My friend Michelle has a whole system: She sleeps with layers of blankets on her bed and a towel underneath her. A stack of towels is on standby. That way, when she wakes up in the middle of the night drenched in sweat, she just moves the towel and blanket under her, layers a new towel on the new blanket, and the cycle begins again. (She even sent me a video to show how the whole thing works.)
As someone who wakes up with completely damp clothes every morning, I’m in awe.
Cue the expert
So I was eager to talk to Dr. Monica Christmas, the associate medical director of The Menopause Society and the director of the Center for Women’s Integrated Health at University of Chicago Medicine, about whether it is unusual to be, well, this sweaty. She assured me that my friend and I are not alone — that night sweats are not at all unusual and also are one of the symptoms of perimenopause and menopause with great, evidence-backed treatment options.
First, a biology lesson, via Christmas:
The old explanation for hot flashes and nights sweats was that when estrogen levels drop — as they do during perimenopause and menopause — the thermal regulatory system of the brain is disrupted, becoming more sensitive and less well-regulated.
But new research says that’s not the whole story: The drop in estrogen levels actually prompts the brain to signal the release of a flood of neurotransmitters called KNDy neurons. Those neurons are what impacts our thermal regulatory centers. When they’re hyperstimulated, you can have hot flashes, which the brain reacts to by going into overdrive by cooling you off — e.g., making you sweat buckets.
If you can elevate estrogen levels to what they were before perimenopause, you block the release of those KNDy neurons and minimize hot flashes and night sweats and even reduce sleep disruptions. And for most people, this can be done safely — for a finite period of time — with hormones.
Here’s what hormone therapy can do
While Christmas said she’s discouraged by people who talk about hormone therapy like it’s “an antidote to aging,” hormone therapy *can* have a huge impact on managing night sweats.
What that therapy looks like depends on whether you’re still having periods or not — in other words, if you’re perimenopausal or postmenopausal.
Having periods? Then Christmas recommends using continuous birth control. (Think: Skipping the placebo pills in your oral contraceptional and going straight to your next pill pack.) Since your body is still ovulating, it is also experiencing hormonal ebbs and flows, so traditional hormone therapy for someone who is postmenopausal is probably not for you.
But for those who have stopped having periods, hormone therapy is a good option. Christmas stressed that hormone therapy is best used for a finite window of time to manage acute symptoms.
(I just wrote about the debate over the “black box” warning on estrogen treatments for menopause; you can check that out here.)
However menopause is different for everyone, she said. The severity and duration of symptoms vary, and race plays a factor: For most people, vasomotor symptoms like night sweats start a few years before the last period and persist for a few years after. Black women have the longest average duration of symptoms — 11 years, according to research. For Hispanic women, it’s an average of nine years, and for White women, it’s an average of seven years. (This also underscores the reason why we need so much more research on midlife health, to better understand exactly why these kinds of disparities exist.)
All this said, for about 90 percent of the population, these symptoms will in fact go away with time. How long someone should be on hormone therapy should be based on that person’s symptoms, Christmas said, though she cautioned that risks can outweigh the benefits for many — especially those who still have a uterus — after 10 years.
And all that said, Christmas also emphasized that these risks are associated with higher-dose, systemic hormone therapy — which is different from low-dose, local vaginal estrogen, which has pretty minimal risk for almost everyone and can often be taken for longer periods of time.
(But of course all bodies are different! Including yours! So talk to your own provider about your symptoms and health history to find the best answer for you.)
What else can help
And everything doesn’t always have to be all about hormones, Christmas said. Some antidepressants can help with these symptoms, including one that is FDA-approved for managing hot flashes and night sweats — and because they are antidepressants, they can also help with mood symptoms and, for some people, sleep symptoms as well.
She also pointed out that cognitive behavioral therapy has been found to be highly effective and is frequently cited as a first-line treatment not only for hot flashes and night sweats, but for sleep disruption, anxiety and depression.
“There are mind-body techniques for people that don’t want to be on medication or have had contraindications,” she said.
Some of you had suggestions too!
I asked 19th readers what their top tips are for dealing with night sweats. While we can’t personally vouch for any of these tips or products, we can tell you what some of your peers swear by:
Reader Carrie said she keeps a washcloth bedside, and when she gets really sweaty in the middle of the night, “I wipe my body down with the wash cloth. It proves quite soothing.”
Aimee, another newsletter reader, swears by the Chilipad, a cooling mattress topper: “It is expensive, which I know means it’s out of reach for many — but I haven’t had night sweats when I am sleeping at home since we started using it two months ago.”
More than one of you mentioned Wise Woman Tea.
And many of you also stressed the importance of drinking water — and keeping a glass bedside!
Reader Caroline said, “Ceiling fan always on” and suggested opening the windows at night during the cooler months.
A number of you mentioned how some simple dietary changes have made a big difference: We heard that avoiding alcohol, milk chocolate, and simple carbs in the evening all helped different people sleep better (and dryer).
Others recommended lightweight pajamas, and there was one special callout for A Domani’s sleepwear, specifically made and marketed for perimenopausal and menopausal women.
Bedding also matters, you said: We also got suggestions for silk pillowcases and linen sheets.
And yes, some of you also told us how much hormone therapy helped with these symptoms too!
But if you don’t feel like buying anything new, may I recommend doing what I do and just freezing out your loved ones at night and turning the thermostat way down and explaining that yes, you simply do need it that cold to sleep. They can always get another blanket.
I almost forgot!
My group text is still processing the news of the Nicole Kidman-Keith Urban separation. If yours is also wondering if all love is dead, may I offer an alternate perspective: Think how many more shows we are about to get in which Nicole wears a wig, makes an attempt at an American accent and has a dark secret.
I feel like we are on the brink of an especially fertile period for this genre of show as the 58-year old Kidman shows us exactly what is possible (and deliciously campy) for women of a certain age onscreen.