Managing your symptoms

Managing hot flushes and night sweats

About 80% of women experience hot flushes (also called hot flashes) and night sweats during menopause.

There are lots of ways to deal with hot flushes.

Menopausal hormone therapy (MHT) and non-hormonal medication

MHT is the most effective way to manage hot flushes and night sweats. If you can’t use MHT, or don’t want to, there are non-hormonal medications that can help with these symptoms. Read more about these management options.

Avoid triggers

Try to avoid things that trigger your hot flushes or make them worse.

For example:

• spicy food
• hot drinks
• alcohol
• caffeine
• smoking.

Reduce stress

For some women, stressful situations can make hot flushes worse. Reducing stress and using mind-body techniques can help.

Cognitive behavioural therapy (CBT) has been shown to be effective in managing hot flushes and night sweats. While CBT doesn’t usually reduce the frequency of hot flushes, it can reduce their impact.

There is some evidence that breathing and relaxation techniques can help you manage the impact of hot flushes.

Yoga has also been shown to be a safe and effective way to reduce menopausal symptoms, including hot flushes.

Keep cool

It can be hard to manage hot flushes in different environments, particularly during warmer weather.

During the day, try to:

• wear layered clothing so you can take some clothes off if you get hot
• wear lightweight, looser-fitting clothes made of natural fibres
• carry a hand fan or water spray bottle to cool down if needed
• control the air temperature at home through air-conditioning or fans
• drink cold drinks.

At night, try to:

• wear breathable, light pyjamas
• use cotton sheets on your bed
• use separate bed covers if you sleep with a partner
• sleep with the window open
• use a fan in your bedroom or adjust your air-conditioning to a cooler temperature
• use a cold pack under your pillow or place one in your bed before going to sleep.

Maintain a healthy weight

Maintaining a healthy weight may help to improve menopausal symptoms. There is some evidence that weight gain can increase the severity of hot flushes and night sweats. More severe symptoms are associated with being overweight.

Managing sleep disturbance

It’s common to experience sleep disturbance during menopause. Around 25% of women aged 50–64 years have sleep problems. Menopausal symptoms, sleep habits and other lifestyle factors can make it hard to get a good night’s sleep.

There are many ways to improve your sleep.

Keep cool

Hot flushes during the night (known as night sweats) can interrupt your sleep or make it hard to sleep well.

You can try:

• wearing lightweight, cotton pyjamas (or sleeping naked) to help you stay cool
• using bed linen made from natural fibres like cotton, bamboo or linen
• using layers of blankets instead of a heavy doona
• keeping your bedroom cool by using air-conditioning or a fan
• using an ice pack in your bed (as you would a hot water bottle in winter)
• keeping a change of clothes and a glass of cool water nearby, in case you wake with a night sweat.

Improve sleep habits

Healthy sleep habits can improve your sleep.

You can:

• go to bed and wake up at the same time each day – this helps to regulate your circadian rhythm
• avoid napping during the day
• do relaxing things before bed, such as reading, listening to music, yoga or meditation
• reduce screen and electronic device usage before bedtime – studies have shown that ‘blue light’ can reduce or delay the production of melatonin at night
• ensure your bed and pillow are comfortable and supportive
• ensure your room is quiet and dark.

Lifestyle factors

Healthy lifestyle choices can have a positive impact on your sleep.

You can:

• avoid nicotine, caffeine and alcohol in the late afternoon and early evening – these can disrupt sleep and reduce sleep quality
• expose yourself to sunlight during the day, as this helps produce melatonin (a hormone that helps regulate sleep)
• exercise most days, although not too close to bedtime
• avoid eating heavy, acidic or spicy foods at night, as these may lead to digestion problems or trigger hot flushes
• avoid drinking lots of fluids before bed
• wee before you go to bed.

If you do wake up during the night, try not to look at your phone or watch TV, as this can make it harder to get back to sleep.

Therapies and supplements

Menopausal hormone therapy (MHT)

Menopausal hormone therapy (MHT) can help ease hot flushes, which can improve sleep quality.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) can help you manage hot flushes and night sweats by reducing the impact they have on you. CBT is also effective in treating sleep problems such as insomnia.

