Hot Flashes and Night Sweats: Why They Happen and What Actually Helps

Part 1 of our 6-week menopause series

Imagine you're in the middle of a meeting, a grocery line, or a good night's sleep, and suddenly heat rises through your chest and face. Your skin flushes, you start to sweat, and a minute or two later you may feel chilled. If that sounds familiar, you're experiencing one of the most common symptoms of the menopause transition. The good news is that there are more effective, evidence-based treatment options today than ever before.

This week kicks off our six-week menopause series. Whether you live here in Princeton or are one of our patients driving in from the surrounding area, our goal is to help you understand what's happening in your body and what you can do about it.

What Is a Hot Flash?

Doctors call hot flashes and night sweats vasomotor symptoms (VMS). A hot flash is a sudden feeling of warmth, usually in the upper body and face, often with flushing, sweating, and sometimes a racing heart. When it happens during sleep, it's a night sweat. Night sweats can soak your sheets and leave you exhausted the next day.

Why do they happen?

Deep in the brain, the hypothalamus works like your body's thermostat. Estrogen helps keep a group of nerve cells in that area (called KNDy neurons) in balance. When estrogen levels fluctuate and then fall during perimenopause and menopause, a signaling chemical called neurokinin B becomes more active. That makes the thermostat overly sensitive, so even a tiny change in body temperature can trigger a full "cool down" response: blood vessels widen, you sweat, and you feel a flash of heat. Understanding this pathway led to a newer class of medicines, which we'll cover below.

How Long Do They Last?

Hot flashes often last longer than people expect. The Study of Women's Health Across the Nation (SWAN), a long-term study that followed women through the menopause transition, found that among women with frequent hot flashes or night sweats, symptoms lasted a median of 7.4 years, and they continued for a median of 4.5 years after the final menstrual period. Women whose hot flashes started early, while their periods were still regular or just beginning to change, tended to have them the longest.

So if you've been told to "just wait it out," know that waiting can mean years. You don't have to tough it out.

Common Triggers

Triggers vary from person to person, but many women notice flashes after:

• Hot drinks, spicy food, or alcohol
• Warm rooms, heavy bedding, or layered clothing
• Stress or anxiety
• Smoking

Keeping a simple symptom diary for a couple of weeks can help you spot your own patterns, and it's useful to bring to your visit.

Treatment Options

The right treatment depends on how much your symptoms bother you, your age, how long it has been since your last period, and your personal and family medical history. Here's an overview of the options backed by The Menopause Society (formerly NAMS) and ACOG.

1. Lifestyle steps

Dressing in layers, keeping your bedroom cool, using a fan, and limiting known triggers can help. They're worth doing, but for moderate to severe symptoms they're usually not enough on their own.

2. Hormone therapy (HT)

According to The Menopause Society's 2022 position statement, hormone therapy remains the most effective treatment for hot flashes and night sweats. The benefit-risk balance is most favorable when hormone therapy is started before age 60 or within 10 years of your last period, in healthy women without reasons to avoid it. That's a guide, not a hard cutoff. The same statement says there is no general rule for stopping hormone therapy at age 65, and it doesn't need to be routinely discontinued after 60 or 65 when there's a good reason to continue, along with regular reassessment.

At Summit Women's Health, Dr. Lingenfelter does treat women who are older than 60 or more than 10 years past menopause, after a candid, individualized discussion of their symptoms, health history, and risks.

About progesterone: If you still have your uterus, estrogen must be paired with a progestogen to protect the uterine lining (endometrium) from overgrowth and cancer. That part is required. Beyond that, oral micronized progesterone can have benefits of its own for some women, whether or not they have a uterus. It's mildly sedating and is taken at bedtime. Studies suggest it can help you fall asleep faster, and in one dose studied it also reduced hot flashes and night sweats. Using it for these reasons is off-label and based on more limited evidence, so it's something we decide together case by case.

What changed at the FDA: For more than 20 years, hormone therapy labels carried a "boxed warning" based on early interpretations of the Women's Health Initiative. In November 2025, the FDA asked manufacturers to remove the cardiovascular disease, breast cancer, and probable dementia language from that warning, and in February 2026 it approved the first updated labels. Labels are being updated product by product, and systemic estrogen-only products keep a boxed warning about endometrial cancer. The change doesn't make hormone therapy right for everyone. It may still not be recommended if you've had certain cancers, blood clots, stroke, or heart disease, which is why it's always an individualized decision. We'll dig into the myths and the evidence, including what the Women's Health Initiative really showed, in week 3 of this series.

