Perimenopause night sweats: why they happen and what can help

Night sweats in perimenopause are hot flashes that happen while you sleep: a sudden wave of heat, heavy sweating, and often a chill afterward [1][4]. They’re common, they can start while you still have regular or irregular periods, and they often disturb sleep [4]. Simple changes to your evenings and bedroom can make nights easier, and you can talk with your doctor about hormone therapy and other options.

I hear about night sweats from many of the women I see in Östermalm. Often the sweating itself isn’t the worst part. It’s the broken sleep, and the tired, short-fused day that follows.

What happens in your body

During perimenopause, the ovaries gradually make less estrogen and progesterone, and the levels can swing from month to month. These hormones also affect how your body regulates temperature. A hot flash often comes suddenly: you feel warm in the chest, neck or face, you may turn red, and then you start to sweat [4]. Some people get palpitations, anxiety or dizziness with it, and an episode can last several minutes [1].

At night, the same thing happens while you’re asleep. 1177 notes that hot flashes and sweating often come at night and can disturb sleep [4]. Many people also describe a cold spell afterward, which makes sense when you’re lying in damp sheets.

Night sweats don’t follow a neat timeline. According to the NHS, menopause symptoms usually last 7 to 9 years, sometimes longer, and they change over time [1]. Some people find their night sweats ease, and that low mood or anxiety becomes more noticeable instead [1].

Not every night sweat is perimenopause

Night sweats in your 40s are easy to blame on hormones, but they have other common causes too. The NHS lists anxiety, some medicines (for example some antidepressants, steroids and painkillers), low blood sugar, alcohol or drug use, and hyperhidrosis, a harmless condition with heavy sweating [2]. Sweating because your bedroom or duvet is too warm is normal, and not what doctors mean by night sweats [2].

If your night sweats started around the same time as a new medicine, mention it to your doctor. It’s not a reason to stop the medicine on your own.

What you can try tonight

The NHS suggests a few practical steps for hot flashes and night sweats [3]:

• wear light clothing to bed
• keep your bedroom cool at night
• have a fan, a cold drink or a cool shower close at hand
• look for ways to lower your stress
• notice your triggers and cut back on them, such as spicy food, caffeine, hot drinks, smoking and alcohol
• move regularly and keep to a healthy weight for you

It can help to keep a simple log for two or three weeks: what time you woke up, what you ate and drank in the evening, how stressed the day was. Some people find a clear trigger, like wine with dinner or a late coffee. Others don’t, and that’s useful to know as well.

I want to be honest about the evidence here. These steps make nights more bearable for many people, but a 2023 review by the North American Menopause Society did not recommend cooling techniques, avoiding triggers, exercise or relaxation for hot flashes, because the evidence was limited or inconsistent [5]. So see them as comfort and better sleep conditions rather than a fix.

What the research says about other options

Hormone therapy. The same review concluded that hormone therapy remains the most effective option for hot flashes and night sweats [5]. Whether it suits you is a decision you make with your doctor. If you’re weighing the choice, I’ve written more about perimenopause without HRT.

CBT and clinical hypnosis. Both were recommended in the 2023 review, with good and consistent evidence [5]. The NHS also mentions CBT as a way to manage hot flashes [3].

Acupuncture. The research is mixed. A Cochrane review of 16 trials with 1,155 women found that acupuncture reduced hot flashes compared with no treatment, but not compared with sham acupuncture, and hormone therapy worked better than acupuncture [6]. The evidence was of low or very low quality, and the authors could not say whether acupuncture is effective for hot flashes [6]. The 2023 review did not recommend acupuncture for hot flashes, based on limited or inconsistent evidence [5]. More on this in acupuncture for menopause symptoms.

Herbs and supplements. The 2023 review did not recommend supplements or herbal remedies for hot flashes, based on the current evidence [5]. I still use Chinese and Western herbs in my work, and I’m open with you that the research behind them for night sweats is limited.

How I work with night sweats

Night sweats rarely come alone. They tend to sit together with lighter sleep, worry in the evening, a busy job and a cycle that has started to change. At your first visit, we go through all of it: when the sweats come, how you sleep before and after, what you eat and drink, stress, digestion, your periods and what you’ve already tried.

Then you get a written plan. Depending on what we find, it can include:

• changes to your evenings, food and sleep routine
• Chinese or Western herbs and high-quality supplements
• acupuncture, mainly Japanese style
• lab tests if needed, alongside the tests your doctor takes

I work in parallel with your doctor, whether or not you take HRT. Your notes and test results become something you can bring to your next appointment with your doctor or gynecologist. If sleep is the main thing, you may also want to read about perimenopause insomnia and my sleep and fatigue page.

If you’d like to take a next step

You can book a first visit: 60 minutes, 3,500 SEK, at Kommendörsgatan 9 or online, in English or Swedish. Not sure it fits your situation? You can book a free 15-minute call on Tuesdays, or email me first. All options are on prices, and there’s more on this phase of life on my perimenopause page.

When to see a doctor

Contact your vårdcentral (local primary care clinic) or call 1177 (Sweden’s public health information service) if:

• you regularly have night sweats that wake you up or worry you [2]
• you also have a fever, feel shivery, or have a cough or diarrhea [2]
• you’re losing weight without trying [2]
• you have palpitations [1]
• you’re bleeding more heavily than before, or you start bleeding again more than a year after your last period [1][4]
• hot flashes, sweating or poor sleep affect your everyday life, or your mood feels low

If you have thoughts of not wanting to live, or in an emergency, call 112.

Sources

1. NHS. Symptoms: Menopause. 2026. https://www.nhs.uk/conditions/menopause/symptoms/
2. NHS. Night sweats. 2023. https://www.nhs.uk/conditions/night-sweats/
3. NHS. Things you can do: Menopause. 2026. https://www.nhs.uk/conditions/menopause/things-you-can-do/
4. 1177. Klimakteriebesvär. 2026. https://www.1177.se/Stockholm/sjukdomar--besvar/hormoner/klimakteriebesvar/
5. The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. https://pubmed.ncbi.nlm.nih.gov/37252752/
6. Dodin S, et al. Acupuncture for menopausal hot flushes. Cochrane Database of Systematic Reviews. 2013. https://www.cochrane.org/evidence/CD007410_acupuncture-menopausal-hot-flushes