Hot Flashes in Your 40s? How to Get Relief During Perimenopause

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If you wake up in a pool of sweat, and you're in your 40s, you may be wondering what's going on. You may think of hot flashes and night sweats as symptoms of menopause, which is when you have your final period.

But these symptoms can start during the years leading up to menopause. This period of time is called perimenopause. It typically occurs any time in your mid-to-late 40s, but it can start even earlier in some people.

Here's what to know about hot flashes during perimenopause and what you can do to reduce how intense and frequent they are.

What is perimenopause?

Perimenopause is the transition period that leads up to menopause. During this time, your body starts to produce less reproductive hormones, like estrogen.

This can cause symptoms like hot flashes and night sweats. Perimenopause typically lasts about 4 years. But it can be shorter or longer - even as long as 8 years or more.

What does a hot flash feel like during perimenopause?

Hot flashes can feel like a sudden rush of heat in the upper body. You usually feel it in the face, neck, or chest. Each hot flash typically lasts from 2 to 4 minutes, though they can last longer. You may also start to sweat and feel like your heart is racing (called palpitations).

Other symptoms that can occur with hot flashes include:

• Clammy skin

• Chills

• Flushing

How often can perimenopause hot flashes occur?

About 8 in 10 women experience hot flashes or night sweats during perimenopause. How often they get them varies. The average is 4 to 5 hot flashes a day. But some people have only a couple a week, while others have as many as 20 a day. They tend to become more frequent as you get closer to menopause.

What causes hot flashes in perimenopause?

Scientists don't know exactly what causes hot flashes. They may be triggered by changes in the hypothalamus, which is the part of the brain that helps control body temperature.

Normally, if the hypothalamus detects that you're too warm, it triggers your body to cool down. Blood vessels near the skin's surface widen to increase blood flow there. That helps get rid of some of your body heat. But it can also make you feel hot, make your skin flush, and can cause sweating - the symptoms of a hot flash.

During perimenopause, even small increases in body temperature can set off these hot flashes.

Treatment for hot flashes from perimenopause

If your hot flashes are making you uncomfortable, there are treatments you can take during perimenopause. One option is hormone replacement therapy (HRT). One review found that HRT reduced the frequency of hot flashes by 75%. The hot flashes were less intense as well.

HRT replaces reproductive hormones that are declining during perimenopause. They usually contain estrogen, progestin, or a combination of the two.

A range of hormonal options are available, including:

• Patches

• Oral medications

• Gels

• Creams

• Injections

If you don't want to take hormones, or can't take them for medical reasons, several non-hormone medications may help treat hot flashes. They include:

• Veozah (fezolinetant) can treat moderate to severe hot flashes. Veozah plays a role in how the brain regulates body temperature.

• Certain antidepressants, like selective serotonin reuptake inhibitors (SSRIs), may help. Paroxetine (Brisdelle) is one SSRI that's FDA-approved for treating hot flashes.

• Gabapentin (Neurontin) is an anti-seizure medication that can be used off-label to help relieve hot flashes.

• Clonidine (Catapres-TTS) is a blood pressure medication that also can be used off-label to help hot flashes.

Lifestyle changes to help reduce hot flashes

There are a few lifestyle changes that may help reduce how often and intense your hot flashes are. You can see if these work alone. Or you can do these along with taking medication.

Limiting certain foods and drinks

Alcohol, caffeine, and spicy foods may make hot flashes worse. You can keep an eye on whether you get hot flashes after you have any of these foods. If you do, try cutting back on them and seeing if it makes a difference.

Quitting smoking

Smoking cigarettes can make hot flashes worse. Studies show that quitting smoking decreases the frequency and intensity of hot flashes. If you decide you want to try to quit smoking, it's a good idea to work with your primary care provider. They can discuss medications and other approaches to help you quit smoking.

Exercising

Some research shows that physical activity may help reduce the intensity and number of hot flashes you have. But the evidence is mixed. Some reviews of the research show that it helps, and some show it doesn't. So, it's not clear whether exercising will help or not.

If you want to try it, aim to do moderate-intensity exercise - like brisk walking or swimming - or strength training at least 3 days a week.

Keeping cool

You can also try these strategies to help regulate your body temperature when a hot flash hits:

• Dress in light layers. You can remove layers when your body starts to heat up.

• Try deep breathing. Taking slow, deep breaths when you feel a hot flash coming on may help reduce your stress, which may shorten the hot flash.

• Drink cold water. Drinking ice water can help cool you off.

Natural remedies

You may get some relief from hot flashes with certain herbal remedies. These herbs contain phytoestrogens, which may mimic the effects of natural estrogen. Some people report getting relief from various herbal remedies. However, the research is inconsistent. This means scientists don't know for sure if these will help.

These are the more commonly used herbal supplements for hot flashes:

• Black cohosh

• Red clover

• Dong quai

Always talk to your primary care provider or OB-GYN before trying any supplements. You want to make sure they won't interact with any medications you're taking or affect any medical conditions you have. For example, phytoestrogens may act similarly to estrogen and may not be safe for people who are advised against taking estrogen.

Other symptoms of perimenopause to watch for

Perimenopause is a different experience for everyone. There are many possible symptoms of perimenopause. Some may overlap with symptoms of other conditions. If you're having any of these other symptoms, talk to your gynecologist to get an accurate diagnosis and effective treatment.

Symptoms of perimenopause you may experience include:

• Mood changes

• Changes in sexual desire

• Trouble concentrating

• Headaches

• Vaginal dryness

• Poor sleep

• Urinary incontinence (losing control of your bladder)

• Weight gain

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