Does exercise help or worsen hot flashes?

Regular exercise does not appear to make hot flashes worse over time, but the best trials show it does not reliably reduce them either. A single workout can set off a flash, especially if you are not used to exercising, and a few small studies suggest that training that builds fitness or strength may lower flash frequency. Exercise is worth doing for many reasons; just do not count on it as your hot flash treatment.

Why exercise and hot flashes are connected

Hot flashes are linked to changes in the body’s temperature control that follow the drop in estrogen. Exercise generates heat, so a hard session, a warm room or a sudden jump in activity can trigger a flash during or after a workout.

There is also a reason to think training could help in the long run. In a small 16-week trial of 21 women with hot flashes, supervised exercise that improved fitness was followed by fewer self-reported hot flashes than in a control group. After training, women started sweating and increasing skin blood flow at a slightly lower core temperature, a sign of more efficient heat control. The trial was small, and larger trials have not consistently confirmed a benefit.

What the trials show

Study	Who and what	Result for hot flashes
Cochrane review, 2014	5 trials, 733 women; exercise compared with no treatment, yoga or hormone therapy	No difference between exercise and no treatment; evidence rated low quality. In one small trial, hormone therapy reduced flashes more than exercise
MsFLASH trial, 2014	248 sedentary late perimenopausal and postmenopausal US women; moderate aerobic training 3 times a week for 12 weeks	Daily flashes fell by 2.4 with exercise and 2.6 with usual activity, no meaningful difference; small improvements in sleep and mood
Swedish resistance trial, 2019	58 postmenopausal women (average age 55) with at least 4 moderate or severe flashes a day; 8 exercises, 2 sets of 8 to 12 repetitions, 3 times a week for 15 weeks	Moderate to severe flashes fell 43.6 percent with training versus 2.0 percent in controls, about 2.7 fewer a day
Thermoregulation trial, 2016	21 women; 16 weeks of supervised training	Fewer hot flashes with training, alongside better fitness and heat control
Daily diary study, 2012	121 women aged 40 to 60 over 15 days, including one 30-minute moderate treadmill session	Flashes decreased in the 24 hours after the session; women with lower fitness reported more flashes on days they were more active than usual

Note the pattern. The largest, most rigorous trial, MsFLASH, found no effect of aerobic exercise. The positive results come from smaller trials, and in the Swedish trial the comparison group was asked not to change their routine, so women knew whether they were exercising, which can influence symptom diaries.

What the guidelines say

The Menopause Society’s 2023 position statement on nonhormonal treatments lists exercise among options it does not recommend for treating hot flashes, based on limited or inconsistent evidence. Yoga, cooling techniques and avoiding triggers are in the same category. The statement recommends cognitive behavioral therapy, clinical hypnosis, SSRIs and SNRIs, gabapentin and fezolinetant, with good and consistent evidence, and notes that hormone therapy remains the most effective treatment. Weight loss is listed as a recommended option with more limited evidence.

None of this is a reason to skip exercise. It means hot flashes deserve their own treatment plan. Our hot flashes guide and what is hormone therapy cover the options.

How to exercise when you have hot flashes

• Build up gradually. The diary study suggests that sudden jumps in activity are more likely to bring on flashes in women who are less fit. Add time or intensity in small steps.
• Keep it cool. Choose cooler times of day, air-conditioned spaces, a fan or outdoor shade. Swimming is a good option if you have access to a pool.
• Dress in layers of light, moisture-wicking fabric you can peel off.
• Drink cold water before, during and after.
• Cool down properly. Five minutes of easy movement and a lukewarm or cool shower can help you cool off faster.
• Consider strength training. It has the most encouraging, if limited, hot flash data, and it protects muscle and bone. Our strength training guide has a starter plan.
• Track your pattern. Note flashes, sleep and workouts for two to four weeks. Responses vary from woman to woman, and your own record will tell you more than averages.

A reasonable week:

Day	Session
Monday, Wednesday, Friday	Strength training modeled on the Swedish trial: 8 exercises, 2 sets of 8 to 12 repetitions, with the weight raised as you get stronger
Tuesday, Thursday	Brisk walk, bike ride or swim at moderate effort, 30 to 40 minutes
Saturday	Something you enjoy outdoors in the cooler part of the day
Sunday	Rest or gentle stretching

That works toward the federal target of 150 minutes of moderate aerobic activity a week. If three strength days is too many to start, two is a reasonable beginning.

If a particular workout reliably sets off flashes, change one thing at a time, such as the time of day, the room temperature or the intensity, rather than giving up exercise altogether.

Who should check first

Most women can start moderate exercise on their own. Talk to a clinician first if you have heart disease, diabetes, high blood pressure that is not controlled or another chronic condition, or if you plan to move straight into vigorous training after a long break. If you have night sweats that soak your sheets, see our night sweats guide as well.

When to see someone

Stop exercising and get medical care for chest pain or pressure, fainting, or a racing or irregular heartbeat that does not settle with rest. Make an appointment if:

• hot flashes or night sweats are disrupting sleep, work or exercise
• flushing comes with fever, unexplained weight loss, diarrhea or palpitations, which can point to other causes such as thyroid problems
• flashes start or change suddenly after a new medication
• you want to discuss hormone or nonhormonal treatment

Our symptom checker can help you organize what you are noticing before a visit, and you can find a menopause-informed clinician near you.