Night sweats

The NHS website describes night sweats as sweating so heavily that your nightclothes and bedding are soaked, even though the place you sleep is cool. That is different from waking warm under a heavy razai in December.

The Pakistan Menopause Society's recommendations call a hot flush that happens in your sleep, with sweating, a night sweat. Doctors group the two together as vasomotor symptoms. Night sweats can start in perimenopause, while your periods are still coming.

Heat climbing in your sleep, then waking wet through. Changing your clothes at 3am, turning the pillow to the dry side, pulling the sheet back once the chill sets in.

Then the next day, slow and short-tempered. The NHS website notes that sleep problems can be worse when night sweats come with them. If the broken nights are what is wearing you down, sleep disruption has its own page.

This is one of the few symptoms Urdu already has words for. Raat ke paseene is what you can say to your doctor, as it is.

The Pakistan Menopause Society's recommendations describe hot flushes and night sweats as coming from the brain's temperature control going off balance as estrogen changes. The body decides it is overheating when it is not, and switches on the sweat.

That is the menopause explanation, not the only one. The NHS website also lists anxiety, some antidepressants, steroids and painkillers, low blood sugar, alcohol or drugs, and a harmless condition that makes some people sweat too much all the time. So a doctor will ask more than one question before putting the sweats down to perimenopause. Bring the names of any medicines you take.

• The Pakistan Menopause Society lists light, absorbent nightwear, cooling aids such as a face spray or a cold pillow pad, avoiding hot drinks and sudden changes of temperature, layers you can adjust, and a bedroom kept cool, quiet and dim (section 4.2.3).
• The NHS website lists lightweight clothing, a cool bedroom at night, a cool shower, a fan or a cold drink, ways to lower stress, regular exercise and a healthy weight. Among the triggers it suggests avoiding or cutting down are spicy food, caffeine, hot drinks, smoking and alcohol.
• The European Menopause and Andropause Society (EMAS) says the evidence on whether exercise eases hot flushes and night sweats is mixed. It still advises exercise for stronger bones and fewer falls. Just do not count on it to stop the sweats.
• The British Menopause Society says caffeine may increase hot flushes and disturb sleep. On chai, the PMS recommendations note that tea drinking is high in Pakistan and that excess caffeine may break up sleep, and they ask doctors to talk through timing and amount with you (Table 7). Chai and caffeine has more.

NICE NG23 and the PMS recommendations both list HRT as a first-line option for hot flushes and night sweats, in women who can take it. Whether you can is a decision for your doctor to make with you. The NHS website says HRT may not suit women with a history of breast, ovarian or womb cancer, untreated high blood pressure or liver disease, and NICE NG23 tells doctors to consider specialist advice for a woman with a condition HRT may affect (1.8.2).

NICE NG23 also tells doctors to consider menopause-specific CBT, alongside HRT or instead of it, and names fezolinetant, a non-hormonal medicine, as an option for moderate to severe symptoms when HRT is unsuitable. It advises against routinely offering antidepressants such as SSRIs first when flushes and sweats are the only problem.

If night sweats wake you regularly or worry you, the NHS website says that is reason enough to see a GP.

Go sooner if the sweats come with a very high temperature, or feeling hot, cold or shivery, a cough or diarrhoea, or if you are losing weight without trying. The NHS website lists those as signs a doctor should check, because they can point to something other than the menopause. Outside England, take the same list to your own doctor.

The Menopause Society adds one more: sweats that begin many years after your periods have stopped need checking. It names an overactive thyroid and tuberculosis among the conditions that can cause them, along with some medicines.

A soaked bed is hard to hide from a husband, and harder to explain when neither of you has the word for it. Now you both do.

In Ramadan, an alarm before suhoor lands on top of a night already broken. Questions about the fast belong with a qualified scholar. Questions about when to take a medicine during Ramadan belong with whoever prescribes it.