Cold flushes

A cold flush is a sudden feeling of cold, chills or shivering with nothing in the room to explain it. It can come on its own, or straight after a hot flush. Some women get them at night and wake chilled rather than soaked.

Cold flushes are part of the same temperature changes as hot flushes. The NHS website describes a hot flush as the face, neck and chest suddenly feeling very hot or cold, so the cold is already in its description. No guideline we checked names cold flushes separately. Doctors group hot flushes and night sweats under one name, vasomotor symptoms, which is the word you will find in the guidelines.

• cold or shivery in a warm room, while everyone else is comfortable
• a chill that follows a hot flush, as the heat breaks and the sweat cools
• waking in the night cold, then lying awake trying to warm up
• cold hands and feet
• shivering that comes in waves and passes within minutes

In Urdu, Roshara calls it cold flush, beside the words women already use: thand lag rahi hai, I feel cold, and kapkapi, shivering.

The Pakistan Menopause Society's recommendations describe hot flushes as coming from the brain's temperature control going off balance as estrogen changes.

A 2021 review in Endocrinology, by Zhang and colleagues, describes how estrogens act at several points in the brain's temperature-control circuits, centred on the hypothalamus, and calls hot flushes and night sweats the archetypal symptoms of perimenopause. The review does not discuss cold flushes directly.

Put simply, a thermostat that has been knocked off balance can misjudge in either direction. Cooling that overshoots leaves you cold; a chill with nothing in the room to cause it is the same system getting it wrong the other way. That is our reading, not the review's, and it is why cold flushes so often travel with hot ones.

No guideline we checked lists anything for cold flushes on their own. The everyday answers are simple: layers you can put on and take off quickly, such as a cardigan, a shawl or a dupatta; a light sheet with a blanket folded at the foot of the bed; socks at night if your feet go cold; and a warm drink when a chill comes.

If you are tracking your hot flushes, note the cold ones in the same place, so your doctor sees both. Trigger tracking explains how.

NICE NG23 and the Pakistan Menopause Society both list HRT as a first-line option for hot flushes and night sweats, in women who can take it. Neither names cold flushes. If your chills come along with hot flushes or night sweats, it is fair to ask your doctor whether the same options apply to you.

Feeling cold and shivery can have other causes. The NHS website says to see a GP if night sweats come with a very high temperature, or feeling hot, cold or shivery, a cough or diarrhoea, or weight loss you cannot explain.

Feeling cold all the time, rather than in waves, is worth raising too. A doctor may want to check your thyroid or test your blood count before putting it down to the menopause.

A chill at Fajr on a winter morning, with cold water for wudu, can feel twice as hard when your body is already swinging between hot and cold. A shawl kept by the prayer mat is a small thing that helps.

At home, a woman wrapped in a blanket in June gets asked whether she has a fever. Having a word for it, and knowing it belongs with the hot flushes, makes it easier to explain.