Hot flashes at night: what the guidelines actually say
Night sweats are hot flashes that happen during sleep, and they are common: up to 80% of women have hot flashes during menopause, lasting a mean of 7 to 10 years. [1] The Menopause Society calls hormone therapy the most effective treatment, and also lists several nonhormone options that are recommended. [3][4] Which one is right for you is a decision for you and your clinician.
What are night sweats, and how common are they?
The Menopause Society defines hot flashes and night sweats as vasomotor symptoms: feelings of warmth that can come with flushing and sweating. [1] They occur in up to 80% of women during menopause. [1] An episode typically lasts between 1 and 5 minutes and may come with sweating, chills and anxiety, and night sweats are simply hot flashes that occur during sleep. [1] The Society adds that hot flashes may contribute to sleep problems. [1]
How long do night sweats last?
Longer than most women are told. The SWAN study followed women across the transition and counted "frequent" hot flashes or night sweats as six or more days in the previous two weeks. [2] The median total duration was 7.4 years, and the median time they persisted after the final period was 4.5 years. [2] Timing mattered: women who first reported frequent symptoms while premenopausal or early perimenopausal had the longest median duration, more than 11.8 years, while women who were already postmenopausal at onset had the shortest, 3.4 years. [2] The authors also reported that African American women had the longest median duration, 10.1 years. [2] They concluded that clinicians should counsel women to expect that frequent symptoms could last more than 7 years. [2] Our article on how long menopause lasts puts this in the wider picture.
Do night sweats really wreck your sleep?
They can contribute. In the SWAN sleep study, women who reported nocturnal hot flashes had more sleep fragmentation, reduced sleep efficiency and were less likely to feel rested. [5] The National Institute on Aging notes that hot flashes, especially night sweats, can contribute to poor sleep, and that waking itself may trigger hot flashes, rather than the other way around. [6] It is not the only cause of waking at night, as we cover in why you wake at 3 a.m. after 45. The Office on Women's Health says that if hot flashes are causing sleep problems, treating them will usually improve sleep. [7]
What does the Menopause Society say about hormone therapy?
Its 2022 position statement says hormone therapy remains the most effective treatment for vasomotor symptoms. [3] For women younger than 60 or within 10 years of menopause onset who have no contraindications, the benefit-risk ratio is favorable for treating bothersome symptoms. [3] For women who start more than 10 years after menopause onset or are older than 60, the benefit-risk ratio appears less favorable because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism and dementia. [3] The statement is clear that treatment should be individualized and periodically reevaluated. [3] It also says risks differ by type, dose, duration, route of administration and timing of initiation, and whether a progestogen is used, which is why the conversation is about your specific situation. [3]
On sleep specifically, the SWAN analysis of 3,045 women found that postmenopausal women using hormones, compared with those who were not, generally had lower odds of disturbed sleep. [8] That is an association from an observational study, not a trial, so treat it as a reason to ask the question rather than an answer. [8]
Which nonhormone options are recommended?
The Society's 2023 statement was written for women who are not good candidates for hormone therapy, for example because of estrogen-dependent cancers or cardiovascular disease, or who prefer not to use it. [4] Its recommended list, graded Level I (good and consistent evidence), is cognitive behavioral therapy, clinical hypnosis, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, gabapentin and fezolinetant. [4] Oxybutynin is also recommended (Levels I-II). [4] These are prescription or clinician-delivered options, which is why this is a conversation to have with a clinician.
What is not recommended for night sweats?
The same 2023 statement lists what it does not recommend. At Level I it names paced respiration. [4] At Levels I-II it names supplements and herbal remedies. [4] At Level II it names cooling techniques, avoiding triggers, exercise, yoga, mindfulness-based intervention and relaxation, among others. [4] The Menopause Society's patient page describes several of the measures on this list, including cooling techniques and supplements, as having limited solid data to evaluate their effectiveness or as having failed to show significant benefits in clinical trials. [1] That is a statement about the quality of the evidence for hot flashes, not a reason to skip a cool room or a regular walk for other reasons. For what the evidence says on supplements specifically, see perimenopause supplements.
What to bring to the appointment
How often the symptoms happen. The SWAN study counted six or more days in two weeks as frequent. [2] How long ago they began, and where you are relative to your last period, since timing shapes the benefit-risk balance. [2][3] Your health history, including any estrogen-dependent cancer or cardiovascular disease, since those change which options are open. [4] What you have already tried and how your sleep has been. [7]
When to talk to your clinician
If hot flashes or night sweats are disrupting your sleep, that alone is a reason to book the appointment. [7] The decision between hormone therapy, a nonhormone prescription, a behavioral approach or watchful waiting depends on your age, your timing relative to menopause and your health history, and it belongs to you and your clinician together. [3][4]
Sources
- The Menopause Society, Hot flashes (patient education). No revision date shown on the page. Retrieved 2026-10-18.
- Avis et al., Duration of menopausal vasomotor symptoms over the menopause transition (SWAN), JAMA Intern Med 2015. PMID 25686030. Retrieved 2026-10-18.
- The 2022 hormone therapy position statement of The North American Menopause Society, Menopause 2022. PMID 35797481. Retrieved 2026-10-18.
- The 2023 nonhormone therapy position statement of The North American Menopause Society, Menopause 2023. PMID 37252752. Retrieved 2026-10-18.
- Kravitz et al., An actigraphy study of sleep and pain in midlife women: the SWAN Sleep Study, Menopause 2015. PMID 25706182. Retrieved 2026-10-18.
- National Institute on Aging, Sleep Problems and Menopause: What Can I Do? Content reviewed September 30, 2021. Retrieved 2026-10-18.
- Office on Women's Health, Menopause symptoms and relief. Page last updated May 30, 2025. Retrieved 2026-10-18.
- Kravitz et al., Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women (SWAN), Sleep 2008. PMID 18652093. Retrieved 2026-10-18.
Every statement above was checked against the linked source on October 18, 2026. This article is education, not individual medical advice. Related: How long does menopause last?, Perimenopause supplements, Why you wake at 3 a.m. after 45.