Night sweats in perimenopause – why and what to do about it?

December 13, 2023.

medically reviewed by Patricia Shelton, MD

Vasomotor symptoms – hot flashes and night sweats in perimenopause are extremely common . Both hot flashes and night sweats involve a feeling that the body is overheated, but they’re a little different. Hot flashes occur during the day, and they may cause sweating, although not always. Night sweats happen during the night, and the sweating is generally more intense. 

So if you’re experiencing night sweats, what can you do about this?

What causes night sweats in perimenopause?

Vasomotor symptoms are caused by a drop in estrogen levels. Your body temperature is controlled in a brain region called the hypothalamus. The balance between two substances is important – estrogen and a substance known as neurokinin B (NKB). When levels of estrogen drop, this balance is disrupted. The hypothalamus may falsely receive the signal that the body is hot, even though the temperature is normal. You’ll begin to feel hot, and your body will also do things to try and cool down – like sweating.

Women experience night sweats and hot flashes for an average of seven years. However, for some women, they can last twelve years or even longer. After menopause is complete, vasomotor symptoms will usually fade away over time. However, they generally won’t stop immediately – women continue experiencing hot flashes and night sweats for an average of about four and a half years after their final menstrual period.

It’s very important to note that peri isn’t the only potential cause of night sweats. A variety of conditions, including thyroid disease, lupus, infections, and cancer, can also cause night sweats. If you suddenly find yourself experiencing more night sweats than normal, it’s a good idea to bring this up with your doctor, to make sure that you don’t have any signs of a medical condition. Night sweats are common in the menopausal transition, so this is the most likely cause – but it’s a good idea to check in with your doctor to be sure.

What are the effects of night sweats?

Although both hot flashes and night sweats fall into the same category of symptoms, recent research has indicated that night sweats may have more detrimental effects than hot flashes. This is probably because night sweats often interfere with sleep.

A lack of sleep can have a huge impact on your quality of life. Even one night of poor sleep affects mood, memory, and cognitive performance, and it even makes you more susceptible to stress. Over the long term, a lack of sleep leads to a higher risk for a variety of chronic diseases, including heart disease, diabetes, and cancer. It also increases the risk of depression.

When you have a night sweat, the sudden feeling of heat may wake you up. You might also be awakened later, by the cold and clammy feeling that results from sleeping in sweat-soaked pajamas and sheets. In some cases, you might remember these awakenings. However, many people don’t remember the disruptions to their sleep – they just feel tired and sluggish the next morning. If you wake up damp from sweat, it’s likely that you’re having night sweats, and that these are interfering with the quality of your sleep – even if you don’t remember being woken up.

What can you do about night sweats?

It’s clearly important to make sure that you’re getting enough sleep, to protect your mental and physical health. If you’re experiencing night sweats, what can you do to help avoid disruptions to your sleep? Here are a few things you can try:

  • Consider medical treatment. Hormone replacement therapy (HRT) is highly effective at relieving vasomotor symptoms, including night sweats. Although HRT is considered to be safe for most women, there are some who have medical conditions that make HRT not a good option for them, and others who prefer to avoid hormones. These women could consider taking the recently released nonhormonal medication for vasomotor symptoms. 

  • Keep your environment cool. During the menopausal transition, your comfortable temperature zone will tend to shift. Cooling down your room may help – you may want to open a window at night, turn down the heat, and/or turn on a fan. It’s also important to make sure that your bedding isn’t causing you to overheat. Choosing cooling bedding (such as cooling comforters and pillows from Slumber Cloud) can help with this.

  • Choose bedding and pajamas that help you stay dry. Similarly, it’s important to pay attention to the dampness factor. A night sweat can drench your pajamas and sheets, which can later disrupt your sleep because you feel cold and damp. Instead of changing your sheets in the middle of the night, it’s better to choose sheets that wick moisture away from your body to help keep you feeling dry. You can also find loose-fitting pajamas that won’t absorb moisture – or simply sleep without pajamas.

  • Get enough exercise. There’s some evidence that exercising during the day can help to reduce the frequency of hot flashes and night sweats. Exercise can also help to improve sleep quality. Try to get at least 20 to 30 minutes of moderate exercise (brisk walking or the equivalent) each day. If you exercise close to bedtime, this could actually trigger hot flashes, so try to exercise earlier in the day.

  • Avoid triggers. Certain lifestyle factors have a tendency to exacerbate night sweats. These include spicy foods, caffeine, alcohol, and cigarettes. Most of these tend to interfere with your sleep quality anyway, so reducing or removing them from your life is likely to help you sleep better.

Night sweats can have a huge impact on your quality of life. Being unable to sleep makes almost anyone miserable. Fortunately, you do have options that may help to reduce the number of night sweats you experience, so you can sleep better – and feel better.

Disclaimer: This article is no medical advice


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