Updated November 14, 2025

Hot flashes — those sudden surges of hot skin and sweat associated with menopause and perimenopause — start for most women in their 40s.

Hot flashes can start even before a woman starts skipping periods or has other symptoms of perimenopause. For some women, these symptoms can be worse in perimenopause than in postmenopause. There are several ways you can manage these heat spikes to lessen their impact on your daily life.

Wen Shen, M.D., director of the Women’s Wellness & Healthy Aging Program at Johns Hopkins and a Johns Hopkins gynecologist specializing in perimenopause and menopause, shares information about hot flashes and steps you can take to minimize their effect. 

Q: What is a hot flash?

A: Hot flashes are quick bursts of hot skin and often drenching sweat that last anywhere from 30 seconds to about five minutes. Your face and neck may turn red, your heart rate may increase and you will most likely break out in a sweat. Night sweats are the same thing, only you’re asleep and are jolted awake by the heat and sweat sensation consuming your body.

These sudden bursts, especially at night, can cause fatigue, irritability and even forgetfulness. For 10% to 15% of women, hot flashes are so severe that they disrupt normal functions, such as leading a meeting or sticking to a schedule. If you feel your daily activities are affected by hot flashes, make sure to speak with your gynecologist.

Q: How long will I get hot flashes?

A: On average, you may be looking at 5–10 years of living with hot flashes. Though they are sporadic, their unpredictability is very frustrating. Let’s look at what you can expect:

• 40s: This is when most women start perimenopause. Some hot flashes and night sweats begin. (For some, perimenopause starts in the 30s.)
• 46–53: In the U.S., this is the average age for menopause, which is defined as 12 straight months with no period. Hot flashes tend to be most frequent in the two years after menopause.
• Late 50s: Most women continue to have hot flashes anywhere from 4–10 years after menopause. But in most cases, they will decrease in frequency and severity.

Q: What causes hot flashes?

A: The exact causes of hot flashes are still unknown, but they are thought to be related to changes in the brain’s thermoregulatory center, which controls heat production and loss, and is influenced by your hormones. During perimenopause, hormones start acting like a rollercoaster, with progesterone and estrogen levels changing in wide variations. These ups and downs don’t settle down until almost 10 years after menopause.

Q: How can I control hot flashes?

A: There are several ways to deal with hot flashes. Since hormone levels are changing all the time, we don’t treat the hormone levels — we treat the symptoms.

Lifestyle Changes to Relieve Hot Flashes

Keep Yourself Cool

• Dress in layers so you can easily remove clothes if you get hot. 
• Wear natural fibers instead of synthetic materials.
• Carry a portable fan in your purse. 
• Use cold water and pretreated wipes to cool the back of your neck when you feel a hot flash coming on. 

Avoid Triggers

• It may take you a while to figure out your triggers. For most women, they include coffee and red wine.
• Review your medications with your doctor or medical practitioner. Certain high blood pressure and cholesterol medicines are known to cause hot flashes.

Know the Risk Factors

• Smoking, obesity and race (Black women report more frequent hot flashes) may influence how likely you are to get hot flashes.
• New research is showing increased risk for heart disease, strokes and metabolic syndrome in women with moderate to severe hot flashes. You should consult with a menopause specialist if you have severe hot flashes.

When should I see a doctor for hot flashes?

Start with these lifestyle changes, but if you’re not seeing relief, consider talking to your gynecologist about prescription medication.

You should always see a doctor about hot flashes if they are:

• Severe
• Interfere with your sleep or daily life
• Occur suddenly after years of menopause
• Are accompanied by other symptoms like chest tightness or shortness of breath

Prescription Medications to Treat Hot Flashes

1. Menopause Hormone Therapy: Hormone therapy is an option for some women in the early stages of menopause or perimenopause to help relieve moderate to severe symptoms. Hormone therapy can increase the risk of certain health issues, and may not be suitable for everyone. The decision to start using these hormones should be made only after you and your clinician have evaluated your risk versus benefit ratio.
2. Nonhormonal Medications: For women who do not wish to use hormone therapy, or cannot use it due to medical conditions, there are nonhormonal medications such as elinzanetant, which was recently approved by the FDA, fezolinetant, gabapentin, selective serotonin reuptake inhibitors (SSRIs) and clonidine.

With lifestyle choices and perhaps help from your gynecologist, you can manage hot flashes with minimal disruption to your life. 

Medically reviewed by Wen Shen, M.D., November 14, 2025