How to Stop Hot Flushes: Why Your Internal Thermostat is Broken
There is no more defining and disruptive symptom of the menopausal transition than the sudden, overwhelming wave of heat known as the hot flush (flash).
If you’ve ever found yourself peeling off layers in a meeting or soaked with sweat at 3 AM, you know this is more than a minor inconvenience; it’s a symptom that profoundly impacts sleep, focus and quality of life.
What’s Actually Going On: Oestrogen and Your Internal Thermostat
The mechanism for hot flushes and night sweats (collectively called Vasomotor Symptoms, or VMS) is surprisingly simple: your brain is confusing a normal body temperature with overheating.
The Hypothalamic Trigger: As Professor Susan Davis, Director of Monash University's Women’s Health Research Program, explains, the reproductive centre in the brain, which responds to the drop in oestrogen, projects nerves onto the brain’s temperature control centre (the hypothalamus). This communication triggers the temperature regulation centre to behave inappropriately.
According to Professor Davis, the resulting hot flush is the body performing a natural cooling reaction called vasodilation (blood vessels dilating) and sweating, even when it doesn’t need to, essentially setting your comfort zone too narrow.
A Diagnostic Marker: Recent Monash University-led research co-authored by Professor Davis found that the new onset of moderate to severe VMS is highly specific to perimenopause, being nearly five times more likely than in the pre-menopause stage.
This highlights VMS as a critical diagnostic clue for practitioners. (Source: Monash University Research, 2025)
The Sleep Impact: Night sweats, VMS that occur during sleep, are particularly damaging. They fracture your sleep architecture, leading directly to the fatigue, brain fog and anxiety you may feel the next day.
Small wonder so many women say: “It’s not the heat, it’s the exhaustion that follows.”
Lifestyle Factors That Turn Up the Heat
While the hormonal driver is outside your control, several lifestyle factors can amplify symptoms and these are modifiable.
Weight and metabolism:
Research suggests women with overweight or obesity often experience more intense VMS. For suitable individuals, even modest, sustainable weight loss may help reduce severity.
Smoking:
Strongly associated with earlier menopause and more severe VMS.
Dietary triggers:
For some women, caffeine, spicy food, alcohol and very hot drinks can lower the threshold for a flush.
These triggers don’t cause VMS but they can reduce your body’s tolerance, making symptoms more intense or frequent.
Three Evidence-Based Ways to Cool the System
You have tools beyond hormonal therapies (MHT/HRT) to gain control over VMS. These approaches focus on behaviour change, lifestyle, stress reduction and body awareness. They work by calming the nervous system and widening that hypothalamic comfort zone.
1. Practice Paced Breathing & Relaxation
This simple intervention is consistently recommended by menopause societies because it works on the autonomic nervous system, which VMS disrupt.
The Technique: At the onset of a hot flush or for 10-15 minutes daily, practice slow, deep, diaphragmatic breathing (paced breathing). This immediately engages the body's parasympathetic ('rest and digest') state, counteracting the stress response that fuels the flush.
Evidence: Research has shown that relaxation techniques and paced breathing reduce the frequency and severity of hot flushes.
2. Mind-Body Therapies for Symptom Distress
While you may not stop the flush from happening, you can change how your brain reacts to it, reducing the distress and anxiety that follows.
CBT (Cognitive Behavioural Therapy): Professor Susan Davis notes that Cognitive Behavioural Therapy (CBT) and Hypnosis have been shown to help women manage VMS and deal with their symptoms. They do not necessarily eliminate the symptoms but alleviate the negative impact of symptoms. (Source: Monash University/myDr)
Evidence: CBT is recommended for easing how much hot flushes and night sweats bother you, improving quality of life even if the frequency remains stable.
3. Discuss Prescription Options with Your Doctor
For women whose severe VMS significantly impact their quality of life, there are medical interventions available. As a Health Coach, I cannot recommend or prescribe medication but it is essential to be aware of the options to discuss with your GP. Whether these are suitable depends on your health history and should always be discussed with a qualified clinician.
Non-Hormonal Prescription Treatments: Certain low-dose medications, such as some SSRIs/SNRIs (e.g., Paroxetine, PMID: 29705291) or the newer neurokinin 3 receptor (NK3R) antagonists, have been clinically shown to reduce the frequency and severity of hot flushes by acting directly on the brain’s temperature centre.
Crucial Note: These are prescription medications. If you feel your symptoms require medical intervention, please consult your doctor (GP) or a qualified healthcare provider to discuss whether these options are safe and suitable for you.
As a health coach, I support clients to apply CBT-informed tools, thought reframing and emotional regulation techniques within the boundaries of coaching practice.
What You Can Take From This
The intensity of hot flushes and night sweats is a direct reflection of your body trying to adjust to hormonal shifts. You gain agency when you realise you can influence this core temperature confusion. By proactively managing your stress, making small dietary adjustments and exploring evidence-based behavioural or medical strategies with your healthcare provider, you can significantly reduce the grip VMS has on your daily comfort and sleep.
You don't have to simply tolerate the heat. You can learn to cool the system from the inside out
Small, consistent lifestyle shifts guided by an understanding of your biology can make a profound difference.
If vasomotor symptoms are leaving you exhausted, irritable, or feeling unlike yourself, you don’t have to navigate this transition alone. Evidence-based information is helpful but real change comes from personalising it, understanding your own triggers and building habits that support your nervous system, sleep and overall wellbeing.
This is the work I do every day with women just like you.
If you’re ready for calmer days and cooler nights, let’s talk.
Book a free Menopause Heart-to-Heart call
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You deserve to feel steady, supported and back in control again and you don’t have to figure it out alone.
References
Susan R. Davis Research (Monash University): Findings on the mechanism of VMS related to the hypothalamus and its response to oestrogen decline and the role of VMS as a diagnostic criterion for perimenopause. (Source: The Lancet 2025)
Paroxetine Evidence, Weber et al, 2014 (PMID: 24601805): Vasomotor symptoms and nonhormonal options for their management for postmenopausal women.
Systematic review detailing the efficacy of non-hormonal options, including SSRIs like paroxetine, for VMS reduction.
CBT and Hypnosis (Non-Hormonal Consensus): The use of Cognitive Behavioural Therapy (CBT) and clinical hypnosis for VMS is supported by the North American Menopause Society (NAMS) and other bodies as effective for reducing the severity and distress associated with the symptoms. (Source: NAMS/BMS Consensus Statements)
Dietary Factors: Barnard ND, et al. A dietary intervention for vasomotor symptoms of menopause: a randomized, control trial. (PMID: 36253903)
Highlights the association between diet (including refined carbohydrates and fats) and VMS severity.