3. Nonhormonal prescription options

For women who can't or prefer not to take hormones, The Menopause Society's 2023 nonhormone therapy position statement supports several options:

• Elinzanetant (Lynkuet). Approved by the FDA on October 24, 2025, this Bayer medicine blocks two receptors in the brain's temperature-control pathway (neurokinin 1 and neurokinin 3). It's taken once daily at bedtime. In our practice, we use it more often than fezolinetant. Its label has no boxed warning for liver injury, and its liver monitoring is lighter: a blood test before starting and one recheck at 3 months. In our experience, insurance coverage is often better too, though coverage varies by plan. Like any medicine, it has its own cautions. It can cause sleepiness, so you shouldn't drive if you feel drowsy. Other cautions include liver enzyme elevations, a seizure-risk warning, and interactions with some medicines and grapefruit. It must not be used during pregnancy.
• Fezolinetant (Veozah). Approved by the FDA on May 12, 2023, this was the first medicine of its kind. It blocks the neurokinin 3 receptor. It carries an FDA boxed warning for rare but serious liver injury, added in December 2024. Liver blood tests are required before starting, then monthly for the first 3 months and again at 6 and 9 months. You should stop it right away and contact your prescriber if you notice signs of liver problems, such as yellowing skin or eyes, dark urine, unusual fatigue, nausea, or itching.
• Certain antidepressants (SSRIs/SNRIs). Low-dose paroxetine is FDA-approved for hot flashes, and others in this class are also used. They can reduce hot flashes even if you aren't depressed.
• Gabapentin. This can be especially helpful for night sweats, since it may cause drowsiness.
• Oxybutynin. A bladder medicine that can also reduce hot flashes, though it's generally not preferred for older women because of possible effects on thinking and memory.

4. Nondrug approaches with evidence

Cognitive behavioral therapy (CBT) and clinical hypnosis are both recommended by The Menopause Society for bothersome hot flashes. They can make symptoms less frequent or less bothersome.

What about supplements?

Many over-the-counter "menopause support" products are marketed heavily. The Menopause Society's 2023 statement found that the evidence doesn't support recommending most of them, including many herbal and dietary supplements, for hot flashes. If you're taking one, bring it to your visit so we can review it with you.

When to Make an Appointment

Schedule a visit if:

• Hot flashes or night sweats are disrupting your sleep, work, or relationships
• You're having symptoms in your early 40s or younger
• You have bleeding after menopause (12 months without a period). This always needs evaluation.
• You're unsure whether your symptoms are menopause or something else, such as thyroid problems, which can cause similar symptoms
• You've tried lifestyle changes and still feel miserable

At your appointment, we'll review your symptoms, health history, and goals. We'll talk honestly about benefits and risks and build a plan that fits you.

You Don't Have to Just Live With It

Hot flashes are common, but feeling miserable for years isn't something you have to accept. Patients come to us from across southern West Virginia and southwest Virginia, from Beckley and Lewisburg to Peterstown, Giles County, and the Blacksburg and Christiansburg area. Dr. Brandon M. Lingenfelter, Dr. Samantha Snyder, Megan Lingenfelter, PA-C, and VaLeah Bradshaw, CNM, are here to help you feel like yourself again.

Ready for relief? Schedule an appointment with Summit Women's Health today.

Summit Women's Health
411 12th Street Ext, Princeton, WV 24740
To schedule an appointment: 681-282-5591

Watch our hot flash video on Summit Social for a quick overview, and come back next Friday for week 2: the early signs of perimenopause.

This post is for general education and isn't a substitute for personal medical advice.

Sources

1. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. https://doi.org/10.1097/GME.0000000000002028
2. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. https://doi.org/10.1097/GME.0000000000002200
3. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine. 2015;175(4):531-539. https://pubmed.ncbi.nlm.nih.gov/25686030/
4. U.S. Food and Drug Administration. FDA approves novel drug to treat moderate to severe hot flashes caused by menopause (May 12, 2023). https://www.fda.gov/news-events/press-announcements/fda-approves-novel-drug-treat-moderate-severe-hot-flashes-caused-menopause
5. U.S. Food and Drug Administration. FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant) for hot flashes due to menopause (updated Dec. 16, 2024, with boxed warning). https://www.fda.gov/drugs/drug-safety-communications/fda-adds-warning-about-rare-occurrence-serious-liver-injury-use-veozah-fezolinetant-hot-flashes-due
6. U.S. Food and Drug Administration. Drug Trials Snapshots: LYNKUET (approval date October 24, 2025). https://www.fda.gov/drugs/drug-trials-snapshots/drug-trials-snapshots-lynkuet
7. Bayer HealthCare. LYNKUET (elinzanetant) Prescribing Information (revised 08/2026). https://labeling.bayerhealthcare.com/html/products/pi/Lynkuet_PI.pdf
8. U.S. Food and Drug Administration. FDA Requests Labeling Changes Related to Safety Information to Clarify the Benefit/Risk Considerations for Menopausal Hormone Therapies (Nov. 10, 2025). https://www.fda.gov/drugs/drug-alerts-and-statements/fda-requests-labeling-changes-related-safety-information-clarify-benefitrisk-considerations
9. U.S. Food and Drug Administration. FDA Approves Labeling Changes to Menopausal Hormone Therapy Products (Feb. 12, 2026). https://www.fda.gov/news-events/press-announcements/fda-approves-labeling-changes-menopausal-hormone-therapy-products
10. American College of Obstetricians and Gynecologists. The Menopause Years (patient FAQ). https://www.acog.org/womens-health/faqs/the-menopause-years
11. MedlinePlus (U.S. National Library of Medicine). Menopause. https://medlineplus.gov/menopause.html