Menopause: Does caffeine make hot flashes worse?

As your body approaches menopause, there are many changes to contend with.

While some people barely notice the transition, others face a raft of symptoms that appear and disappear seemingly at random. 

Hoping to minimize these symptoms, many people turn to their diets. After all, food has a huge effect on how we feel, and we can make some dietary changes relatively easily.

When you also consider the fact that everyone’s biology is unique, understanding what you should and shouldn’t eat becomes even more challenging.

A common question is whether to give up caffeine during perimenopause or menopause. So, we decided to dive deep and see what the science says.

To help us untangle fact from fiction, we spoke with Dr. Louise Newson, a general practitioner in the United Kingdom who specializes in health during menopause. She explained:

Caffeine and menopause

If you’re trawling through Google looking for ways to reduce the symptoms of menopause, you’ll often meet the advice to cut out caffeine.

For instance, the United States' National Institute on Aging suggests that women might manage minor symptoms through changes such as “avoiding caffeine.”

Across the pond, the U.K.'s National Health Service (NHS) suggests that avoiding caffeine might ease hot flashes.

But where is this advice coming from? While researching this article, we found a number of websites and papers linking to this study from 2015. 

It’s one of the largest to investigate possible links between caffeine and menopause symptoms. So, let’s have a look at it.

What did they do?

The scientists recruited more than 1,800 women aged 40 or older. All had attended a women’s clinic with “menopausal concerns.” 

Each participant filled out a questionnaire asking about a range of symptoms, including vasomotor symptoms. These are caused by the constriction or dilation of blood vessels. 

During perimenopause (the time leading up to menopause) around 75% of women report having hot flashes. For some, these come and go for 6 months. For others, they might last up to 10 years.

And for some women, hot flashes might never stop. As the Menopause Society explains, “There is no reliable way of predicting when they will start — or stop.”

The authors of the 2015 study also collected information about caffeine consumption, smoking, and other lifestyle factors.

What did they find?

The scientists concluded that people who consumed caffeine reported more vasomotor symptoms. 

But when they looked at many other menopause symptoms, affecting sleep, bowel and bladder function, and sexual function, caffeine consumption made no difference either way.

And for some other symptoms, caffeine was linked with improvements.

Some limitations

Importantly, this study was cross-sectional, so it only looked at caffeine consumption at one point in time. 

And it hinged on a simple yes or no question: “Do you consume drinks with caffeine (coffee, tea, soda drinks)?” 

So, one participant in the “yes” group might drink one cup of tea each week, while another could have 10 cans of cola a day.

Another limitation was that the researchers couldn't account for whether the participants were taking hormone replacement therapy (HRT). This is important because HRT greatly influences how regular and severe hot flashes are.

Also, it’s worth looking at the extent of the difference in vasomotor symptom severity between caffeine drinkers and non-caffeine drinkers.

The size of the difference

The participants had completed a questionnaire about the severity of their symptoms using a 4-point scale. 

It asked people to “indicate how bothered you are now and in the past few weeks by any of the following,” and it listed a range of symptoms.

Participants had four options:

1. not at all

2. a little bit

3. quite a bit

4. extremely

For vasomotor symptoms, those who didn’t drink caffeine had an average score of 2.15, and those who did drink caffeine had an average score of 2.3.

Although this difference is statistically significant, it’s not a huge gap — both groups are still closer to “a little bit” bothered than “quite a bit” bothered.

Is there any other research?

This isn't the only study to have looked for links between caffeine and hot flashes. We’ll outline a couple below.

A study from 2011 took a longitudinal approach, following a group of participants over time. To do this, the researchers took data from the Study of Women’s Health Across the Nation (SWAN).

For over 10 years, the researchers followed more than 3,300 women from five racial or ethnic groups in the U.S. Each year, the scientists collected detailed information about various factors, including the women's lifestyles, diets, and menopause symptoms.

Ultimately, the team found no association between consuming caffeine and having vasomotor symptoms. 

Meanwhile, a 2018 study looked at vasomotor symptoms in more than 900 women aged 60 or older. They found that drinking caffeine was associated with increased vasomotor symptoms, but only in those aged 70 or older.

There are other studies, but they’re generally smaller, which means that their findings might be less generalizable to the population at large.

For instance, one study involving 196 people looked at the role of several factors, including caffeine, on hot flashes. The authors concluded that, overall, caffeine increased the severity of hot flashes. And drinking caffeinated soda was linked to increased severity and frequency of hot flashes.

On the other hand, a study involving 243 people found that caffeine intake was linked with less severe vasomotor symptoms. 

We need more research. Not just into caffeinated beverages, but into menopause more generally.

Caffeine and other symptoms

Hot flashes are far from the only symptom that appears during perimenopause. So, could caffeine make some of these other symptoms worse?

Sleep troubles

People experiencing perimenopause and menopause often have trouble sleeping. Night sweats, a vasomotor symptom, can interfere with sleep. But other symptoms can disrupt sleep, too.

Because it's a stimulant, caffeine may have a role to play here. But as with so much in health and nutrition, it really depends on your body.

Also, there's evidence that as we age, we become more sensitive to caffeine-induced insomnia.

So, even if caffeine didn’t use to keep you awake, as your body changes over time, caffeine might slowly become a factor in sleep troubles.

Palpitations

Palpitations —  where your heart feels like it’s pounding or fluttering — “are another lesser-known but actually very common symptom of menopause. Caffeine can sometimes trigger palpitations in otherwise healthy women,” explained Dr. Newson. 

And if your sensitivity to caffeine is slowly increasing as you age, palpitations might be more likely.

However, a study looking at palpitations in 394 women aged 40–59 did not find a link with caffeine consumption. 

The authors did find that palpitations were associated with vasomotor symptoms — so people with more hot flashes and night sweats were more likely to experience palpitations. 

But they weren’t associated with caffeine intake.  

Bladder issues

During menopause, “A lack of estrogen can cause the lining of your urethra and your bladder to become thinner and more susceptible to harmful bacteria,” explained Dr. Newson.

“A lot of women I see in my clinic will suffer from bladder issues such as urge incontinence and frequent urinary tract infections. Caffeine acts as a diuretic, which can increase bladder irritability.”

What should you do?

For some people experiencing the menopause transition, giving up caffeine might be an easy and effective change. For others, giving up morning coffee might be a very difficult adjustment at an already challenging time.

We asked Dr. Newson for her advice:

“If you are the type of person who just can’t function without a morning cup of coffee, and cutting out caffeine is unrealistic,” she continued, “try to be more mindful of when and how much you have.”

Dr. Newson has developed a free menopause support app called balance. It helps people track their symptoms along with their daily food and drink intake to help identify any triggers.

If you do drink a lot of caffeine, Dr. Newson suggests cutting back slowly to reduce the risk of rebound headaches.

Overall, giving up your beloved caffeine might be an extra struggle that you don’t need to put yourself through. But if it works for you, go with it.

The last word

We asked Dr. Newson for the best, evidence-based ways to reduce the impact of hot flashes. She responded:

“HRT is the gold-standard treatment recommended by the National Institute for Health and Care Excellence for menopause symptoms.”

“As the name suggests, it replaces the hormones you are deficient in, and hot flashes and night sweats should start to subside within a few weeks of starting HRT.”