A perimenopausal woman wonders if what she is experiencing is a hot flash. Jessica explains hot flashes, night sweats, the differences, and how to manage these symptoms of perimenopause and menopause.
Ask Jessica is an advice column for women in midlife. We cover all things related to midlife from changing bodies to career transitions to parenting teens to sandwich generation challenges to shifts in marital or life partnerships and everything in between. My hope is that in sharing these questions and answers I can women as we face the midlife journey together. Got a question or challenge you would like me to address? Fill out this form to submit your issue! Want to see the answers to other questions, check out our archive here.
HEY JESSICA: Hot flashes. I still can’t tell if I’m having them, or having some pre-HF version? The person I share a bed with is a damn furnace, so it’s often hard to tell if I’m just reacting to him or if it’s coming from me. So, will it be abundantly clear once I really have one or, like the weight gain, is this a slow creep kinda thing and they just build up until I’m my own private hot spring? ~I’m Melting
DEAR I’M MELTING: It sounds like you have discovered the joys of the insane sweating that can occur, seemingly at random, for many women in midlife. Congratulations, you’ve managed to snag one of the hottest tickets in town! (Sorry, dad joke.) All kidding aside, these periods of intense heat are no fun and can really impact your life. It sounds as if you are experiencing your super-hot episodes at night, which leads us to two questions: (1) is this due to hormonal changes that are happening in your body (i.e., perimenopause/menopause) or is it due to some other physical reason? And (2) if they are due to hormones, are they hot flashes or night sweats? Yup, there’s a difference. Once that is figured out, then what can be done becomes clearer.
First, let’s rule out reasons outside of menopause. If this is a new thing (which I assume it is from what you have described), I don’t think we can blame your furnace of a partner (unless he’s new to your bed, of course). But there are some other potential reasons for temperature surges outside of hormones. If you have started a new medication (especially antidepressants, cortisone, or diabetes medications); struggle with sleep apnea; are experiencing other symptoms such as unexplained weight loss, mood changes, or an unexplained fever; or have a more serious health condition such as hyperthyroidism, neurological disorders, or cancer, then it may be wise to check in with your doctor. If none of these seem to apply to you, then it is likely due to hormonal shifts.
So, now let’s talk about hot flashes v. night sweats. A hot flash is a brief surge of heat that focuses itself in the upper body, usually lasting anywhere from 2-4 to at most 10 minutes. When a woman is experiencing a hot flash, she will often get flushed and sweaty, and then, once the surge is over, chilled and even shivering. Hot flashes can occur both during the day and at night.
Night sweats, on the other hand, only happen at night and are a more prolonged experience of heat where your entire body gets drenched in sweat. Once the sweating has ceased, you can also get cold and shivery, but it is the full body and longer length of time that distinguishes them from hot flashes.
Then, the next question becomes: what to do about it. And this is where it really is a personal decision and, perhaps, an evolving one as many women will experiences ebbs and flows in the frequency and intensity of their hot flashes/night sweats, depending on their hormone levels and other external factors such as stress and diet. If this is only happening occasionally, then you may decide it is just an infrequent annoyance and that you can live with it. If, on the other hand, they are frequent or just really uncomfortable, then you may want to take some action.
The first thing I recommend, and this is something that I think is helpful for all kinds of issues that we face both during perimenopause and throughout life, is to fill out a food journal for about a week to see what patterns might arise. Now, to be clear, this is not a food log like you might have done when you were on a diet. You are not tracking calories or even macronutrients and this is not meant to make you feel guilty about what you have had to eat or drink. Instead, this is a food journal to track what you eat and drink and how it makes you feel. So, for about a week, you just jot down everything you eat and drink and then note how you feel immediately afterwards, about 2 hours later, and then again how you felt that night. To do this you can use just a plain notebook (or, if you want, just hit reply and I will send you a PDF of a food journal that you can print out and use for this purpose). After a week, review your journal and see what patterns you notice. Are there certain foods that trigger these temperature surges? In particular, pay close attention to alcohol, caffeine, spicy foods, and meat as those tend to be triggers for many women. (For me, I discovered that I got night sweats when I had more than two glasses of wine, so I now usually stick to one glass and then make exceptions when the loss of sleep feels worthwhile to me.) Once you have that information, then you can decide what you want to do, which could range from nothing to reducing your intake to cutting the triggering items out completely.
Another thing you can do is make your bedroom more conducive to sleep. You can do this by making the room cooler, changing your sheets and pajamas to more breathable fabrics (cotton and bamboo are both great), or investing in cooling sheets, pillows, and/or mattress toppers. (Personally, I switched our sheets to organic cotton and now wear shorts and a tank top to sleep all year long – no more flannel PJ pants for me in winter!)
Finally, if these interventions don’t provide the relief you desire or if you decide that you are not willing to give up that spicy curry you love so much or that glass of wine at the end of the day (which would be understandable since the point is to be happy, not to feel deprived all the time), then you can also consider talking with your OB/GYN about whether you are a good candidate for a medical intervention.
One last thought: I think it is important to note that it is, of course, always your choice how proactive you want to be about these sweating episodes. If they become more frequent and/or severe, though, I do encourage you to try to find a solution for yourself as research has shown that women who experience frequent night sweats struggle more with stress and depression, which will only make this time of change more difficult.