Night sweats (hot flashes at night) are very common in perimenopause, affecting up to 80% of women, with frequency varying widely from a few times a week to many times daily, often worsening closer to menopause, disrupting sleep and energy levels due to fluctuating hormones. While some get mild sweats, others have severe episodes waking them up drenched, requiring sheet changes, with durations from seconds to minutes, though they can persist for years.
Hot flashes and night sweats.
An estimated 35%–50% of perimenopausal women suffer sudden waves of body heat with sweating and flushing that last 5–10 minutes, often at night as well as during the day.
If you're experiencing symptoms but aren't sure what stage you're in, testing your hormones is the best way to find out. Our Advanced Hormone Test provides clear insights into your hormone levels, giving you the answers you need to take control of your symptoms.
Hormone therapy.
Systemic estrogen is hormone therapy for the whole body. It comes as a pill, skin patch, spray, gel or cream. It is the best treatment for hot flashes and night sweats. Based on your health history, your healthcare professional may recommend estrogen in the lowest dose that helps your symptoms.
Overview of Night Sweats
They're usually not caused by external temperature but by internal factors, such as hormonal shifts, infections, or medical conditions. Common symptoms of night sweats include: Waking up in damp or soaked clothing and bedding.
Perimenopause, the transition to menopause, typically starts in a woman's mid-to-late 40s, but can begin as early as the mid-30s or even earlier, and usually lasts for about four to eight years before menopause (the final period) occurs around age 51. Average onset varies, with some sources pointing to age 46, but it's a highly individual process, influenced by genetics and lifestyle.
Hot flashes, night sweats, loss of regular menstrual periods and sleep problems. These familiar symptoms of menopause appear in most women around age 50. But if they arise before age 40—which happens for about 1 in 100 women—it's a sign that something's wrong.
During perimenopause, avoid or limit spicy foods, caffeine, and alcohol (which can trigger hot flashes and disrupt sleep), refined carbs and sugar (causing blood sugar spikes/mood swings), and processed/fatty foods (increasing cholesterol/weight gain); also watch out for smoking and excessive sodium to better manage symptoms like hot flashes, mood swings, and weight changes, focusing instead on whole foods, hydration, and balanced nutrition.
“Your doctor will take a look at your detailed medical history and may order tests, such as blood counts and virus and thyroid tests, to determine if you have any underlying medical conditions that could be responsible,” says Dr. Rosch.
But while her mood swings, irritability and distance affect you, they're not about you. This isn't a relationship crisis – it's a hormonal one. During perimenopause, estradiol, progesterone and testosterone fluctuate wildly, affecting mood, memory, libido, sleep – and just about everything else.
Many people notice they're gaining weight more easily in the years before and after menopause. Typical gains range from 8 to 12 pounds. Any extra weight tends to accumulate around the belly (abdomen).
Perimenopause, the transition to menopause, is often broken down into four overlapping stages focusing on menstrual cycle changes: the Late Reproductive Stage (slight cycle variations), Early Perimenopause (cycles vary by 7+ days), Late Perimenopause (cycles 60+ days apart, skipping periods), and finally, Menopause (12 months without a period), marking the end of perimenopause's hormonal fluctuations. Symptoms like hot flashes, mood swings, and brain fog can appear in any stage, though they often intensify in later stages as hormone drops become more significant, especially progesterone.
Topping the list of reasons for older women's 3 a.m. wake-ups are drastic drops in estrogen and progesterone that accompany menopause. These hormonal shifts spur many changes throughout the body, but one of the most noticeable is disrupted sleep cycles.
If you are sweating enough that you have to get up and change your nightclothes or the sheets because they are wet, that is more significant. It may indicate a side effect of a medication, such as antidepressants or hormone therapy, or the existence of an underlying illness. Night sweats can be related to infection.
We recommend chelated magnesium, such as magnesium glycinate. It's well known that good vitamin D status is critical for bone health, which becomes critical in perimenopause and menopause. However, vitamin D is also involved in immunity, blood sugar regulation, and genetic expression.
But several lesser-known symptoms can also be attributed to the hormonal shifts of perimenopause. These include: Anxiety and depression (worsening or new onset) Brain fog and fatigue.
Common symptoms that can be worse in the morning
Other symptoms that can often feel worse in the morning include joint pain, fatigue, and low energy, as well as brain fog low mood or mood swings, nausea, and dizziness.
Perimenopause is when you have symptoms of menopause but your periods have not stopped. Perimenopause ends and you reach menopause when you have not had a period for 12 months. Menopause and perimenopause can cause symptoms like anxiety, mood swings, brain fog, hot flushes and irregular periods.
Changes to your period
In addition to each period becoming further apart, you may also notice other variations in your menstrual bleeding that signal your final period is close including: Missed periods. Heavier or lighter periods. Longer or shorter periods.
The first signs of perimenopause often involve changes to your menstrual cycle, such as irregular periods (longer, shorter, heavier, lighter, or missed periods), alongside common symptoms like hot flashes, night sweats, sleep problems, mood swings (anxiety/irritability), and vaginal dryness, all due to fluctuating estrogen levels. Other early signs can include forgetfulness, brain fog, changes in libido, headaches, sore breasts, or increased joint/muscle pain.
Another reason for the misdiagnosis of perimenopause is that the symptoms can be similar to those of other health conditions, such as thyroid problems, depression, and anxiety. There is no specific blood test that defines perimenopause. Our hormones are fluctuating and typically fall in the range of normal.
Ageing is a gradual process… until menopause. Women are faced with a faster period of ageing in the perimenopausal period when youth appears to be slipping away with every look in the mirror.
You can take hormone replacement therapy (HRT) if you have menopause symptoms, including during perimenopause and after your periods stop (post-menopause). Menopause usually affects women between the ages of 45 and 55, but it can happen earlier.