Night Sweats in Women: Causes, When to Worry and Treatments That Work
Medically reviewed by Sabeen Munib M.D.Night sweats in women are most often caused by perimenopause and menopause, when falling estrogen triggers hot flashes during sleep for an average of 7 to 10 years. Medicines such as antidepressants, an overactive thyroid, low blood sugar, sleep apnea and infections can also lead to them. Hormone therapy is the most effective treatment for menopause night sweats, and FDA-approved non-hormonal pills are available for women who cannot or prefer not to take hormones.
What counts as night sweats?
Night sweats are heavy sweating episodes during sleep that soak your nightclothes or sheets, even when the room is not hot. Feeling warm under a heavy blanket is not the same thing. True night sweats often wake you up, and some women need to change clothes or bedding 1 or more times a night.
Most night sweats in women are the nighttime version of hot flashes. A hot flash is a sudden wave of heat over the face, neck and chest, often with a flushed face, a fast heartbeat and sweating, and it usually lasts 1 to 5 minutes. Doctors call hot flashes and night sweats vasomotor symptoms. Many women feel chilled afterward, which is why so many wake up drenched in sweat but freezing.
What causes night sweats in women?
Perimenopause and menopause
Perimenopause and menopause are the leading reasons for night sweats in women over 40. As estrogen levels fall and swing, the brain's temperature control center becomes more sensitive to small changes in body temperature and triggers sweating to cool you down. Hot flashes and night sweats often start in perimenopause, sometimes years before the last period, and hot flashes, night sweats and poor sleep last about 7 to 10 years on average during menopause, though some women keep experiencing them much longer.
Night sweats in the week before a period, especially in your 40s, are often an early sign of perimenopause. They also happen in pregnancy and in the weeks after childbirth, when hormone levels shift quickly.
Read more about perimenopause and its early signs
Medicines
Many medicines list sweating as a side effect, including:
- Antidepressants, especially SSRIs and SNRIs such as sertraline, escitalopram and venlafaxine.
- Hormone-blocking medicines for breast cancer, such as tamoxifen and aromatase inhibitors.
- Diabetes medicines that can cause low blood sugar, such as insulin and sulfonylureas.
- Steroids such as prednisone, some blood pressure medicines, and fever reducers.
- Thyroid medicine at too high a dose.
If you think a medicine is behind your sweats, talk with the doctor who prescribed it. Do not quit an antidepressant suddenly, because that can trigger withdrawal symptoms within days.
Thyroid problems
An overactive thyroid speeds up your metabolism and can lead to sweating, feeling hot all the time, weight loss, a racing heart, anxiety and trouble sleeping. A TSH blood test checks for it, and results usually come back within 1 to 2 days.
Low blood sugar at night
Low blood sugar during sleep can bring on sweating, nightmares, damp sheets and a headache on waking. It happens mainly in people who take insulin or a sulfonylurea for diabetes, and it is rare in people who do not take these medicines.
Sleep apnea
Obstructive sleep apnea, where breathing stops and starts during sleep, is linked with frequent night sweats. Loud snoring, gasping at night, morning headaches and daytime sleepiness are clues, and a 1-night sleep study, often done at home, confirms it.
Infections and other causes
Infections such as tuberculosis, HIV and bacterial infections of the heart valves or bones can trigger night sweats, usually with fever that lasts days or weeks. Alcohol, acid reflux, anxiety and, rarely, lymphoma or other cancers are other possibilities. Some people sweat heavily with no medical reason at all, which is called idiopathic hyperhidrosis.
When should you be concerned about night sweats?
See a doctor promptly if your night sweats come with:
- Fever or chills that are not from hot flashes.
- Weight loss you cannot explain.
- Swollen glands (lymph nodes) in the neck, armpits or groin.
- A cough that will not go away, or coughing up blood.
- New pain in one area, or ongoing diarrhea.
- Night sweats that start years after menopause, or that are severe and come with no other menopause symptoms.
Most night sweats are not dangerous, but these combinations need a timely exam and blood tests.
