If you’re in menopause or perimenopause, you’re probably no stranger to a hot flush, or the more extreme form of of night sweats.

They send a rush of heat through your upper body and, if they’re especially strong, can cause red blotches on your skin, a racing heart, and sudden, drenching sweats.

And for many women, hot flushes are accompanied — perhaps even caused — by anxiety.

What exactly is a hot flush?

It is a sudden feeling of intense heat that isn’t caused by something external such as being near a stove or fire or out in the sun.

Unfortunately nobody is exactly sure why a hot flush starts, but like so much else, it is hormonal.

It may be that changing hormone levels disrupt your body’s ability to warm up or cool down. As a result, the blood vessels near your skin open up and your skin temperature suddenly rises (though your core temperature doesn’t).

After the flush, sweat evaporates from your skin, delivering a welcome cooling sensation. The swift change can literally leave you feeling dizzy.

Does a hot flush cause anxiety or is it the other way round?

The relationship between anxiety and hot flushes may be a chicken and egg situation.

In one older study researchers followed 436 premenopausal women for 6 years and found that anxiety was not only a symptom, but that those with anxiety were 3 to 5 times more likely to have hot flushes.

When researchers returned to that same cohort in 2016 to analyze their symptoms at the 14-year mark, they were able to confirm the strong relationship between anxiety and hot flashes.

In the 2016 study researchers distinguished between affective anxiety (emotional worry) and somatic anxiety (anxiety with physical symptoms such as stomach upset, headache, fast heart rate, and dizziness).

People whose anxiety was emotional didn’t have a greater risk of hot flushes, but having physical anxiety symptoms was a strong indication that hot flushes would happen throughout menopause.

What else could be causing or contributing to your hot flushes?

A number of other conditions and behaviours can increase the likelihood that you’ll experience at least some, and these are some of the most common:

• Alcohol, caffeine, and spicy foods are common hot flash triggers.
• Some prescription medications may cause or worsen hot flashes, including those used in chemotherapy.
• Cigarette smoking is associated with midlife hot flashes.
• Radiation therapy for cancer treatment may also cause hot flashes and night sweats.

How can you decrease anxiety during menopause?

Menopause is often described as a roller coaster ride. Your anxiety levels can peak and plunge as your body’s hormone production fluctuates.

While you may not be able to do much about the up-and-down hormones, you can certainly take advantage of proven anxiety-reducing strategies.

Here are some options to consider:

1. Rest is key particularly when flushes become night sweats, and anxious thoughts lead to insomnia, sleep may be delayed or interrupted.

The relationship between sleep disturbance, anxiety, and menopause is well-researched

2. Exercise helps and although there’s no such thing as avoiding menopause. However, a growing body of evidence does suggest that physical movement both prevents and treats anxiety.

Both cardio (aerobic exercise) and strength training are recommended during menopause — not only because they reduce anxiety, but because they can keep you from losing bone strength and gaining extra weight as your body changes.

3. Talk about it with someone you trust because menopause can raise a number of thorny issues — changes to your body image, sex life, and identity; dealing with the shift in fertility; and reacting to the societal expectations around menopause.

You may find it helpful to talk about your symptoms and any other menopause-related issues with an online or in-person therapist. Cognitive behavioral therapy has been found to be especially effective for treating anxiety.

If one-on-one therapy doesn’t appeal to you, you might see whether there’s a support group devoted to menopause or anxiety issues nearby.

4. Take good care of yourself — mind and body and in particular pay attention to your diet. Eat rainbows of healthy vegetables and muscle-building protein — which are vital as you get older.

Take time and space to create things. Numerous studies have shown that art, music, drama, and dance help people prevent and manage stress.

And consider taking a mindfulness course. In a 2012 study involving 110 women in menopause, those who learned to notice the sensations in each part of their bodies, to meditate, and to perform gentle stretching exercises were bothered less by hot flushes than those who did not.

How can you manage them?

If they are barely noticeable, you may decide to accept them as unpleasant but natural.

If, on the other hand, they are keeping you up at night, causing you severe anxiety, or otherwise interfering with your work or home life, there are a range of treatment options for you to consider.

Hormone balance is key and your doctor is likely to recommend HRT which gives you oestrogen and synthetic progestins and should not be prescribed long-term to avoid causing other health problems.

It’s important to understand that it can have risks. Women who take HRT during or after menopause may have a higher risk of certain kinds of cancer, cardiovascular disease, stroke, and dementia.

Women who prefer a more natural approach can choose a bioidentical approach, either with bioidentical progesterone or a combination of bioidentical progesterone and naturally sourced oestrogen.

Medications such asas HRT has become less popular because of the associated risks, or experience of side effects, we are seeing doctors prescribing other medications such as these:

• antidepressants (paroxetine and others)
• antiseizure medications (gabapentin and pregabalin)
• blood pressure medications (clonidine)
• antispasmodics used for bladder control (oxybutynin)

Exercise researchers in one study tracked hot flushes among menopausal women participating in a 16-week cardio fitness regimen, they found that those who exercised experienced fewer hot flushes as a result.

This may be because the brisk exercise improved circulation and boosted the body’s ability to regulate its temperature.

Zumba is your friend, or several brisk laps in the pool, if cool water sounds better but anything you enjoy and will maintain is what you are aiming for.

Natural remedies

Although solid research on the effectiveness of natural remedies for menopause symptoms is limited, there’s some evidence that black cohosh and evening primrose oil may help reduce the severity of hot flushes.

Some researchers have found acupuncture is an effective treatment, but the evidence is conflicting on whether or not it helps.

Before you try any natural remedy, it’s a good idea to talk with a doctor or healthcare provider to see if it will have an interaction with any other medication you’re taking as herbs and certain alternative remedies are powerful substances.

Practical considerations

Managing hot flushes may be a little easier if you change some of the habits that seem to strengthen or trigger them.

You may want to try:

• limiting foods and drinks that trigger them- spices and caffeine for instance, it will be very individual how you respond
• choosing clothes made of cotton and wearing layers you can remove when sweating starts
• using cotton sheets on your bed
• having a fan in your bedroom at night
• eliminating cigarette smoking