Hot flushes and night sweats—collectively termed vasomotor symptoms (VMS)—are among the most recognisable symptoms of the menopause transition. They can disturb sleep, reduce concentration, increase fatigue and interfere with work, exercise and daily activities. Although exercise is frequently promoted as a natural treatment for hot flushes, the evidence requires a more careful interpretation.

Current research supports physical activity strongly for cardiovascular health, muscle and bone preservation, mood, sleep, metabolic health and physical function during menopause. However, whether exercise directly and consistently reduces the frequency of hot flushes is less certain. The physiotherapist, therefore, has an important role: prescribe exercise because of its substantial health benefits and recognise that some individuals may also experience symptom improvement, but avoid presenting exercise as a proven replacement for established VMS treatments.

What Are Vasomotor Symptoms and Why Do They Occur?

A hot flush is a sudden sensation of heat, usually affecting the face, neck and upper chest, which may be accompanied by flushing, sweating, palpitations or subsequent chills. When episodes occur during sleep, they are commonly described as night sweats. VMS may begin during perimenopause and can persist for several years; The Menopause Society reports that they may affect up to approximately 80% of women during the menopause transition.

The mechanism is primarily thermoregulatory rather than simply an intolerance to environmental heat. Declining and fluctuating oestrogen levels alter signalling within hypothalamic thermoregulatory pathways. Increased activity of kisspeptin–neurokinin B–dynorphin, or KNDy, neurones appears particularly important. The thermoneutral zone—the range of core temperatures within which neither sweating nor shivering is required—becomes narrower. Small increases in body temperature can therefore trigger vasodilation and sweating, producing a hot flush.

This mechanism also explains an important rehabilitation observation: exercise itself may temporarily provoke heat or sweating without being harmful. An exercise-related rise in core temperature can overlap with VMS in susceptible individuals. The immediate presence of a hot flush during exercise therefore does not necessarily indicate that exercise is worsening menopause overall.

Does Exercise Actually Reduce Hot Flushes?

The answer is currently possible for some women but not consistently enough to prescribe exercise as a stand-alone VMS treatment.

Earlier evidence was uncertain. A Cochrane review found insufficient evidence that exercise reduced menopausal VMS compared with control interventions (Daley et al., 2014). A later systematic review and meta-analysis involving 21 randomised controlled trials suggested that exercise may reduce VMS severity, but evidence for reducing frequency was less convincing, and study quality and intervention methods varied considerably (Liu et al., 2022).

This distinction remains important. The 2023 Nonhormone Therapy Position Statement from the North American Menopause Society concluded that exercise should not currently be recommended as a single treatment specifically for VMS because available evidence was limited and inconsistent. Importantly, the statement did not argue against exercise for health; it specifically evaluated whether exercise could be considered an evidence-based treatment for hot flushes and night sweats.

Newer evidence is encouraging, particularly for resistance exercise. In an earlier randomised trial, 15 weeks of progressive resistance training reduced moderate-to-severe hot-flush frequency substantially compared with unchanged physical activity (Berin et al., 2019). A 2024 meta-analysis similarly reported beneficial effects of resistance training on hot-flush outcomes, although only a small number of eligible studies were available (Choudhry et al., 2024).

A 2025 randomised trial further found that a 12-week programme combining twice-weekly resistance exercise with moderate walking three times per week improved VMS severity, sleep and several quality-of-life domains. However, only 38 participants were randomised, so the result is promising rather than definitive (Yilmaz Babacan et al., 2025).

Overall, the evidence is evolving rather than settled.

A 2024 overview of 17 reviews involving 80 unique studies likewise concluded that evidence for vasomotor improvement remains inconclusive and that no single exercise form can yet be recommended specifically for menopause-symptom reduction (Money et al., 2024).

Why Exercise Still Matters When VMS Are Present

Uncertain evidence for direct hot-flush reduction should not be interpreted as evidence that exercise is unimportant during menopause.

The menopause transition coincides with changes in body composition, bone turnover, cardiovascular risk factors and skeletal-muscle function. Regular aerobic and resistance exercise helps preserve cardiorespiratory fitness, muscle strength, physical function and metabolic health. It also provides an important mechanical stimulus for bone and may support mood and sleep—domains that frequently interact with the burden of VMS.

This distinction is clinically useful:

Exercise may not reliably remove the hot flush, but it can improve the health of the person experiencing it.

Sleep provides a good example. Night sweats may fragment sleep and produce daytime fatigue. Exercise cannot necessarily eliminate the night sweats, yet some exercise programmes have improved sleep quality in postmenopausal participants. The 2025 combined-training trial demonstrated improvements in Pittsburgh Sleep Quality Index scores alongside improvements in VMS severity.

Exercise can therefore be part of a multidimensional menopause-management plan, even when medical treatment is required for VMS themselves.

A Practical Exercise Prescription

Exercise prescription should be based on health status, previous activity, symptoms and goals rather than on the assumption that one particular workout will suppress hot flushes.

For a generally healthy midlife adult beginning or rebuilding activity, a practical programme may include:

Aerobic exercise: moderate-intensity walking, cycling, swimming or similar activity accumulated across the week.
Resistance training: at least two sessions per week involving the major muscle groups, with progressive loading as technique and tolerance improve.
Weight-bearing activity: walking, stair climbing and appropriately progressed impact exercise where bone health and joint status permit.
Mobility and balance work: added according to individual limitations and functional goals.

General exercise prescription should follow established FITT principles—frequency, intensity, time and type—with gradual progression rather than sudden increases in workload (American College of Sports Medicine [ACSM], 2021).

