestyle and dietary choices. Used within this setting, women with hot flashes and night sweats most often find that phytotherapy can gently and naturally ease them into hormonal balance.

Traditional Chinese Medicine & hot flashes

According to Traditional Chinese Medicine (TCM), several different imbalances in the body’s flow of energy (known as qi) are possible during menopause. Some of the most common imbalances that can cause hot flashes are kidney yin deficiency, uprising deficiency heat, and blood deficiency. With TCM, there is never any one-size-fits-all approach; treatments (acupuncture and/or herbal combinations) are always custom-tailored according to a person’s specific set of imbalances.

5 natural ways to reduce hot flashes and night sweats — from Women's Health Network

Most of the women we talk with prefer to use the most natural and least invasive methods available for health care. For them, addressing their menopausal symptoms by filling a prescription doesn’t hold the appeal it might for others. Antidepressants, anti-anxiety drugs, sleeping pills, and synthetic hormones — the solutions conventional medicine continues to offer women for hot flash relief — don't have to be the first things you try. For years we’ve been offering women safe alternative solutions that effectively address the underlying causes of hot flashes and provide equivalent — if not superior — results. Here are some options we find helpful:

1) Understand your triggers. The first step in pulling the plug on your hot flashes is to identify and understand your unique triggers. Are you more prone at certain times of the day or night? Do certain foods or alcohol set you off on a heat wave? Tracking these observations and patterns in your journal or a wellness diary can help you make connections.

2) Nourish your body’s neuroendocrine pathways. Cut out the sugar, eat whole, fresh foods, and balance your meals and snacks with plenty of fruits and vegetables, healthy fats, and protein. Add a top-grade multivitamin-mineral complex, essential fatty acids, and soy to augment your core nutrition. All of these will help with neurotransmitter and hormonal balance. With a solid nutritional foundation, you will find the passage through menopause to be a lot less bumpy. (To learn more, read our dietary pointers for quelling hot flashes.)

3) Stay active. Exercise helps reduce hot flashes, partly by reducing anxiety. In a small study looking at the effect of exercising three times per week on overall menopause symptoms, women who exercised had fewer hot flashes, while those who did not experienced an increase. Whatever form of exercise you enjoy likely makes for better hormonal health, provided it does not make you feel more stressed-out or overheated. Forms of exercise that raise core body temperature can trigger hot flashes, so be sure to keep it gentle and provide ample cool-down time.

4) Cultivate emotional health. Make a commitment to yourself to follow a path that brings you emotional wellness. Take incremental steps to reduce stress, whatever form it takes in your life. Whether that means setting better boundaries at work, at home, or within your community, learn to value your own well-being enough to keep commitments and expectations reasonable. Use your inner guidance to seek out and cultivate practices that calm rather than stimulate your inner thermometer. Find your own best style of stress reduction, whether that means meditation, yoga, mindfulness-based stress reduction, walks in nature, relaxing while focusing on your breathing, or something else..

5) Add gentle hormonal support when needed. Given that phytohormones approximate the molecular configuration of the hormones produced in our own bodies, it stands to reason that we’re better equipped to utilize them safely and effectively than pharmaceutical drugs or synthetic forms of hormone therapy. If you’re considering herbal support, a product containing a range of plant constituents, like the one we offer in our SHOP, can offer synergistic benefits that a single herb may not. You may also want to explore acupuncture and Traditional Chinese Medicine, or talk to your practitioner about the idea of using bioidentical hormone replacement.

After all, it’s your body

Waking up in a pool of perspiration at night or having to leave an important meeting because of a hot flash can be frustrating, embarrassing, or even scary. No one likes to feel helpless or limited to one-size-fits-all solutions. Take comfort in knowing that there are safe natural ways to help limit the frequency and severity of your hot flashes and night sweats.

Your body is magnificent in its ability to recover and maintain balance through life’s transitions — sometimes it just needs extra support — on both the physical and emotional planes. A natural combination approach can help you restore hormonal balance and regain personal comfort — while tuning in to your body, finding greater peace of mind, and creating better long-term health.

References

Freeman, E.W., et al. 2005. The role of anxiety and hormonal changes in menopausal hot flashes. Menopause, 12 (3), 258–266. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/15879914 (accessed 01.29.2008).

[AMA format for Freeman article]: Freeman EW, Sammel MD, Lin H, et al. The role of anxiety and hormonal changes in menopausal hot flashes. Menopause. 2005 May-Jun;12(3):258-66.

1 Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL. Pathophysiology and treatment of hot flashes. Mayo Clin Proc. 2002 Nov;77(11):1207-1218. ENotes Web site. http://www.enotes.us/hotflashes2002.pdf. Accessed June 13, 2014.

1 Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL. Pathophysiology and treatment of hot flashes. Mayo Clin Proc. 2002 Nov;77(11):1207-1218. ENotes Web site. http://www.enotes.us/hotflashes2002.pdf. Accessed June 13, 2014.

1 Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL. Pathophysiology and treatment of hot flashes. Mayo Clin Proc. 2002 Nov;77(11):1207-1218. ENotes Web site. http://www.enotes.us/hotflashes2002.pdf. Accessed June 13, 2014.

1 Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am. 2011 Sep;38(3):489-501.

1 Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am. 2011 Sep;38(3):489-501.

1 Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am. 2011 Sep;38(3):489-501.

1 Tremblay A1, Sheeran L, Aranda SK. Psychoeducational interventions to alleviate hot flashes: a systematic review. Menopause. 2008 Jan-Feb;15(1):193-202.

1 Elkins GR, Fisher WI, Johnson AK, et al. Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial. Menopause. 2013 Mar;20(3):291-298.

1 Study looks at breathing techniques to manage hot flashes. Indiana University Simon Cancer Center; News Archives. IU Simon Cancer Center Web site. http://cancer.iu.edu/news-publications/article.shtml?id=3215. Accessed June 13, 2014.

1 Thurston RC, El Khoudary SR, Sutton-Tyrrell K, et al. Vasomotor symptoms and insulin resistance in the study of women's health across the nation. J Clin Endocrinol Metab. 2012 Oct;97(10):3487-3494.

1 Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am. 2011 Sep;38(3):489-501.

1 Thurston RC, Sowers MR, Chang Y, et al. Adiposity and reporting of vasomotor symptoms among midlife women: the study of women's health across the nation. Am J Epidemiol. 2008 Jan 1;167(1):78-85.

1 Thurston RC, Santoro N, Matthews KA. Adiposity and hot flashes in midlife women: a modifying role of age. J Clin Endocrinol Metab. 2011 Oct;96(10):E1588-E1595.

1 Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am. 2011 Sep;38(3):489-501.

1 Chen J. Menopause: Western and Traditional Chinese Medicine Perspectives, Part II. Acupuncture Today. May, 2002;3(5). Acupuncture Today Web site: http://www.acupuncturetoday.com/archives2002/may/05chen.html. Accessed June 13, 2014.

1 Ueda M. A 12-week structured education and exercise program improved climacteric symptoms in middle-aged women. J Physiol Anthropol Appl Human Sci. 2004 Sep;23(5):143-148.

Further reading

Davis, M., et al. 2000. The relaxation and stress reduction workbook. Oakland, CA: New Harbinger Publications.