Melatonin supplements

You might benefit from taking melatonin before bed. Melatonin might interact with other prescription or over-the-counter medicines, so talk to your doctor if you’re not sure.

In this podcast Jean Hailes endocrinologist Dr Sonia Davison talks about menopause and sleep on this Sleep Talk podcast.

Managing mood and emotional health

During the transition to menopause, hormonal changes can cause your mood and emotions to fluctuate. It’s common to feel low during this time. You might also feel irritable, frustrated or anxious.

Anxiety and depression

Hormonal changes around the time of menopause can lead to anxiety and depression, but other factors may also cause these feelings.

If you experienced anxiety before reaching menopause, some symptoms could make your anxiety worse. For example, hot flushes could lead to an anxiety attack.

Also, symptoms such as night sweats can affect your mood and make you feel exhausted, grumpy or depressed.

At this stage of life, you may experience depression for different reasons. For example, if you are having relationship problems or feeling more stress than normal.

You might also reflect on negative past experiences during this time, leading to feelings of depression.

If you are experiencing strong emotions, anxiety or depression, see your doctor.

Learn more about anxiety.

What you can do

There are lots of things you can do to look after your emotional health.

Work through your emotions

If you are feeling strong emotions, ask yourself:

• What is making me feel this way?
• What is the real feeling?
• Am I masking something I feel uncomfortable expressing?

If you feel stressed, try to identify and challenge your thoughts or inner voice.

It can be helpful to:

• identify what makes you feel stressed
• rate the situation out of 10, with 1 being least stressful and 10 being most stressful
• say positive affirmations, such as “I can do this”
• remember it’s OK to accept the way you are feeling – you’re not bad, silly or crazy for having those feelings.

Practical ideas

You can take some practical steps to manage your mood, emotions or stress during menopause.

For example:

• talk about your feelings with someone you trust (e.g. doctor, psychologist, friend or partner)
• keep a diary to identify and understand your symptoms
• do things you love doing (e.g. yoga, walking with a friend, gardening or writing)
• get quality rest if you can
• do regular exercise to improve your mood and physical health
• learn and practise relaxation techniques.

Self-management techniques

There are many techniques to help you deal with poor mood, depression, anxiety and stress.

Cognitive behavioural therapy (CBT)

CBT involves recognising the unhelpful thoughts that influence depression and anxiety, and replacing them with more helpful thoughts. It also uses relaxation and breathing techniques to reduce the impact of the physical symptoms of anxiety. Recent research suggests that CBT can be effective in managing hot flushes.

Mindfulness

Mindfulness training teaches you to focus on the present moment and not get so caught up in your thinking. It’s also important to reduce stressors, as these can set off anxiety and depression. Mindfulness is a clinically proven technique that can be learned and used in your daily life to help manage anxiety and improve your wellbeing.

Relaxation

Relaxation is a skill that needs to be learned. There are different techniques that can help you to relax but it may take time to learn which ones suit you best.

Learn more about different relaxation techniques.

Look after your health

There is no doubt that fluctuating hormones can lead to changing mood and emotions, but mood can also be affected by your lifestyle.

Learn more about ways to look after yourself.

Other therapies

You can talk to your doctor about different therapies that might work for you.

Sometimes it may be helpful to use a combination of therapies. These may include medication, MHT, CBT or ‘talk therapy’ with a registered psychologist or psychiatrist.

More information about managing mood and emotional health

If you are concerned about your mood and emotional health, visit Beyond Blue.

To find a qualified psychologist, you can ask your doctor, or visit the Australian Psychological Society website.

To find a registered psychiatrist, you can ask your doctor, or visit the Royal Australian & New Zealand College of Psychiatrists website.

Managing bladder, vaginal and vulval problems

Vaginal atrophy, dry vagina and pain during sex

If you have vaginal dryness, talk to your doctor about different treatment options. Depending on your situation, they may recommend:

• vaginal lubricants or oils
• vaginal moisturisers
• vaginal oestrogen in the form of a cream, pessary or tablet
• menopausal hormonal therapy (MHT).