Resistance training deserves particular attention because of both its established musculoskeletal benefits and its emerging VMS evidence. The programme used by Berin et al. (2019), for example, involved progressive resistance exercise approximately three times weekly rather than simply light, non-progressive activity.

Nevertheless, there is currently no validated “anti-hot-flush” exercise dose. Physiotherapists should therefore prescribe exercise primarily according to established fitness and health principles while monitoring whether VMS, sleep and recovery improve for the individual.

Managing Hot Flushes During Exercise

Some people avoid exercise because increased warmth and sweating resemble or provoke their symptoms. The appropriate response is usually adaptation rather than unnecessary exercise restriction.

Useful strategies include choosing tolerable clothing, ensuring access to hydration, using a cooler or well-ventilated environment when preferred, incorporating an adequate warm-up and allowing gradual progression in intensity. These strategies can improve comfort even though cooling techniques themselves have not been proven to treat the underlying VMS.

The physiotherapist can also use symptom monitoring:

Exercise → monitor symptoms during the session → assess recovery and later response → progress, maintain or modify the dose.

A brief hot flush that settles without concerning symptoms does not automatically require exercise cessation. In contrast, chest pain, unexplained marked breathlessness, syncope, persistent palpitations or symptoms that appear atypical for the patient's established VMS pattern require appropriate medical assessment rather than being attributed automatically to menopause.

The Physiotherapist’s Role: Exercise Without Overpromising

The physiotherapist's contribution extends beyond telling a patient to “exercise more". Assessment should consider current activity; cardiovascular and musculoskeletal health; bone risk; sleep; fatigue; weight-bearing tolerance; pelvic-health symptoms; and barriers created by VMS.

Education is equally important. Patients should understand that exercise and medical treatment are not competing options. Menopausal hormone therapy remains the most effective treatment for bothersome VMS for appropriate candidates, while evidence-based nonhormonal treatments are also available when hormone therapy is unsuitable or not preferred. Persistent or function-limiting hot flushes therefore warrant medical discussion rather than increasingly aggressive exercise in an attempt to control symptoms.

The best message is balanced: continue or begin appropriately prescribed exercise because the health benefits are substantial; improvement in VMS may occur, particularly with structured resistance or combined training, but symptom reduction should be considered a possible additional benefit rather than a guaranteed outcome.

Viva-Ready Summary

Vasomotor symptoms include hot flushes and night sweats and arise largely from altered hypothalamic thermoregulation during the menopause transition.
Exercise has strong established benefits for cardiovascular, metabolic, musculoskeletal and psychological health during midlife.
Evidence that exercise directly reduces VMS remains mixed, particularly for hot-flush frequency.
Recent trials and meta-analyses suggest resistance training and combined aerobic–resistance programmes are promising.
Current menopause guidance does not support exercise as a stand-alone treatment specifically for VMS because the evidence remains insufficient.
Physiotherapists should prescribe progressive aerobic and resistance exercise, modify sessions according to symptoms and recovery, and refer for medical management when VMS are persistent or significantly disruptive.
Exercise should complement—not replace—evidence-based menopause care.

One-line recall point:
Exercise is essential for health through menopause and may reduce vasomotor symptoms in some women, but current evidence does not support prescribing it as a guaranteed stand-alone treatment for hot flushes.

References

American College of Sports Medicine. (2021). ACSM's guidelines for exercise testing and prescription (11th ed.). Wolters Kluwer.

Berin, E., Hammar, M., Lindblom, H., Lindh-Åstrand, L., Rubér, M., & Spetz Holm, A.-C. (2019). Resistance training for hot flushes in postmenopausal women: A randomised controlled trial. Maturitas, 126, 55–60. https://doi.org/10.1016/j.maturitas.2019.05.005

Choudhry, D. N., Saleem, S., Hatim, S., & Irfan, R. (2024). The effect of resistance training in reducing hot flushes in post-menopausal women: A meta-analysis. Journal of Bodywork and Movement Therapies, 39, 335–342. https://doi.org/10.1016/j.jbmt.2024.03.018

Daley, A., Stokes-Lampard, H., Thomas, A., & MacArthur, C. (2014). Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews, (11), CD006108. https://doi.org/10.1002/14651858.CD006108.pub4

Liu, T., Chen, S., Mielke, G. I., McCarthy, A. L., & Bailey, T. G. (2022). Effects of exercise on vasomotor symptoms in menopausal women: A systematic review and meta-analysis. Climacteric, 25(6), 552–561. https://doi.org/10.1080/13697137.2022.2097865

Money, A., MacKenzie, A., Norman, G., Eost-Telling, C., Harris, D., McDermott, J., et al. (2024). The impact of physical activity and exercise interventions on symptoms for women experiencing menopause: Overview of reviews. BMC Women's Health, 24, 399. https://doi.org/10.1186/s12905-024-03243-4

Nilsson, S., Henriksson, M., Hammar, M., Berin, E., Sederholm Lawesson, S., Ward, L. J., Li, W., et al. (2024). A 2-year follow-up to a randomized controlled trial on resistance training in postmenopausal women: Vasomotor symptoms, quality of life and cardiovascular risk markers. BMC Women's Health, 24, 511. https://doi.org/10.1186/s12905-024-03351-1

The North American Menopause Society. (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573–590. https://doi.org/10.1097/GME.0000000000002200

Yilmaz Babacan, G., Guler Cekic, S., Candan Algun, Z., et al. (2025). Effects of exercise training on vasomotor symptoms and quality of life in postmenopausal women: A randomized controlled trial. BMC Women's Health, 25, 612. https://doi.org/10.1186/s12905-025-04231-y