Hot flashes can persist after menopause because low estrogen affects how the brain regulates body temperature. Doctors may recommend hormone therapy or other nonhormonal treatments.

A hot flash is a sudden, intense feeling of heat, often in the face, neck, or chest. It happens as estrogen levels drop during menopause.

Menopause is a process with different phases. It includes perimenopause (the transition), menopause (12 months without a period), and postmenopause (the time after).

Around 70% to 80% of people assigned female at birth get hot flashes during menopause. But for some, they can persist for years after, often affecting sleep, mood, and quality of life.

A hot flash feels like a sudden rush of heat, often starting in the face, neck, or chest. Each episode lasts 1 to 5 minutes and can happen anytime, even while you’re sleeping.

During a hot flash, you may start sweating, feel flushed, or get cold chills afterward. Some people also feel anxious, irritable, or mentally foggy during an episode. This reaction begins in your brain. Lower estrogen levels after menopause affect the hypothalamus, the part of your brain that regulates body temperature.

Even a small increase in body temperature can trigger the brain to cool you down by widening blood vessels and making you sweat, causing a hot flash. This happens because your thermoneutral zone, the body’s comfort range, becomes narrower after menopause.

Hot flashes don’t just affect the body. They can affect sleep, lower your mood, and reduce your quality of life if they happen often.

What does that mean?

  • Thermoneutral zone: The temperature range where your body feels comfortable and doesn’t need to heat up or cool down.
  • Hypothalamus: A part of the brain that helps regulate body temperature.
  • Estrogen: A hormone that helps regulate many body functions, including temperature.
  • Sympathetic nervous system: A part of your nervous system that manages your fight-or-flight response and physical reactions to stress.

Hot flashes can continue after menopause because estrogen stays low and still affects how your brain regulates temperature.

Lower estrogen levels make the hypothalamus more sensitive to changes in body heat. Your thermoneutral zone narrows, so even small temperature rises can trigger a hot flash.

The sympathetic nervous system may also become more reactive, triggering intense feelings of heat or anxiety, even in a cool room

Other contributing factors include:

  • genetics
  • extra body fat, which traps heat
  • brain chemicals like serotonin and norepinephrine
  • anxiety, poor sleep, or changes in mood
  • lifestyle habits like smoking or low activity levels

A 2019 study review found that hot flashes often last about 7 years after your final period. But for 1 in 3 women, they can persist beyond 10 years, and nearly 1 in 12 still have them after 20 years.

Certain factors can affect their duration, including:

  • Genetics: If your mother or sister had long-lasting symptoms, you might too.
  • Race or ethnicity: Research shows that Black women tend to have more severe and longer-lasting hot flashes, while Asian women report fewer.
  • Body weight: A higher BMI may be linked to more frequent or intense hot flashes than those with a lower BMI.
  • Surgical or early menopause: Hot flashes may start sooner and last longer for those who’ve had their ovaries removed or entered menopause early.
  • Lifestyle habits: Smoking and low physical activity can make symptoms persist longer.

Certain factors may increase your risk of having hot flashes after menopause, including:

Several options can help treat postmenopausal hot flashes, including:

Hormone Therapy (HT/MHT)

Hormone therapy, formerly called hormone therapy (HT), involves taking estrogen, with or without progesterone, to ease symptoms. HT isn’t aimed at trying to “replace” hormones an individual’s hormone levels to premenopausal level, but rather treat menopause symptoms in a personalized manner.

It can reduce hot flashes by up to 75%. Experts recommend using the lowest effective dose for the shortest possible time.

However, HT may not be suitable for people with a history of breast cancer, stroke, blood clots, or liver disease. A healthcare professional can help you weigh the risks and benefits.

Non-Hormonal Medications

If hormone therapy isn’t safe or effective for you, a healthcare professional may recommend nonhormonal medications.

These are often used by people with a history of breast cancer, liver disease, or other health risks. Some common options include:

  • Gabapentin (Neurontin): Often used for nerve pain or seizures. It can help reduce nighttime hot flashes and improve sleep.
  • Clonidine (Catapres): A blood pressure drug that may offer mild relief for hot flashes.
  • SSRIs and SNRIs: Antidepressants like paroxetine (Brisdelle) and venlafaxine (Effexor XR) can reduce intensity and frequency by 20% to 65%.
  • Fezolinetant (Veozah): This is a newer nonhormonal option approved by the FDA in 2023. But due to a rare risk of liver injury it requires regular liver tests.

Lifestyle Approaches

Lifestyle habits for managing postmenopausal hot flashes include:

  • dressing in layers and using fans to stay cool
  • maintaining a moderate weight
  • stopping smoking
  • avoiding common triggers like spicy foods, alcohol, and caffeine
  • using guided breathing
  • staying active with regular exercise
  • avoiding highly refined foods or foods high in sugars

Complementary and Alternative Treatments

Many people find relief with non-medication options, including:

  • Cognitive behavioral therapy (CBT): Can reduce the distress caused by hot flashes and improve coping skills.
  • Clinical hypnosis: A recent study review found that clinical hypnosis may reduce hot flashes by 50%.
  • Soy isoflavones and plant-based diets: Provide modest benefits, especially in people who metabolize them well.
  • Black cohosh: Some studies suggest relief, but results are inconsistent. There are risks associated with taking this supplement. It’s hepatotoxic, which means it may harm your liver.
  • Acupuncture: Mixed evidence, some report improvement, others notice no change.

If symptoms feel overwhelming, support groups, mindfulness practices like yoga, or counseling may help ease the emotional weight.

Always talk with a healthcare professional before trying herbal remedies or supplements to ensure your safety.

You should also talk with a healthcare professional if:

  • your hot flashes become more frequent, intense, or last longer than usual
  • you notice new symptoms after years without hot flashes
  • you experience night sweats that disturb your sleep
  • you have other symptoms like chest pain, palpitations, dizziness, or unusual fatigue during episodes

Tracking your symptoms in a notes app or on a printable log can also help your doctor see patterns. Try noting the time, how long it lasted, and what might have triggered it.

Here are a few questions you can bring with you during your appointment:

  • Are my symptoms typical, or should I be concerned?
  • What treatment options are safe for me?
  • Should I get tested for other conditions?
  • Are there any lifestyle changes I can try first?
  • How can I track my symptoms more effectively?

Yes, you can still have night sweats after menopause. They’re hot flashes that happen during sleep.

Night sweats can wake you up drenched in sweat and affect your sleep quality, mood, and concentration the next day.

You can manage night sweats by:

  • keeping your bedroom cool
  • using moisture-wicking bedding
  • wearing lightweight, breathable sleepwear

No, the cause is similar, changes in estrogen and brain temperature regulation. But the frequency and severity may differ. Some people notice milder symptoms, while others have more intense episodes.

Yes, hot flashes after menopause can sometimes indicate other health concerns. If they begin suddenly after years without symptoms or worsen over time, talk with a healthcare professional to rule out other causes.

Hot flashes after menopause are common and manageable. Treatments may include hormone therapy, medications, or lifestyle changes, but each person responds differently.

So what works for you may not work for another person. It’s important to seek treatment because untreated hot flashes can affect your sleep, mood, and overall quality of life.

If symptoms are affecting your quality of life, talk with a healthcare professional about what options may work best for you.