Hot flashes and mood swings in perimenopause! Make ‘em go away!

Reproductive Health

Ugh! We are right there with you!

Perimenopause (the time before, during, and right after menopause) is a normal and expected process for ~50% of the human population.


🔥Studies show between 50-85% of us experience hot flashes during the late menopausal transition and early postmenopause. For most of us, these are mild to moderate. But some of us will find them affecting our sleep, moods, and quality of life.

Great news!

🧯We have effective treatments that can help.

Continue reading to find out more.

Let’s start with hormones! Menopause Hormonal Therapy (MHT)

Menopausal Hormone Therapy is the most effective treatment for *moderate to severe* hot flashes and night sweats.
The potential benefits of Menopausal Hormone Therapy appear to outweigh the potential harms for most symptomatic women with no existing contraindications who are either *under the age of 60* or *less than ten years from the beginning of their menopause*.

✨See below for the nitty-gritty on potential benefits and potential harms.

As stated above, Menopausal Hormone Therapy can help with hot flashes and night sweats *and* decrease sleep interruptions, which can help with daytime mood ups and downs.

And we have options for those who can’t or don’t want to take hormones!🥳

Antidepressants: there are a group of antidepressant medications called SSRIs and SNRIs that can help with hot flashes alone or help with mood *and* hot flashes.

Anti-epileptics/anti-seizure medicine: Gabapentin has been shown to be helpful for people who don’t respond to or can’t take antidepressants.

As with all medications, discuss possible interactions and side effects with your clinician.

Non-medication options:

Cognitive Behavioral Therapy (CBT) has been studied for the treatment of hot flashes and insomnia related to menopause. Though more research is needed, it has promise in the treatment of both. So far, research has shown that it reduces the “bother” of hot flashes but not the number of them.

Other non-medication options that work wonderfully for *mild to moderate* symptoms include:

Hot flashes and night sweats:

🧊Dress in layers so you can take off clothes if a flash hits!
🧊Keep the thermostat down (your family can wear sweaters 😜!)
🧊Avoid hot drinks☕
🧊Put a cold washcloth against your neck.
🧊Put an ice pack under your pillow. Flip your pillow as needed.
🧊Quit smoking if you smoke. (Smoking makes hot flashes worse.) 🚭See our post on quitting here.


💃Try to move. Dance, sway, step, stretch. Movement improves mood.
👭Camaraderie is everything! Seek social support from people going through this time, too.

Talk to your GYN, certified midwife, women’s health NP or menopause specialist to find out if Menopausal Hormone Therapy or any other treatment options would be helpful for you. Click this link to find a menopause practitioner.

To recap:

Perimenopause is normal and expected. It is not a disease process; it doesn’t mean you are past your prime. You are still fabulous…even more fabulous, as a matter of fact.

You are not alone. There are roughly 3.9 billion others of us who have gone through, are going through, or will go through this process.

We have treatments that can make the process easier.

Talk to your clinician to find the best treatment(s) for you.

Those Nerdy Girls

✨The nitty-gritty of the potential benefits and potential harms (condensed version😉):

🙂Potential Benefits:

For people under the age of 60 years old who are taking estrogen plus progestogen* therapy (EPT) or estrogen therapy (ET), the absolute risks are reduced for:

🔶 all-cause mortality 🔶fracture 🔶diabetes

*Estrogen plus progestogen therapy is a choice for people with uteruses because progestogen protects the uterus.

For people under the age of 60 years old who are taking estrogen therapy (ET), the absolute risks are *reduced* for:

🔶breast cancer

🤔Potential Harms:

The increased absolute risks associated with estrogen plus progestogen therapy (EPT) or estrogen therapy (ET) are rare: less than 10 people in 10,000 per year.

They include an increased risk for blood clots in the veins (VTE) and gallbladder disease.

In addition, estrogen plus progestogen therapy (EPT) carries a rare, increased risk for stroke and breast cancer. If estrogen is taken without progestogen or another uterus protector, there is an increased risk of growth of endometrial tissue (the lining of the uterus) and endometrial cancer.

For more detailed information, click here.

**This post is part of a series on menopause. Future posts will discuss the potential benefits and harms of hormone therapy and other medications, the history of hormone therapy, different formulations, non-pharmacologic approaches to symptom management, and other questions that readers pose. Please submit your questions here.


Find a menopause practitioner near you.

Menopause Hormone Therapy FAQs

Great book on the topic of menopause and feminism
The Menopause Manifesto by Dr. Jen Gunter

Link to Original FB Post