This Is the No. 1 Menopause Symptom — But No One Talks About These 11 Facts

The most common symptom of perimenopause and menopause? Hot flashes. 87% of people going through menopause experience hot flashes daily. Yes, daily. You read that right.

But despite how widespread they are, hot flashes are still widely misunderstood. (Much like menopause itself, unfortunately.) Many people don’t realize how early they can start, what they actually feel like, or what they might signal about broader health issues.

Most people associate hot flashes with menopause in your late 40s or 50s, but they can begin much earlier. Perimenopause, the transitional window before menopause, can start as early as your mid to late 30s1. Symptoms during this time can be subtle and easily mistaken for something else: stress, burnout, or just a bad night's sleep.

The word “hot flash” barely captures the experience. Yes, there’s sudden warmth, but also facial flushing, intense sweating, heart palpitations, chills, and a rollercoaster of other sensations. Some women describe them as disorienting or even panic-inducing, with dizziness, tunnel vision, and a sense of dread.

“Flash” implies these are quick, but that’s not always the case.  

For the most part, they last a few minutes each (about 1 to 5 minutes). But serious episodes can last as long as an hour. And they’re not exactly rare, as we’ve discussed: Research shows that 87% of women going through menopause have hot flashes daily, with some reporting 10 or more per day.  

You may feel them in the body, but hot flashes originate in the brain—specifically the hypothalamus, which helps regulate body temperature. As estrogen levels drop during perimenopause and menopause, the hypothalamus becomes hypersensitive to even small changes in core body temperature.

“Estrogen is well-established as central to thermoregulation,” explains naturopathic doctor and menopause expert Trevor Cates, N.D. “It interacts directly with the hypothalamus. As estrogen declines, the hypothalamus becomes hypersensitive, narrowing what’s known as the body’s ‘thermoneutral zone.’ Even slight temperature fluctuations can now trigger exaggerated responses like flushing, sweating, increased heart rate, and overheating.”

Emerging research suggests a link between hot flashes and heart health. Some studies have found that women with more frequent or severe hot flashes may be at higher risk for cardiovascular issues later in life.

Experts believe that the same vascular reactivity that triggers a flash may reflect broader changes in blood vessel function. 

“Emerging research indicates that women who experience more frequent or severe hot flashes, particularly earlier in the menopausal transition, may have a higher risk of developing cardiovascular disease later in life3,” says board-certified OB/GYN Somi Javaid, M.D., medical advisor at the menopause skin care brand Stripes. 

She goes on to explain that “hot flashes are increasingly viewed as a window into vascular health.” 

For example, “studies have linked severe or early-onset hot flashes to 

Night sweats and disrupted sleep are some of the most commonly reported menopause symptoms5—and hot flashes are a major reason why. 

“Hot flashes are not limited to the daytime. Night sweats, hot flashes that occur during sleep, are extremely common and can significantly disrupt rest, contributing to fatigue, mood changes, and even cognitive symptoms,” says Javaid. 

On top of that, hormone changes during menopause can alter circadian rhythms, making quality rest even harder to come by.

Hot flashes also contribute to increased exercise intolerance6 during this life stage. Many women find themselves feeling more fatigued or less motivated to work out, and the sudden heat surges don’t help. 

Mentally, the unpredictability of flashes can affect mood, energy, and emotional resilience—especially if they’re tied to anxiety. Case in point: a phenomenon called “hot flash anxiety”, a form of chronic anxiety around when the next episode might hit. 

“‘Flash anxiety’ refers to the anticipatory worry or fear that many women experience about having a hot flash, especially in social or professional settings,” says Javaid. 

Roughly 73% of women experiencing hot flashes don’t treat them—often because they don’t realize that non-invasive, simple changes can help. 

“Managing hot flashes starts by effectively supporting the systems most impacted by perimenopause and menopause: hormone balance, nervous system regulation, metabolic health, and the gut-brain connection,” says Hanway. 

A few of our favorite tips from our team of experts:

Start a journal:

Logging when and how your hot flashes occur can help you pinpoint patterns—like time of day, food choices, stress levels, or cycle phase. These insights can guide smarter lifestyle tweaks that actually make a difference.

