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Hot flashes and night sweats: Symptom management

This piece was originally published on Elektra Health.

When you think of menopause, chances are hot flashes are one of the first symptoms that come to mind. Hot flashes are an extremely frustrating — yet common — side effect of menopause. Hot flashes can begin to seriously impede your life and disrupt your sleep and you shouldn’t just have to tough it out. Here are some tips to help you manage the symptoms.

Nutrition and diet

Food can help minimize hot flashes by supporting hormone health — specifically cortisol and insulin. Here are some specific foods that Elektra’s founding physician, Dr. Anna Barbieri, MD recommends.


Soy products like tofu contain isoflavone compounds (genistein & daidzein) that can help control hot flashes. Isoflavone works essentially by mimicking natural estrogen. Studies have shown benefits with isoflavone supplements and one small study suggests that dietary soy might also help.


Like soy, ground flaxseed contains phytoestrogens and may help reduce hot flashes. The research shows conflicted results. But like dietary soy, there are other health benefits. Ground flaxseed is a great source of fiber and omega-3s. Add 1-2 tablespoons to smoothies, oatmeal, and yogurt. Make sure that it’s ground though! Consuming it in whole seed or oil form does not deliver the same benefits.


Legumes, like chickpeas and lentils, are a weaker source of phytoestrogens and may help reduce hot flashes, although the magnitude of the effect isn’t clear.

While some food can be a beneficial tool in mitigating hot flashes and night sweats, other foods can actually trigger these symptoms.

Common food triggers 

Spicy foods

Exercise caution when it comes to late-night dinners that bring the heat! They can also bring you the heat and cause full-body flushing.


While any alcohol can be a trigger, red wine is known to be particularly problematic. If you do choose to drink, try switching to white wine or a different beverage and enjoy your drink with food, earlier in the evening rather than right before bed. 


The correlation between coffee and sleep is widely understood. Plus, the effect your cup ‘o Jo has on hot flashes can be just as bothersome. Try cutting down on caffeine if you find it triggers your hot flashes.

Symptom management 

Here are some effective ways to manage and mitigate hot flash symptoms.

Paced breathing exercises

The North American Menopause Society recommends paced respiration (slow deep breathing sustained for a specific period of time) as a behavioral treatment for hot flashes. To start, try for five minutes twice per day, with a target rate of 6-8 breaths per minute. If that works, try to get up to 15-minute sessions. It might feel a bit odd and unnatural at first, but stick with it, and it will become like second nature.

Cognitive Behavioral Therapy (CBT)

CBT involves working with a coach or therapist to recognize and change beliefs — including negative thoughts and worries — that may be triggering or exacerbating hot flashes. That’s the “cognitive” part. And then there’s the “behavioral” part, which helps you develop better habits and a mindset to improve the hot flash experience (vs the hot flash itself). It’s ideal for those looking to address underlying causes while working toward long-term management.


When it comes to night sweats, it’s important to keep your bedroom cool. Right around bedtime, our body temperature drops 1-2 degrees, which signals to our internal clock that it’s time to hit the hay. In doctor-speak, this is what’s called “thermoregulation.” Try keeping your bedroom at a cool 60 – 67°F. Here are some other ways to keep cool at night:

  • Cooling sheets made with bamboo, effectively wick moisture (read: sweat) from your skin
  • Cooling mattress pad or blanket, or a heated blanket for your bed partner (look into one with dual controls to accommodate your partner)
  • Cooling system for your bed that uses circulating water to maintain a consistent, cool temperature 
  • A fan! Simple, low-cost, and effective


Although exercise does not directly reduce vasomotor symptoms, it’s beneficial for a slew of other symptoms that may indirectly affect hot flashes, such as sleep health and mood. 

Supplements and over-the-counter solutions

Supplements and over-the-counter solutions can be effective in supporting your sleep health. We recommend talking to your healthcare provider first to ensure you’re using the right solution for you. 

Low-dose contraceptives

Some providers advise perimenopausal women to take low-dose birth control pills as a way to regulate hormones that impact our cycles, and decrease risk of ovarian/uterine cancer, bone loss, and hot flashes. 

Hormone replacement therapy (HRT)

The treatment with the highest reported rate of efficacy for hot flashes is estrogen-based hormone therapy, which comes in the form of a skin patch, gel, cream, spray, or pill. It’s proven to be effective and, as an added bonus, also helps with other symptoms of menopause like vaginal dryness and pain with sex. There are some downsides, so speak with your provider about what makes most sense for you.

Tissue selective estrogen complex

Tissue selective estrogen complex involves a combination of selective estrogen receptor modulators (SERMs) and estrogen, which is most often recommended to postmenopausal women for the joint purpose of vasomotor symptom treatment and osteoporosis prevention. 


SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors. These neurotransmitters are typically used as antidepressants; however, they’re also effective in treating certain menopausal symptoms such as hot flashes. They work by regulating serotonin and norepinephrine.


Gabapentin (Neurontin) is an anti-seizure medication also used to treat menopausal symptoms such as vasomotor symptoms and sleep disruptions.


Oxybutynin (Ditropan), a medication commonly used for urinary incontinence, has also been shown to be effective for hot flash treatment.


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  • Burns, D. S., & Carpenter, J. S. “Paced Respiration for Hot Flashes?” The Female Patient. Web. July 2012.
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  • Avis, N. E., Coeytaux, R. R., Isom, S., Prevette, K., & Morgan, T. “Acupuncture in Menopause (AIM) study”. Menopause. 23(6), 626–637. March 2016.
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  • Pickar, J. H., Boucher, M., & Morgenstern, D. “Tissue selective estrogen complex (TSEC): a review”. Menopause. 25(9), 1033–1045. September 2018. 
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