When you treat the physical symptoms, it may help to reduce any anxiety or fear you associate with sex.

If you still feel anxious, you can:

• practise relaxation exercises
• see a pelvic floor physiotherapist to learn pelvic floor relaxation, as these muscles often become tight, which increases sexual pain
• talk to a psychologist or sex therapist who specialises in women’s sexual problems.

Read more information about vaginal atrophy.

Vaginal irritation

If you experience vaginal irritation (e.g. burning or itching), your doctor might suggest non-hormonal therapies, for example:

• a cool compress to reduce itching and discomfort
• vaginal moisturisers to add more moisture to cells in your vagina and ease symptoms
• water or silicone-based vaginal lubricants to reduce pain during sex.

Your doctor may also suggest hormonal therapies such as:

• vaginal oestrogens in the form of tablets, pessaries or creams
• menopausal hormone therapy (MHT).

You can try other practical ideas, for example:

• avoid using soap, perfumed products (including talcum powder and perfumed toilet paper) or douches on your vulva
• wear cotton underwear
• avoid tightly fitted clothes such as G-strings, pantyhose and tight jeans
• change out of bathers or Lycra gym pants straight away
• wipe from front to back after going to the toilet to avoid the spread of germs
• wash your underwear using unscented or hypoallergenic products and rinse well.

Urinary symptoms

If you notice changes, such as the need to wee more often than usual, you can talk to your doctor about different treatment options. They may refer you to a continence specialist or a trained physiotherapist who can help you strengthen your pelvic floor muscles.

Managing aches and pains

Some women notice joint pain and other musculoskeletal symptoms at menopause.

There are lots of ways to ease your aches and pains.

Maintain a healthy weight

Try to maintain a healthy weight, as being overweight can put added stress on your joints (especially your knees and hips), causing pain and discomfort.

Eat a healthy diet

Eating a healthy diet will help you maintain a healthy weight. Focus on fresh fruit and vegetables, wholegrains, nuts and seeds, lean protein and low-fat dairy products. Healthy fats can also help with joint pain. Eating foods that are rich in omega-3 fatty acids (found in oily fish) can reduce inflammation and lead to reduced joint pain and stiffness of joints.

Exercise regularly

You can protect your joints by moving your body regularly. Research shows that regular exercise leads to healthier joints and bones. Women who consistently exercise also have lower incidence of joint symptoms compared with those who are inconsistent or don’t engage in exercise.

The current guidelines for physical activity recommend :

• women should be active on most (preferably all) days of the week and avoid sitting for long periods of time
• women aged 18–64 years should do 2.5–5 hours of moderate activity per week and strength train 2 days per week
• women aged 65 years and over should do at least 30 minutes of moderate activity on most (preferably all) days of the week and do a range of different activities.

You can reduce the chance of injury and further pain by:

• stretching gently before exercising
• engaging in low impact activities such as swimming, walking, cycling or yoga
• avoiding high-impact activities that can be hard on your joints, such as running and jumping.

Drink plenty of water

Dehydration can make joint pain worse, so aim to drink lots of water throughout the day.

Use hot and cold packs

Using hot and cold packs on sore and aching joints can bring some relief.

Pain relief medication

Over-the-counter pain relief, such as paracetamol or non-steroidal anti-inflammatories, can help relieve pain. You can also try topical treatments that can be rubbed into the skin over your affected joint.

Dietary supplements

Calcium, vitamin D and magnesium are all important for skeletal health, but evidence does not suggest they will reduce joint pain.

Menopausal hormone therapy (MHT)

MHT may help reduce aches and pains. A large-scale study showed that women who took MHT had a lower prevalence of knee osteoarthritis than women who didn’t take it.

Talk to your doctor

If you have joint pain that is new or getting worse, talk to your doctor. Menopause could play a role, but other conditions such as stiff joints (arthralgia) and arthritis can also happen at this stage of life.

Download our fact sheets or visit resources for more information, including translated fact sheets.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August 2022.