Avoid or reduce triggers:

Once you have a better idea of what’s setting off hot flashes, you can do your best to avoid them. Just don’t let it overrule your life. Remember: Not every trigger can (or should) be avoided completely. Some things, like weather or your favorite cocktail, are just part of life. 

Stabilize blood sugar:

“As estrogen levels decline it becomes harder to regulate our blood sugar, increasing insulin resistance and making blood sugar spikes and crashes more common,” explains Hanway, noting that this directly leads to hot flashes. “Building meals around protein, fiber and healthy fats can help maintain steady blood sugar and reduce vasomotor symptoms.” 

Eat phytoestrogens and cruciferous vegetables:

Cates says to look for foods that help manage the changes in hormones. For example, “phytoestrogens—found in foods like flaxseeds, organic tofu, and fermented soy—can support our estrogen naturally,” she says. “Cruciferous vegetables—such as broccoli, cauliflower, kale—support liver detoxification, helping the body metabolize estrogen efficiently.”

Strength training:

As a fierce advocate for resistance training, Hanway shares it can be particularly helpful for those in menopause. “During the menopause transition levels of lean muscle mass can decline. Muscle mass is a key driver of metabolic and hormonal health,” she says. “Strength training 2-3 times a week can help improve glucose disposal, blood sugar balance and reduce inflammation, all of which can lower the prevalence of hot flashes.”

Stress management:

As we’ve discussed, mood and mental health are often a trigger. Our experts encourage finding a mindfulness practice that works for you. Try: Breathwork, journaling, meditating, nature walks, yoga, guided visualizations, or any self-care habit that grounds you. 

Try Cognitive Behavioral Therapy (CBT):

In addition to daily mindfulness techniques, seeking professional help for your mental health can help improve the physical symptoms of menopause. “CBT has been shown in randomized trials to reduce both the frequency of hot flashes and the distress they cause,” says Javaid. 

Improve sleep hygiene:

Hot flashes disrupt sleep, and being low on sleep triggers hot flashes. It’s a vicious cycle. “Create a cool, dark sleep environment, and consider cooling pillows or breathable clothing and bedding,” says Cates. “Adopt a bedtime routine that includes relaxing activities such a bath, listening to soothing music or cuddling with your partner.” Made with naturally breathable and temperature regulating bamboo, Cozy Earth's Bamboo Sheets can keep you comfortable all night long.

Use gentle skin care:

Hot flashes can cause flushing, so address the visible symptoms by swapping in the right skin care. “Use fragrance-free, soothing skincare products to reduce irritation for sensitive, flushed skin,” says Javaid. Stripes The Cool Factor and The Power Move are great places to start. 

Change up your wardrobe:

Hormone Replacement Therapy (HRT) can be a game-changer for many, but outdated fears still keep people from considering it. Modern HRT options, notably bioidentical hormones, are often safe and effective when tailored to your needs.

They can help with the full scope of menopause symptoms, including hot flashes, notes Cates. 

Not everyone experiences hot flashes the same way. Research shows that Black and Latina women often report more intense and longer-lasting symptoms. Weight, metabolic health7, and even environmental factors like air pollution may also play a role in how severe or frequent symptoms become.

“There are cultures and societies around the world where women do not fear menopause, and that correlates with fewer symptoms,” says neuroscientist Lisa Mosconi, Ph.D, author of The Menopause Brain. 

In Japan, she explains in this episode of the mindbodygreen podcast, the word for menopause—konenki—translates to “renewed energy,” and the transition is seen as a positive life milestone. Perhaps not so coincidentally, research has found that Japanese women report fewer menopause struggles8 than women in the U.S. 

In addition, in some parts of India, postmenopausal women gain new social status and respect. "They have more freedom, they're looked up to, and they don't have symptoms of menopause9 other than a change in eyesight," she explains. 

Javaid reiterates that social perception influences overall experience: “Cultural and lifestyle factors play a role in the intensity and duration of symptoms. In some cultures, hot flashes are rarely reported, which suggests that social and environmental factors may modulate the experience.”

What you need to know: