Temperature during menopause: causes and treatment

Many women experience hot flashes and night sweats during the transition to menopause, which they subjectively perceive as a "fever." These are not the same thing. Fever is an objectively elevated body temperature, typically 38.0°C or higher, most often associated with infection or inflammation. Hot flashes are short-term episodes of heat due to changes in thermoregulation due to estrogen deficiency, during which the internal temperature typically does not reach feverish levels. For appropriate management, it is important to distinguish between these conditions. [1]

Vasomotor symptoms of menopause include sudden hot flashes, flushing, sweating, palpitations, and anxiety. They typically last 1-5 minutes and can recur day and night. They are common and often last for years, significantly affecting sleep and productivity, but are not themselves a sign of infection. [2]

A key reference point at home is a thermometer. If the temperature measured is below 38.0°C (100.5°F) while experiencing a fever, it's more likely to be a hot flash than a fever. If a temperature of 38.0°C (100.5°F) or higher is persistent, accompanied by chills, severe weakness, cough, pain when urinating, or a severe headache, assess the condition as a possible fever and follow the steps below. [3]

Current menopause guidelines emphasize that hot flashes and night sweats are a normal part of the transition and can and should be managed. However, any persistent increase in temperature requires the usual medical approach as a fever, not as a "symptom of menopause." [4]

Why do menopause cause hot flashes? What happens to thermoregulation?

Hot flashes are associated with a narrowing of the so-called "thermoneutral zone" in the hypothalamus. Even small fluctuations in internal temperature, previously unnoticeable, trigger a cascade of vasodilation and sweating in the skin. This is due to the restructuring of neurons sensitive to neurokinins, which are part of the KNDy network of hypothalamic neurons, which becomes unstable with estrogen deficiency. [5]

Classic physiological studies have shown that a hot flash typically begins with a small but significant "spark" of increase in core temperature, followed by cutaneous vasodilation and sweating. This explains why relief is felt with cooling and why the clothing "layering" technique works. [6]

Updated reviews support this model and expand on it with the discovery of the role of neurokinin receptors. This is why new non-hormonal drugs have emerged that block neurokinin pathways and reduce the frequency of hot flashes. However, these drugs do not "reduce fever" during infections—they act only on the mechanisms that cause hot flashes. [7]

It's important to understand the normal range: during hot flashes, most women's core temperature remains below fever levels, and the episode quickly resolves on its own. A persistent increase in temperature or severe chills outside the typical pattern of hot flashes is a reason to look for another cause. [8]

Table 1. Hot flashes or fever: quick differences

Sign	Hot flashes during menopause	Fever
Episode duration	1-5 minutes, then rapid decline	Hours or days, often with chills
Measured temperature	Most often <38.0 °C	Usually ≥38.0 °C
Skin manifestations	Sudden redness, sweating	There may be pallor with chills, sweat - after a "breakthrough" of fever
Reaction to cooling	Quick relief	Partial, short-term
Associated symptoms	Anxiety, palpitations, sleep disturbances	Cough, pain when urinating, sore throat, body aches, severe weakness
What to do	Trigger management, treatment of vasomotor symptoms	Follow the fever and cause assessment algorithm

Table 2. Temperature thresholds and primary actions at home

Measured temperature	What could it be?	First steps
Up to 37.5 °C	Normal or subfebrile, often - hot flashes	Cooling, writing in a symptom diary
37.6-37.9 °C	Borderline: hot flashes, mild viral infection	Repeat measurement after 2-3 hours, monitor symptoms
≥38.0 °C	Fever	Hydration, antipyretic if feeling unwell, assessment of symptoms and causes
≥39.0 °C or any "red flags"	High fever or dangerous condition	Urgent medical attention

When It's Not Menopause: Red Flags

Red flags include: fever ≥38.0°C (101.5°F) for more than 48-72 hours, chills with shaking, severe chest pain or shortness of breath, severe headache or stiff neck, painful urination with burning and frequent urination, a wet cough with chest pain, an unexplained rash, unexplained weight loss, and night sweats with fever and weight loss. If these symptoms are present, it is not necessary to "treat menopause" but to investigate the cause of the fever. [9]

Night sweats without a measurable increase in temperature may be part of menopause. However, night sweats combined with fever and weight loss are a reason to rule out infections and hematological malignancies using generally accepted algorithms. [10]

During peri- and postmenopause, the incidence of urinary tract infections increases due to the genitourinary syndrome of menopause. If fever is accompanied by dysuria, lower abdominal pain, or lower back pain, cystitis or pyelonephritis are the most common causes. Treating hot flashes is not helpful; diagnosis and antibiotic therapy are necessary. [11]

Some medications can cause night sweats and "fever," such as some antidepressants, hormonal drugs, and oncology medications. This factor is considered in the differential diagnosis, and therapy is adjusted if necessary. [12]

Table 3. Common causes of fever in 45-60 year olds and associated symptoms

Group of reasons	Examples	What to look for
Respiratory tract infections	Viral and bacterial infections	Cough, sore throat, shortness of breath
Urinary tract infections	Cystitis, pyelonephritis	Dysuria, frequent urge to urinate, lower back pain
Other infections	Tuberculosis, endocarditis	Night sweats with weight loss, heart murmurs
Inflammatory and autoimmune	Thyroiditis, rheumatic diseases	Muscle and joint pain, laboratory markers
Oncohematology	Lymphomas	Persistent fever, night sweats, weight loss
Drug reactions	Antidepressants, tamoxifen, etc.	Connection with the beginning of the reception, characteristic dynamics

Diagnostic route

Step 1. At home. Measure your temperature with a reliable thermometer and record the readings and accompanying symptoms in a diary. Note the time of day, the relationship with food, alcohol, spicy foods, stress, physical activity, and medications. Repeat the measurement after 2-3 hours and the following morning. [13]

Step 2. If the temperature is ≥38.0°C or there are any "red flags," seek medical attention. Initial evaluation typically includes a complete blood count, C-reactive protein level, urinalysis, pulse oximetry, throat and lung examination, and, if indicated, a chest X-ray and symptom-based testing for infections. Thyroid function testing is indicated for symptoms of heat intolerance without fever. [14]

Step 3. If there is no fever, but hot flashes are a concern, proceed to treatment of vasomotor symptoms: non-drug measures, if necessary, hormonal or non-hormonal drugs according to indications and contraindications, with monitoring of effectiveness after 8-12 weeks. [15]

Step 4. For recurrent urogenital symptoms. Assess for signs of genitourinary syndrome of menopause and consider topical low-dose estrogens to reduce the risk of recurrent urinary tract infections. [16]

Table 4. Red flags and what to do

Situation	Action
Temperature ≥39.0 °C, severe chills, confusion	Seek immediate medical attention
Fever with chest pain, shortness of breath	Exclusion of pneumonia and vascular events
Fever with painful urination and lower back pain	Exclusion of pyelonephritis
Night sweats with fever and weight loss	Diagnosis of infection or oncohematological process
Any "unusual" bleeding from the genital tract	Gynecological examination according to standards

If there is no fever: how to treat hot flashes and night sweats

Hormone therapy. Hormone replacement therapy remains the most effective method for controlling hot flashes in women under 60 years of age or during the first 10 years after their last menstrual period, unless contraindicated. The choice of dosage form and route of administration is individualized; transdermal forms are often preferred in cases of increased vascular risk. In women with a preserved uterus, estrogen is combined with a progestogen. [17]

Non-hormonal options. There are effective non-hormonal treatments: some serotonergic and noradrenergic antidepressants, gabapentin, and oxybutynin. They reduce the frequency and intensity of hot flashes, especially in those for whom hormones are ineffective. [18]

New drugs that act on neurokinin receptors. Fezolinetant is approved as a non-hormonal neurokinin 3 receptor antagonist for the treatment of moderate to severe hot flashes. Liver function monitoring is required during use, as per the official labeling. In October 2025, elizanetant, the first dual neurokinin 1 and neurokinin 3 receptor antagonist, was approved in the US. Availability in European countries is determined by national regulators. [19]

Behavioral and non-pharmacological measures. Weight loss if overweight, smoking cessation, regular moderate-intensity physical activity, cooling techniques, and cognitive behavioral therapy improve hot flash tolerance and sleep. [20]

Table 5. Medication options for hot flashes without fever

Group	Examples	Typical start	Comments
Hormonal therapy	Estradiol with progestogen with preserved uterus	Low doses, individual route of administration	The most pronounced effect is achieved when the indications and contraindications are followed.
Antidepressants	Paroxetine, venlafaxine, desvenlafaxine, escitalopram	Low starting doses, titration according to tolerability	Useful for associated anxiety and depression
Anticonvulsants	Gabapentin	In the evening, with titration	Especially with night symptoms
Bladder medication	Oxybutynin	Low doses	May reduce the frequency of hot flashes
Neurokinin antagonists	Fezolinetant, elinzanetant	Fezolinetant 45 mg once daily; elizanetant 60 mg once daily at night	Liver monitoring is required for fezolinetant; fezolinetant is approved in the US in 10-2025.

Genitourinary syndrome of menopause, urinary tract infections and "fever"

Estrogen deficiency impairs the quality of the vaginal and urethral mucosa, increasing the risk of recurrent urinary tract infections, which are accompanied by a true fever. This is a common cause of fever in postmenopausal women, unrelated to hot flashes. [21]

Local low-dose estrogens reduce the risk of recurrent urinary tract infections in women with genitourinary syndrome of menopause. This is recommended by specialized urological societies for recurrent infections. [22]

Additionally, moisturizers and lubricants are used to reduce dryness and soreness, which indirectly reduces behavioral triggers for infection. In the presence of fever and dysuria, cystitis and pyelonephritis must always be ruled out using standard methods. [23]

It's important to distinguish: topical estrogens and infection prevention measures do not treat hot flashes, but they do reduce episodes of "true fever" when the cause is a urinary tract infection. Hot flashes may persist and require separate management. [24]

Table 6. Genitourinary syndrome of menopause: how to help and what to expect

Target	First line	Proven effect
Dryness and pain	Low-dose vaginal estrogens	Improvement of vaginal atrophy symptoms
Recurrent urinary tract infections	Local estrogens	Reducing the frequency of relapses
Additions	Moisturizers, lubricants, pelvic floor exercises	Further improvement in quality of life
When to see a doctor	For pain, blood in urine, fever	Exclusion of cystitis and pyelonephritis

Common myths and accurate answers

"Menopause causes high fever." No. Hot flashes are brief episodes of heat and sweating due to a narrowing of the thermoneutral zone. Fever is more often associated with infection and is diagnosed by a temperature measurement of 38.0 °C or higher. [25]

"If you have hot flashes, you can ignore night sweats with fever." It's not. Night sweats, along with weight loss and fever, require a general examination, not "menopause treatment." [26]

"Non-hormonal agents are weak." Modern non-hormonal drugs, including neurokinin receptor antagonists, provide a significant reduction in the frequency and intensity of hot flashes, especially when hormones are contraindicated. [27]

"New drugs work on any temperature." No. They specifically reduce hot flashes and night sweats, not fever associated with infections. A standard diagnostic approach is needed for high temperatures. [28]

Table 7. Home checklist for “temperature during menopause”

Step	Action
1	Measure the temperature with a thermometer and record the reading.
2	Assess symptoms: cough, sore throat, dysuria, chills, headache, rash
3	If <38.0 °C and this is a typical hot flash, apply cooling measures, keep a diary
4	If ≥38.0 °C, lasts longer than 48-72 hours, or there are “red flags,” consult a doctor.
5	If there is no fever but frequent hot flashes, discuss treatment for vasomotor symptoms.
6	For recurrent urogenital complaints, discuss topical estrogens.

Briefly about the latest: what has changed today

In 2023, fezolinetant, a neurokinin 3 receptor antagonist, was approved; recommendations for liver function monitoring were added to the label in 2024–2025. In October 2025, the US Food and Drug Administration approved elizanetant, the first dual neurokinin 1 and neurokinin 3 receptor antagonist, for the treatment of moderate to severe hot flashes; the European Union Medicines Committee supported the European marketing authorization. This news concerns the treatment of hot flashes, not fever. [29]

Conclusions

1. Hot flashes and fever are different phenomena: hot flashes are short-lived and rarely accompanied by an objective temperature ≥38.0 °C. 2) Any persistent temperature of 38.0 °C or higher requires a standard examination for infections and other causes. 3) In the absence of fever, measures to control vasomotor symptoms help: lifestyle, hormonal therapy when indicated, and modern non-hormonal drugs. 4) In postmenopause, it is important to remember the genitourinary syndrome of menopause as a risk factor for urinary tract infections, which already produce a "real" fever. [30]