Her Hot Flashes and Night Sweats — How to Help

Hot flashes don't wait for menopause. They frequently begin during perimenopause — sometimes years before her last period — because the underlying cause is hormonal instability, not the absence of hormones. During perimenopause, estrogen levels don't decline smoothly. They swing wildly: spiking higher than they ever have one week, then crashing the next. These erratic fluctuations destabilize the hypothalamus, the part of the brain that acts as her internal thermostat. When estrogen drops suddenly, the hypothalamus narrows the thermoneutral zone — the temperature range the body considers 'normal.' A core temperature change of just 0.4°C, which would normally go unnoticed, now triggers a full vasomotor response: blood vessels dilate, blood rushes to the skin surface causing flushing and intense heat, and the body activates sweating to cool down. Heart rate spikes. She may feel dizzy or nauseated. The whole event is involuntary and can last one to five minutes, sometimes longer. About 80% of perimenopausal women experience hot flashes, and for many, they're the first noticeable symptom — arriving before periods change or stop. Understanding that this is a neurological event, not simply 'feeling warm,' helps you respond with genuine empathy.

Night sweats are hot flashes that happen during sleep, and they're often worse because they cause abrupt awakening, drenched clothing, and the inability to fall back asleep. She wakes up overheated, throws off the covers, may need to change clothes, and then lies there wide awake while her body overcorrects and she starts shivering. This can happen multiple times a night. The cascading effect on sleep quality is devastating — not just for her, but for you. Chronic sleep deprivation affects mood, cognitive function, immune health, and relationship quality for both partners. Practical environmental changes make the biggest difference. Set the bedroom to 65–68°F (18–20°C). Switch to moisture-wicking sheets and sleepwear. Try the Scandinavian sleep method — same bed, separate duvets — so she can throw hers off without uncovering you. A fan on her side of the bed helps. A cold water bottle on her nightstand means she doesn't have to get up. Some couples find that a cooling mattress pad transforms their nights. If night sweats are severe and persistent, encourage her to discuss treatment options with a menopause-informed doctor. HRT can reduce night sweats by 75% or more. Non-hormonal options like fezolinetant or low-dose gabapentin also help, especially at night.

While the root cause of hot flashes is hormonal instability, many women have identifiable triggers that increase their frequency or severity. Common triggers include alcohol (especially red wine), caffeine, spicy foods, hot beverages, warm environments, stress, tight clothing, and hot baths or showers. That said, triggers are highly individual — what affects one woman may not affect another, and her triggers can shift over time as her hormone levels change. Helping her identify patterns without becoming controlling about it is the key balance. If she notices that a glass of wine reliably triggers a hot flash, you can support her by not pressuring her to drink socially, ordering options she enjoys, or suggesting restaurants with better ventilation. If stress is a major trigger, reducing her overall stress load — taking things off her plate, managing household logistics, giving her genuine downtime — has a direct physiological benefit. Temperature is often the biggest modifiable factor. She needs the ability to cool down quickly wherever she is. Layered clothing, proximity to exits or open air in restaurants, and air conditioning in the car are simple adjustments that prevent episodes. The goal isn't to bubble-wrap her life — it's to make these adjustments so naturally that she doesn't have to think about them.

Yes, and they're more effective than most people realize. Hormone replacement therapy (HRT) remains the gold standard for vasomotor symptoms, reducing hot flash frequency and severity by 75% or more in most women. For perimenopausal women specifically, doctors often prescribe low-dose birth control pills or a hormonal IUD combined with estrogen — these stabilize the wild hormonal swings that cause symptoms while also providing contraception (which she still needs during perimenopause). For women who can't or prefer not to use hormones, several evidence-based alternatives exist. Fezolinetant (Veozah) is a non-hormonal medication that targets the brain's temperature control center directly. SSRIs and SNRIs, particularly paroxetine and venlafaxine, reduce hot flashes by 40–60%. Gabapentin is especially helpful for night sweats. Cognitive behavioral therapy (CBT) has been shown to reduce the distress and interference caused by hot flashes, even when it doesn't reduce frequency. The important thing for you to know as her partner is that suffering is not mandatory. If hot flashes are affecting her quality of life, sleep, or ability to function, effective treatments exist. Many women don't seek treatment because they think they just have to endure it, or because a dismissive doctor told them it's 'normal.' Normal doesn't mean untreatable.

Hot flashes aren't just physical — they carry an emotional weight that's easy to underestimate. Many women feel embarrassed, especially when hot flashes happen in professional settings or social situations. There's visible flushing, sudden sweating, and the awkwardness of needing to fan yourself or excuse yourself from a meeting. Some women feel a loss of control over their own bodies that's deeply unsettling. And because hot flashes are culturally associated with 'getting old,' they can trigger grief, anxiety about aging, and a sense that her body is betraying her. The relentless sleep disruption from night sweats compounds everything. Chronic sleep deprivation erodes emotional resilience, patience, and cognitive sharpness. She may be more irritable, more tearful, or more withdrawn than usual — not because of the hot flashes alone but because of the cumulative exhaustion. Your role is to be the safe space. Don't joke about hot flashes unless she initiates humor. Don't draw attention to them in public. When she's flushing at dinner, quietly hand her a cold glass of water rather than announcing 'She's having a hot flash!' The couples who navigate this well are the ones where the partner treats these symptoms as something they're managing together rather than something happening to one person while the other watches.