Hot Flashes, Night Sweats, and Brain Health in Menopause
What emerging research suggests about vasomotor symptoms and why they may be worth discussing with your healthcare provider
Hot flashes and night sweats are often dismissed as an uncomfortable, but ultimately harmless part of menopause. Yet emerging research suggests these classic menopause symptoms may carry more information than we once thought, particularly when it comes to brain health.
A 2023 study published in Neurology explored whether menopausal vasomotor symptoms (VMS), such as hot flashes and night sweats, are associated with changes in brain structure in midlife women.(1) Specifically, researchers looked at white matter hyperintensities (WMHs), areas seen on MRI scans that are considered early markers of small-vessel changes in the brain and have been linked to higher risks of stroke, cognitive decline, and dementia later in life.
What the study found
This study followed more than 200 midlife women who were not using hormone therapy. Rather than relying only on self-reported symptoms, researchers used objective physiologic monitoring to track hot flashes over a 24-hour period.
Key findings included:
- Women with more frequent hot flashes had greater white matter hyperintensity volume
- The strongest associations were seen with nighttime hot flashes
- These associations persisted even after accounting for sleep quality, blood pressure, insulin resistance, cholesterol, inflammation, and estrogen levels
In short, hot flashes (especially those that occur during sleep) may be signaling underlying physiologic changes rather than being purely a quality-of-life issue
What this does not mean
It’s important to keep this research in context.
This study does not show that hot flashes cause brain changes.
It does not mean that everyone with night sweats is at risk for cognitive decline.
And it does not mean hormone replacement therapy (HRT) is automatically the right solution.
This was an observational study, not a treatment trial. It helps identify patterns and associations—but not cause and effect.
Why this matters in conversations about menopause care
Decisions around menopause care, whether that includes hormonal therapy, non-hormonal medications, or lifestyle-based approaches, are highly individualized and best made in partnership with a medical provider.
What this research adds is another layer to the conversation. For some women, frequent or disruptive vasomotor symptoms may serve as a midlife marker worth paying attention to, rather than something to simply “push through.”
Bringing it back to the individual
Studies like this highlight that menopause symptoms don’t exist in isolation. They are often influenced by hormone patterns, stress physiology, sleep quality, metabolic health, and cardiovascular risk. While population research helps guide understanding, insight into your own physiology can provide more meaningful, personalized context.
A supportive next step: DUTCH hormone testing
For women in perimenopause and postmenopause, the DUTCH hormone test offers a more detailed look at hormone patterns, including estrogen metabolism and daily cortisol rhythm. I use this information to support personalized nutrition and lifestyle strategies and to help clients have more informed, collaborative conversations with their healthcare providers.
This testing is used for education and guidance, not diagnosis or medical treatment decisions.
Schedule a free Discovery Call with me to learn more.
References
Thurston RC, Wu M, Chang YF, et al. Menopausal vasomotor symptoms and white matter hyperintensities in midlife women. Neurology. 2023;100(2):e133–e141. doi:10.1212/WNL.0000000000201401