Do all women get hot flashes during menopause?

Hot flashes are one of the most well-known symptoms of menopause, often portrayed in pop culture as the hallmark of “the change.” While they’re incredibly common, not every woman experiences hot flashes during menopause - and for those who do, the severity and duration can vary widely. So why do hot flashes happen, and why do some women breeze through menopause without ever feeling the heat? Let’s take a closer look.

What are hot flashes?

Hot flashes are sudden and often intense sensations of heat, usually starting in the chest or face and spreading throughout the upper body. They can last anywhere from a few seconds to several minutes and are often accompanied by sweating, flushed skin, and sometimes a racing heartbeat or chills afterward. When they occur at night, they’re known as night sweats, which can disrupt sleep and leave you feeling drained the next day.

Why do hot flashes happen?

The exact cause of hot flashes isn’t fully understood, but they are closely tied to hormonal changes during menopause. As oestrogen levels decline, the hypothalamus - the part of your brain responsible for regulating body temperature - becomes more sensitive to even slight fluctuations in temperature. This sensitivity can trigger your body to overreact, dilating blood vessels to release heat and causing you to sweat.

Factors like stress, spicy foods, caffeine, alcohol, and even warm weather can intensify hot flashes, but the underlying hormonal shifts are the primary cause.

Does every woman get hot flashes?

The short answer is no. While hot flashes are extremely common, affecting about 75–80% of women during menopause, not every woman experiences them. For the 20–25% of women who don’t, menopause may present in other ways, such as mood changes, joint pain, or sleep disturbances, but without the signature heat surges.

Even among women who do experience hot flashes, the intensity and frequency can vary. Some women may only have occasional, mild flashes, while others endure frequent, debilitating episodes that significantly impact their daily lives.

Who is more likely to experience hot flashes?

There’s no way to predict for certain whether you’ll experience hot flashes, but several factors can influence the likelihood:

• Age: Hot flashes typically begin during perimenopause, the transitional phase leading up to menopause, and often peak in the years immediately following menopause.
• Genetics: If your mother or sisters experienced severe hot flashes, you might be more likely to as well.
• Lifestyle: Smoking, obesity, and high stress levels are associated with a higher likelihood of hot flashes.
• Health conditions: Certain medical treatments, like chemotherapy or surgical menopause (removal of the ovaries), can increase the risk of hot flashes by accelerating hormonal changes.

What if you don’t get hot flashes?

If you’re going through menopause and don’t experience hot flashes, consider yourself lucky! It doesn’t mean anything is wrong - it simply means your body is handling hormonal changes differently. Instead, you might notice other symptoms, such as fatigue, vaginal dryness, or mood swings. Every woman’s menopause journey is unique, and the absence of hot flashes doesn’t diminish the significance of other symptoms you might be experiencing.

How long do hot flashes last?

For women who do experience hot flashes, the duration can vary significantly. On average, they last 7–10 years, but some women have them for much longer. They’re most intense in the early years of menopause and tend to decrease in frequency and severity over time.

Managing hot flashes if you have them

If hot flashes are part of your menopause experience, there are plenty of ways to manage them and make life more comfortable:

• Lifestyle adjustments: Dress in layers, keep your home cool, and avoid common triggers like spicy foods or caffeine.
• Deep breathing techniques: Practicing slow, deep breathing can help reduce the intensity of hot flashes.
• Supplements: Natural remedies like black cohosh or evening primrose oil may provide relief for some women.
• Menopause Hormone Therapy (MHT): MHT can be highly effective for reducing the frequency and severity of hot flashes, though it’s not suitable for everyone.
• Non-hormonal medications: Certain antidepressants and other medications can also help manage hot flashes if MHT isn’t an option.

If you’re concerned about your symptoms

Whether or not you experience hot flashes, it’s important to focus on your overall well-being during menopause. If your symptoms - hot flashes or otherwise - are interfering with your quality of life, speak with your doctor about treatment options. There’s no need to suffer in silence; menopause is a natural transition, but that doesn’t mean you have to endure it without support.

The bottom line

No, not every woman experiences hot flashes during menopause. While they’re one of the most common symptoms, affecting the majority of women, about 20–25% of women never encounter them. Whether you’re dealing with frequent, intense hot flashes or none at all, your menopause journey is valid and unique to you. The key is understanding your body and finding strategies to manage whatever symptoms you experience, so you can thrive through this transition.

For more tips, advice, and resources on managing menopause, explore The Bloom or symptom library.