How do you stop night sweats?
The right treatment depends on what is driving your night sweats. When they come from menopause, the treatments below have the strongest support. For other causes, treating the underlying problem, such as adjusting a medicine or treating a thyroid problem or sleep apnea, usually ends them within weeks.
Hormone replacement therapy
Hormone therapy is the most effective treatment for hot flashes, night sweats and other vasomotor symptoms during menopause. For healthy women under 60, or within 10 years of their last period, the benefits usually outweigh the risks. Estrogen is the part that treats night sweats, and women who still have a uterus also need a progestogen to protect the uterine lining. Hormone therapy often reduces hot flashes within a few weeks.
Forms include:
- Combination patches that deliver estrogen and a progestin through the skin, changed once or twice a week.
- Oral progesterone, taken by mouth together with estrogen to protect the uterine lining.
- Compounded creams, which some women ask for after reading about them online. These are custom-mixed and are not FDA-approved, so their dose and purity are not checked the way approved products are.
This therapy is not right for everyone, and the decision depends on your age and years since menopause. It is usually avoided after breast or uterine cancer, a blood clot, stroke or heart attack, with active liver disease, or with unexplained vaginal bleeding. Estrogen through the skin carries a lower risk of blood clots than estrogen pills.
Read about common HRT side effects
FDA-approved non-hormonal medicines
For women who cannot or prefer not to use hormones, 3 non-hormonal medicines are FDA-approved for moderate to severe hot flashes due to menopause:
- Paroxetine 7.5 mg (Brisdelle), a low dose of an SSRI taken at bedtime. It should not be combined with tamoxifen, and like other antidepressants it carries a warning about suicidal thoughts.
- Fezolinetant (Veozah), a daily pill that blocks a brain signal involved in temperature control. It carries a boxed warning for liver injury, so liver blood tests are needed before starting and during the first months of use.
- Elinzanetant (Lynkuet), approved in October 2025, a capsule taken once at bedtime. Side effects can include headache, tiredness, dizziness and sleepiness.
Other medicines, such as some other antidepressants and gabapentin, are sometimes used off-label for hot flashes. Gabapentin taken at bedtime may suit women whose main symptom is night sweats, while its drowsiness may make the first 1 to 2 weeks harder.
Lifestyle steps and comfort measures
Some non-drug steps are supported for hot flashes, and others simply make nights more comfortable:
- Cognitive behavioral therapy (CBT) and clinical hypnosis may reduce how much hot flashes bother you.
- Losing extra weight may reduce hot flashes for some women.
- Keeping the bedroom cool, using a fan, layering light bedding and wearing breathable sleepwear can make night sweats easier to manage.
- Limiting alcohol, spicy food and hot drinks near bedtime helps some women.
Herbal menopause supplements, such as black cohosh and soy, have not been shown to work for hot flashes. Supplements are not reviewed by the FDA for effectiveness before they are sold, even ones marketed for years.
How Dr. Munib approaches night sweats
Dr. Munib is the primary care and hormone physician at The Pur Health, with 15+ years in Irvine. She first makes sure night sweats are not a symptom of something other than menopause. A visit usually includes:
- 1.A review of your periods, other symptoms, medicines, sleep, alcohol use and health history.
- 2.An exam and blood tests chosen for your situation, such as TSH, a blood count and blood sugar.
- 3.If menopause is the reason, a discussion of hormone therapy, non-hormonal medicines and lifestyle steps, depending on your health history and preferences.
- 4.Referral for a sleep study or to a specialist when something else is suspected.
Learn about hormone replacement therapy at The Pur Health
Poor sleep from night sweats can also affect focus and memory.
Read about menopause brain fog
Book a visit for night sweats in Irvine
If night sweats are waking you up and wearing you down, a visit can find the cause and the right treatment for you. The Pur Health is at 114 Pacifica, Suite 280, Irvine, and is in-network with most PPO plans. Cash visits are $190 for new patients and $150 for returning patients. Call (949) 647-5234 to book.