Perimenopause, the natural transition period leading up to menopause, is characterized by fluctuating hormone levels that can cause a variety of physical symptoms. These sudden, intense sensations of coldness, sometimes referred to as “cold flashes,” are a recognized component of vasomotor symptoms (VMS). VMS include hot flashes and night sweats, and affect a large majority of women during this phase of life. Chills that occur during perimenopause are directly linked to the body’s attempt to regulate a poorly controlled internal temperature.
The Mechanism of Temperature Dysregulation
The body’s internal thermostat is housed in the hypothalamus, a small region of the brain that maintains a stable core temperature. Fluctuations in estrogen, a hallmark of the perimenopausal phase, interfere with the hypothalamus’s ability to accurately sense and regulate temperature. This hormonal interference effectively narrows the body’s “thermoneutral zone,” which is the comfortable range of external temperatures a person can tolerate without needing to sweat or shiver.
When estrogen levels are erratic, the hypothalamus can mistakenly perceive that the body is overheating. This miscommunication triggers an immediate heat-dissipating response known as a hot flash. During this response, blood vessels near the skin surface widen (vasodilation) and the sweat glands activate to rapidly cool the body through evaporation.
After this heat loss, the core temperature can drop too quickly or too far below the new, narrowed set point. This rapid cooling overshoots the target, triggering a rebound chill or shivering as the body attempts to generate warmth and restore thermal balance. The chills are a secondary reaction, following the intense heat loss of the hot flash.
Lifestyle Adjustments for Managing Temperature Swings
Managing temperature swings begins with environmental control and self-awareness. Layering clothing is an effective strategy, allowing for the quick removal of garments at the onset of a hot flash and easy re-layering when the subsequent chill sets in. Fabrics that wick moisture away from the skin can also minimize the chilling effect caused by sweat evaporation.
Controlling the immediate environment, especially at night, can significantly reduce the frequency and severity of VMS. Keeping the bedroom temperature cool, using a fan directed at the bed, and employing layered bedding that can be easily tossed off and pulled back on are practical steps. Avoiding common triggers can also make a difference. Many women find that consuming spicy foods, hot beverages, alcohol, and caffeine can bring on a temperature swing.
When Chills Signal Other Health Concerns
While chills are a common experience during perimenopause, they must be distinguished from symptoms indicating a more serious underlying health issue. Perimenopausal chills typically occur in isolation or immediately following a hot flash and are not accompanied by signs of infection. Chills accompanied by a high fever, localized pain, persistent cough, or unusual urinary issues should be brought to a healthcare provider’s attention immediately.
Other medical conditions can also cause cold sensations, including thyroid dysfunction, anemia, or an anxiety disorder. If chills are severe, debilitating, or are accompanied by unexplained weight loss or a general feeling of being unwell, a differential diagnosis is necessary. Consulting a doctor helps ensure that the symptoms are correctly attributed to hormonal changes and that other conditions are not overlooked.
Professional Treatment Options
When lifestyle adjustments do not provide sufficient relief from severe or disruptive vasomotor symptoms, medical treatments are available. Menopausal Hormone Therapy (MHT), involving estrogen and often progesterone, is recognized as the most effective method for treating VMS. MHT works by stabilizing fluctuating hormone levels.
For women who cannot or choose not to use hormone therapy, non-hormonal prescription options are effective alternatives. Non-hormonal options include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) such as paroxetine and venlafaxine, and the anticonvulsant gabapentin.
A newer class of medication, neurokinin B antagonists, such as fezolinetant, works by directly targeting the neural pathways in the hypothalamus that regulate temperature. These options offer targeted relief by modulating the brain’s thermoregulatory center without the use of systemic hormones. Medical treatment decisions should be made after a thorough discussion with a healthcare provider to weigh the risks and benefits.