Even after menopause, hot flashes can persist. Here’s why — and what may bring relief.
If you’ve ever broken into a sweat with no advance warning, you may have experienced one of the most common symptoms of menopause. The Menopause Society reports that hot flashes affect as many as 80% of women during the menopause transition.
“Many doctors will tell you that it’s normal to go through this, and you’ll get through it. So many women are still being told it’s a normal, natural process,” said Dr. William F. Lee, an obstetrician-gynecologist with Vanderbilt Center for Women’s Health. “And it is, but that doesn’t mean that you can’t do something about it.”
What are hot flashes?
Hot flashes are what experts call vasomotor symptoms, when you feel a sudden flare of heat in your face and upper body. You might even break a sweat. This flash can last anywhere from a few seconds to a few minutes. In some cases, the hot flash can be followed by the chills. Hot flashes aren’t just a daytime phenomenon, either. You can also experience them at night, waking you up in a puddle of perspiration (night sweats).
Hot flashes and night sweats often begin during perimenopause, the time leading up to menopause. But they don’t necessarily stop once menopause begins. These symptoms can last anywhere from four to 10 years, and many women continue to experience them after reaching menopause, which is defined as 12 consecutive months without a menstrual period.
Why some women experience hot flashes after menopause
As a woman enters menopause, estrogen levels drop sharply. That decline affects the hypothalamus, the part of the brain that helps regulate body temperature. As a result, temperature regulation can become disrupted, triggering hot flashes.
For some women, these symptoms continue for years after menopause, although they often become less frequent over time.
Why you might try menopause hormone therapy
Many women choose hormone therapy to relieve menopause symptoms.
Lee noted that hormone therapy is the most effective treatment for menopause symptoms, including vasomotor symptoms.
“And we know that it has long-term health benefits for you if you start it around menopause and you remain on it for several years,” he said.
In late 2025, the Food and Drug Administration removed the black box warning on menopause hormone therapy after reevaluating evidence related to the risks and benefits of treatment.
Nonhormonal treatments for hot flashes
Your physician may recommend avoiding hormone therapy if you have certain health conditions, such as an active breast cancer diagnosis, Lee noted. Some women may also prefer not to take hormones.
“Fortunately, we now have not one but two nonhormonal medications for the treatment of vasomotor symptoms that [women] can use.”
“Fortunately, we now have not one but two nonhormonal medications for the treatment of vasomotor symptoms that they can use,” he said. “So there are options.”
One option is fezolinetant (Veozah), a once-daily pill for moderate to severe hot flashes. Another is elinzanetant (Lynkuet), a two-pill regimen taken at the same time each day. Both medications are FDA-approved to treat vasomotor symptoms.
These medications work on pathways in the brain involved in regulating body temperature, which can be disrupted by the drop in estrogen that occurs during menopause.
“These medications can really help with hot flashes,” Lee said. “But unlike hormone therapy, they won’t help with vaginal dryness or reduce your risk of osteoporosis.”
Lee said some patients may also benefit from other medications, including certain antidepressants, gabapentin (an antiseizure medication), or clonidine (a blood pressure medication). However, he noted that hormone therapy is generally the most effective treatment option for women who can safely take it.
Need help?
Vanderbilt Women’s Health provides care for women at all stages of their lives at locations across Middle Tennessee. Learn more here or call 615-343-5700.
