Hot Flushes and Night Sweats: Why They Happen And What Actually Works
It's the symptom everyone associates with menopause and the one Malaysian women are most likely to explain away.
A sudden wave of heat through the chest, neck and face. Skin that flushes. Sweat that arrives from nowhere and leaves you chilled and damp a few minutes later. At night, waking up soaked, changing your clothes, and lying awake afterwards.
Doctors call these vasomotor symptoms. Most women call them hot flushes and night sweats. They are the most common reason women seek help in midlife, and they are the symptom that hormone therapy is most reliably prescribed for.
But in Malaysia, they are also easy to dismiss. It is warm here all year. Sweating is normal. So a great many women live with vasomotor symptoms for years without ever naming them (and without knowing they are treatable).
What is actually happening in your body?
Your brain has a narrow internal temperature range it tries to keep you within. When you drift above it, you sweat and your blood vessels widen to shed heat. When you drift below it, you shiver.
As estrogen declines, that comfortable range appears to narrow considerably. A change in body temperature so small you would not normally notice it is now enough to trigger the full cooling response: flushing, sweating, then the chill afterwards as your body overcorrects.
Why yours may not look like the ones you've seen on TV
Most public descriptions of menopause come from Western media. The research tells a more varied story, and it matters for Malaysian women.
In the Study of Women's Health Across the Nation (SWAN), the large multi-ethnic study that shaped much of what we know about symptom patterns, reporting rates were consistently highest among African-American women and lowest among Asian women across most stages of the transition, with roughly half of the Japanese-American women reporting vasomotor symptoms compared with around 80% of African-American women.
Malaysian studies find something similar. Among midlife women in Kelantan, night sweats were reported by 53% and hot flushes by 44.8%, but tiredness (79.1%), reduced concentration (77.5%) and musculoskeletal aches (70.6%) were all more common. A study of 356 women in Kuching using the Menopause Rating Scale found hot flushes and sweating in 41.6%, again behind joint and muscular discomfort (80.1%) and physical and mental exhaustion (67.1%).
The Kuching researchers concluded that classic vasomotor symptoms were less prevalent in their group than in studies of Caucasian women.
So if your dominant experience of perimenopause has been exhaustion, aching joints and a foggy head rather than dramatic hot flushes, you are not unusual, you are typical for this region. However, that does not mean your flushes, when they come, are trivial or untreatable.
If exhaustion and mental fog are your main symptoms, you may find Menopause Brain Fog: Why It Happens And How to Think Clearly Again more relevant to what you're going through.
How long does this go on for?
Longer than most women are told.
SWAN followed women for up to 17 years. Among those with frequent vasomotor symptoms, the median total duration was 7.4 years, and symptoms persisted a median of 4.5 years after the final menstrual period.
The single biggest predictor was when symptoms started. Women whose flushes began while they were still menstruating or in early perimenopause had the longest course, with a median exceeding 11.8 years. Women whose symptoms only began after their final period had the shortest, at 3.4 years.
This is worth knowing because "just wait, it will pass" is common advice, and for a woman who started flushing at 44 it may mean waiting out most of her fifties.
What actually works
Here is where the guidelines are unusually consistent. Hormone therapy
Organisation / Country | Position on vasomotor symptoms |
Clinical Practice Guidelines: Management of Menopause in Malaysia 2022 | Hormone therapy is approved for women with vasomotor symptoms, for prevention of bone loss and reduction of fractures, and for genitourinary syndrome of menopause. |
NICE (UK) Menopause: identification and management (NG23) | Offer hormone therapy to people with vasomotor symptoms associated with menopause. |
The Menopause Society (US), 2023 non-hormone position statement | Concluded that hormone therapy remains the most effective treatment for vasomotor symptoms, and should be considered in women within 10 years of their final menstrual period. |
The Korean Society of Menopause, 2020 guidelines | Treatment should be guided by symptom frequency and severity; severe vasomotor symptoms warrant discussion even if periods are continuing. |
Night sweats are a sleep problem too
If your flushes are mainly nocturnal, the damage often isn't the sweating. It's the fragmented sleep behind it, and everything that follows: the irritability, the short fuse, the sense that your memory has gone.
Treating the vasomotor symptoms often improves the sleep. But sleep in perimenopause has several moving parts, and we've unpacked them separately in Can't Sleep During Perimenopause? Why It Happens And What Helps. When to speak to someone
Consider booking a consultation if:
Flushes or night sweats are interrupting your sleep more than occasionally
You are avoiding meetings, presentations, social events or travel because of them
You are managing them at work and it is affecting your performance or confidence, something we've looked at in Understanding Menopause in Malaysia's Workforce
You simply want to know what your options are before deciding anything
Disclaimer: This article is for general educational purposes only and does not replace professional medical advice. It is not intended to promote any specific medicine or product. Treatment decisions should be made in consultation with a licensed healthcare professional. Next Steps
Not sure whether what you're feeling is perimenopause? Take our 3-minute symptom quiz
Ready to talk to someone? See Hormone Health or read Your First Consultation: What to Expect
References
Obstetrical & Gynaecological Society of Malaysia; Malaysian Menopause Society. Clinical Practice Guidelines: Management of Menopause in Malaysia. Kuala Lumpur: OGSM & MMS; 2022.
National Institute for Health and Care Excellence (NICE). Menopause: Identification and Management (NG23). London: NICE; 2015, updated 2024.
The North American Menopause Society (The Menopause Society). The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
Avis NE, Crawford SL, Greendale G, et al.; Study of Women's Health Across the Nation (SWAN). Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015;175(4):531-539.
Gold EB, Colvin A, Avis N, et al. Longitudinal Analysis of the Association Between Vasomotor Symptoms and Race/Ethnicity Across the Menopausal Transition: Study of Women's Health Across the Nation. Am J Public Health. 2006;96(7):1226-1235.
Dhillon HK, Singh HJ, Shuib R, Hamid AM, Nik Mahmood NM. Prevalence of Menopausal Symptoms in Women in Kelantan, Malaysia. Maturitas. 2006;54(3):213-221.
Syed Abdul Rahman SA, Zainudin SR, Mun VLK. Assessment of Menopausal Symptoms Using Modified Menopause Rating Scale (MRS) Among Middle Age Women in Kuching, Sarawak, Malaysia. Asia Pac Fam Med. 2010;9(1):5.
Academic Committee of the Korean Society of Menopause. The 2020 Menopausal Hormone Therapy Guidelines. J Menopausal Med. 2020;26(2):69-98.
Comments