Hot Flushes in Perimenopause: Causes, Symptoms and Natural Relief
Menopause is defined as the point in a woman’s life when she has not had a menstrual period for 12 consecutive months. Although this marks the official transition, the body’s changes begin well before this stage. In the years leading up to menopause, cycles often become irregular, with missed periods becoming more common until menstruation eventually stops altogether.
Perimenopause refers to this transition phase before menopause. During this time, the body begins to shift hormonally, primarily due to fluctuating levels of oestrogen and progesterone. These changes can lead to a range of perimenopause symptoms including hot flushes, night sweats, disrupted sleep, anxiety, mood changes, joint pain, and reduced libido. Hot flushes in perimenopause are one of the most common symptoms women experience during the transition towards menopause.
Perimenopause most commonly begins between the ages of 40 and 50, but this is not fixed. Factors such as heavy metal exposure, poor diet, smoking, chemotherapy, and other physiological stressors may contribute to earlier onset, sometimes even in your 30s.
One of the most common and disruptive symptoms is hot flushes in perimenopause. It is estimated that up to 85% of women experience hot flushes during this time. For some, they may last 4–10 years, and in more persistent cases, continue for up to 20 years after menopause.
A hot flush is a sudden sensation of heat, often accompanied by sweating, flushing, anxiety, and sometimes chills. They typically last 1–5 minutes. Although hot flushes are common, they are often dismissed as something women should just put up with. In reality, they can have a significant impact on quality of life- disrupting sleep, work, and overall wellbeing. Sleep disruption in particular can create a cycle where poor rest worsens hormonal regulation and intensifies symptoms further. The good news is that there are natural ways to help with perimenopause. With targeted herbal medicine and dietary and lifestyle support, both the intensity and frequency of hot flushes can often be reduced.
From a physiological perspective, fluctuating oestrogen levels can disrupt the body’s temperature regulation centre in the brain. This can create a false signal that the body is overheating, triggering a cooling response such as increased blood flow to the skin and sweating.
There are several herbs that can be helpful in supporting hot flushes in perimenopause.
Zizyphus
Zizyphus is a valuable herb in the management of menopausal symptoms, particularly when anxiety is present alongside night sweats and palpitations. It is especially useful in what can be described as a “vasomotor storm,” where hot flushes, emotional unrest, and disrupted sleep occur together. Clinically, it is often used for clients experiencing frequent daytime flushes and severe night sweating. Many report a clear return of symptoms if doses are missed, often within a few days.
Hops
Hops acts as a phytoestrogen, meaning it can mimic some of the effects of oestrogen in the body. This can be supportive during perimenopause when natural oestrogen levels begin to decline. It may also help regulate luteinizing hormone, which can become elevated as oestrogen drops and has been associated with bone loss. Research suggests hops may reduce both the frequency and severity of hot flushes in perimenopause, while also supporting sleep, anxiety, and symptoms such as vaginal dryness.
Black Cohosh
Black cohosh has a long history of use in women’s health. It is commonly used for hot flushes, night sweats, sleep disturbance, anxiety, and low mood. Importantly, it does not contain oestrogen, making it a suitable option for women who cannot use hormone replacement therapy, including those with a history of hormone-sensitive cancers such as breast, uterine, or ovarian cancer. It may also offer additional support for bone health and menstrual-related migraines. It is particularly useful where vasomotor symptoms are combined with mood changes.
Sage
Sage is a well-established herb for reducing excessive sweating, including hot flushes and night sweats. It is thought to work through mild oestrogen-like activity, helping to stabilise hormonal fluctuations that drive these symptoms. Beyond this, sage is also valued for supporting cognitive function, particularly memory and mental clarity, which many women report as reduced during perimenopause. It may also help reduce high cholesterol levels, another symptom of perimenopause.
To Recap:
What causes hot flushes in perimenopause?
Hot flushes are thought to occur due to fluctuating oestrogen levels, which can affect the body’s temperature regulation system.
How long do perimenopause hot flushes last?
For many women, hot flushes may last several years during the menopausal transition, although the duration varies significantly between individuals.
What herbs may help with hot flushes?
Herbs commonly used in naturopathic practice include sage, black cohosh, hops and zizyphus. These should be used depending on individual symptoms and health history, a consult with your naturopath is the best place to start.
Can naturopathy help with perimenopause symptoms?
Naturopathy may support women experiencing hot flushes, sleep disturbance, anxiety and other symptoms through personalised nutrition, herbal medicine and lifestyle guidance.
While the herbs discussed above can help decrease hot flushes in perimenopause, naturopathy emphasises personalised treatment. What works perfectly for one woman may not be ideal for another. For instance, while Zizyphus excels for the client with severe night sweats, Black Cohosh might be more appropriate for the woman experiencing menstrual migraines and increased anxiety during perimenopause.
The beauty of naturopathic medicine lies in its recognition that everyone experiences perimenopause differently and therefore deserves individualised treatment rather than a one-size-fits-all approach. I would love to work with you if you are experiencing hot flushes or any early signs of perimenopause or menopause. You can find out about my services and pricing here.