Hyperhidrosis & Perimenopause: What to Do When Your Sweating Gets Worse

If you’ve had hyperhidrosis since childhood and you’ve noticed an intensification in your sweating now that you’re entering midlife, you’re probably wondering what’s going on.

In this article we cover the difference between primary hyperhidrosis and secondary hyperhidrosis, discuss hot flashes, and explore what you can do to manage your sweating as you age.

TL;DR: Hot flash or HH?

• Primary hyperhidrosis: A chronic medical condition that results in excessive sweating. It typically begins at a young age or in adolescence, is usually focused in certain areas (like the hands, feet, underarm, face, groin, etc.), and usually stops during sleep.
• Secondary hyperhidrosis: Excessive sweating that’s caused by an underlying medical condition (like menopause, diabetes, lymphoma, etc.) or medication (like SSRIs/SNRIs, ADHD stimulants, diabetes medications, cancer therapies, etc.), and typically involves all-over sweating, including night sweats.
• Hot flashes: Sudden wave of heat from chest up that lasts 1–5 minutes and is sometimes accompanied by heart palpitations.
• Sweat management: A variety of sweat management solutions can be used depending on the type of hyperhidrosis and symptoms. These may include Hormone Replacement Therapy (HRT) for hot flashes; anticholinergics (like glycopyrrolate or oxybutynin), prescription antiperspirants, or iontophoresis for hyperhidrosis; and lifestyle changes like switching to bamboo sheets or tracking sweat triggers in a journal.

Welcome to the ‘second wave’ of sweating

It seems so unfair.

You spent your 20s and 30s finally getting a handle on your hyperhidrosis, and then… BAM.

Your 40s hit.

Suddenly, the sweating feels different. It’s more intense, it’s coming in waves, and you’re wondering if your hyperhidrosis (HH) has evolved or if you’ve officially entered perimenopause (the period leading up to menopause).

For women with a history of HH, perimenopause can feel like a cruel joke.

It’s sweat on top of sweat.

But understanding the difference between your regular HH and hormonal sweat is the first step to reclaiming your comfort.

Understanding the biological thermostat

Our body’s internal temperature is regulated by the hypothalamus.

Think of it as your internal ‘Nest’ thermostat.

If you have primary hyperhidrosis, your wiring has been overactive since birth or puberty. The signal to sweat is stuck in the “ON” position, even when the ambient temperature is a perfect 20 C/68 F.

In perimenopause, estrogen fluctuations confuse that already overactive thermostat.

Estrogen helps regulate the thermogenic window, so when estrogen levels fall, that window narrows.

The hypothalamus suddenly thinks the body is overheating when it isn’t, triggering a hot flash (vasodilation) to cool you down rapidly.

Symptom comparison

So, how do you know what type of sweating you’re dealing with?

Primary hyperhidrosis is usually characterize by focal sweating (i.e., sweating on your hands, feet, underarms, face, groin, etc. rather than overall sweating). It usually starts in youth, and is triggered by relatively constant things like stress, food, humidity, etc. With primary hyperhidrosis, excessive sweating rarely happens during sleep.

Menopausal hot flashes usually start as a sudden rush of heat in the chest and face, lasts for 1–5 minutes, and is often accompanied by a rapid heartbeat or anxiety.

Night sweats are hallmark of perimenopause. If you’re waking up in a puddle but your hands and feet were dry all day, it could be hormonal. Night sweats and other hormonal sweating are technically considered a type of secondary hyperhidrosis.

The double whammy: When HH and perimenopause collide

For those of us who already have HH, the menopause transition can unlock new sweating areas.

You might have always had sweaty hands, but now you suddenly have a sweaty scalp or back. This is because your body’s overall threshold for sweating has lowered.

Or you might be experiencing new forms of sweating, night sweats, hot flashes, or generalized sweating, which you’ve never experienced before. This is often due to fluctuating estrogen.

All this sweating is exhausting, both physically and mentally.

So what can you do? Let’s talk about management strategies

If your sweating has changed, the first step is always to speak about it with your doctor. It’s important to rule out other serious medical reasons that might be causing you to sweat.

From there, under the guidance of your doctor, you might need a multi-pronged approach:

• Hormonal support: Talk to your doctor or OBGYN about HRT (hormone replacement therapy). For many women, stabilizing estrogen levels significantly reduces the frequency of hot flashes.
• Oral medications: If the sweating becomes generalized and unbearable, ask your doctor about anticholinergics like glycopyrrolate or oxybutynin. These work by blocking the acetylcholine receptors that tell your sweat glands to fire.
• Other hyperhidrosis treatment options: If you’ve had hyperhidrosis your whole life, you may have already explored treatment options. But as a reminder, options to manage excessive sweating include: extra strength antiperspirants, prescription antiperspirants, iontophoresis, and oral medications.
• Lifestyle changes: To ease the discomfort of night sweat, you could try switching to Tencel or bamboo bedding. Unlike cotton, which holds onto moisture and gets cold/clammy, these fibers help move moisture away from the body.
• Dietary triggers: Alcohol, caffeine, and spicy foods are all known to be vasodilators. They open up blood vessels and trigger the hypothalamus to sweat. During perimenopause, you may notice that your sensitivity to these triggers increases. If so, it might be worth reducing or eliminating certain triggers to see if it helps.

The key takeaway here is that treatment options and management strategies do exist. You have options.

You don’t need to suffer alone with excessive sweating.

Bonus tip: Create a sweat journal

To get the very best help from your doctor, you need data. Keeping a sweat journal can be one way to amass this data.

For two weeks, try tracking the following:

1. Time of day: Are you sweating more at 3pm or 3am?
2. Intensity: 1 (damp) to 10 (dripping).
3. Location: Is it your old HH spots or new hot flash areas?
4. Food/Drink: Did you have wine or spicy food within 4 hours?

Bringing this data to your doctor or a specialist allows them to distinguish between primary HH and menopausal secondary HH.

Closing thoughts

Going through perimenopause can introduce many new challenges, including an increase in sweat.

For women who already have hyperhidrosis, this feels like a double whammy.

But you don’t need to suffer through it alone. Speak with your doctor about options are available to you.

And if you want to connect with other women in a similar situation, join our free Sweaty Girl Society membership community! We have discussion forums, live events, and other ways to connect, learn, and feel less alone. Join now.