menopause and cold flashes and feeling cold all the time
By Andrea Donsky | Fact Checked | Sources
Everyone warned you about hot flashes. Nobody mentioned the other one, where a wave of cold rolls through you out of nowhere and you are shivering in a warm room while everyone else is fine. If you have wondered whether you are imagining it, you are not. It has just been strangely ignored by science.
Cold flashes or chills? Which one is yours
These two words get used for the same thing and they describe slightly different experiences, so it is worth knowing which page you actually need.
- A cold flash is a wave of cold arriving out of nowhere, often without shivering. That, and feeling cold all the time, is what this page covers.
- Chills are the shiver itself, the teeth chattering and goosebumps, and they most often arrive in the minutes after a hot flash. Our guide to menopause and chills covers that, and also walks through when a chill is pointing at infection, panic, low iron or thyroid rather than your hormones.
What is a cold flash?
A cold flash is a sudden wave of cold that arrives without an external cause. Women describe it as a chill starting in the chest or back and spreading outward, sometimes with goosebumps, shivering, cold hands and feet, or a cold nose. It usually lasts seconds to a few minutes and then passes, exactly like a hot flash but in the opposite direction.
Here is the honest part. There is essentially no peer reviewed research on cold flashes in menopause. Searching the medical literature for "cold flashes" and "cold flushes" turns up around sixteen records, and almost all of them are about opioid withdrawal, panic disorder or phantom limb pain. Researchers looking at temperature complaints after breast cancer treatment stated plainly that there is essentially no scientific study of the large number of women who report feeling excessively cold (Kokolus KM et al, Int J Hyperthermia 2010, PMID 20849261).
So this is a symptom that thousands of women report and that nobody has properly studied. That is not the same as it being imaginary. It means the research has a hole in it.
What causes cold flashes in menopause?
The most credible explanation borrows from the physiology of hot flashes, which has been studied thoroughly.
Your body normally maintains a thermoneutral zone, a small range of core temperature within which you neither sweat nor shiver. In menopausal women with vasomotor symptoms, that zone essentially disappears. In a controlled laboratory study, the gap between the sweating threshold and the shivering threshold was 0.0 degrees Celsius in symptomatic postmenopausal women compared with 0.4 degrees in asymptomatic women (Freedman RR and Krell W, Am J Obstet Gynecol 1999, PMID 10411797).
Read that again, because it explains everything. With no buffer, a tiny rise in core temperature pushes you straight into sweating, and a tiny drop pushes you straight into shivering. You are not overreacting to temperature. Your thermostat has lost its deadband.
Why do I get hot flashes then cold chills?
Because they are two halves of the same event, and this is the best documented part of the whole picture.
During a hot flash your body dumps heat aggressively. Finger blood flow rises around thirtyfold and you sweat. That works, and it overshoots. Measured core temperature falls by 0.2 to 0.6 degrees Celsius during a flash (Kronenberg F et al, Maturitas 1984, PMID 6472126). As described in a review of the mechanism, once core temperature crosses the lower threshold, shivering occurs (Freedman RR, J Steroid Biochem Mol Biol 2014, PMID 24012626).
So the chill is not a separate mysterious symptom. It is your body having overcorrected. The wet nightclothes and damp sheets from the sweat make it considerably worse, because evaporation keeps pulling heat out of you after the flash has ended.
This pattern shows up in what women actually report too. In interviews with 20 women with vasomotor symptoms, the key symptoms identified were sweating, cold sweats and chills, and tiredness (Haberland C et al, J Patient Rep Outcomes 2025, PMID 40591096).
Why am I feeling cold all the time in perimenopause?
Constant cold is a different problem from cold flashes, and it is the one more likely to have a fixable cause behind it. Three are worth ruling out.
Iron deficiency. This one is well evidenced and often missed. In a controlled study of 30 women given a cold challenge, iron deficient anemic women had significantly lower core temperature and lower heat production, and iron supplementation corrected it (Beard JL et al, Am J Clin Nutr 1990, PMID 2239756). And you do not have to be anemic. A separate depletion and repletion study in 11 women found that iron depletion without anemia still reduced metabolic heat production and made shivering start earlier (Lukaski HC et al, Aviat Space Environ Med 1990, PMID 2241732). Both studies are small and old, but they measure the thing directly.
Thyroid. Cold intolerance is a recognized feature of an underactive thyroid, and thyroid problems become more common with age and are more common in women. In a survey of 25,862 people, 9.5 percent had an elevated TSH (Canaris GJ et al, Arch Intern Med 2000, PMID 10695693). No single symptom is reliable enough to diagnose it, which is exactly why a blood test is the answer rather than a symptom checklist.
Less muscle. Muscle generates heat. Lean mass declines across the menopause transition, and less of it means less resting heat production. This one gets no attention and it is probably part of why so many women say they feel the cold more than they used to.
Our Top Picks for Hot Flashes
Why is my nose always cold in menopause?
Enough women search this that it deserves its own answer. The nose, fingers and toes are the first places the body restricts blood flow when it is conserving heat, because they have a lot of surface area relative to volume. If your thermoregulation is running erratically, these are the places you notice first.
Fingers or toes that go white, then blue, then red with cold or stress are a different pattern called Raynaud's phenomenon, and that is worth mentioning to your doctor rather than filing under menopause.
Why do cold flashes happen at night?
Core body temperature naturally drops in the evening as part of falling asleep, so you begin the night closer to the shivering threshold. Add a night sweat that soaks your nightclothes, and evaporative cooling does the rest. Many women describe waking drenched and hot, then waking again an hour later shivering.
The practical fix is unglamorous and it works: sleep in something you can change, keep a dry set within reach, use layers rather than one heavy duvet, and consider a wool or bamboo base layer, both of which handle moisture better than cotton.
What helps cold flashes?
- Layer, do not heat. Cranking the thermostat pushes you toward the hot flash end of a zone that has no buffer. Layers you can add and shed track the swings far better.
- Get out of damp clothing immediately. This is the single most effective thing for the chill that follows a flash. Keep a dry change beside the bed.
- Ask for a ferritin test, not just hemoglobin. Iron stores can be low while your blood count reads normal, and the thermoregulation evidence applies to that group.
- Get your thyroid checked. A TSH is inexpensive and cold intolerance is one of the reasons to run it.
- Build and keep muscle. Strength training twice a week protects your resting heat production as well as everything else it does.
- Eat enough. Very low calorie intake reduces heat production and is a common and unrecognized reason for feeling cold constantly.
- Move when one starts. Two minutes of walking or a few sit to stands generates heat from the inside rather than waiting to be warmed from the outside.
Shop Menopause Vasomotor Support
Cold flashes and hot flashes come from the same narrowed thermoneutral zone, which is why they are best thought about together rather than separately. Morphus's Hot Flashes collection brings together the nutrients and tools we use for vasomotor symptoms during the transition.
Shop Vasomotor Support →These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
When should you see a doctor about feeling cold?
Book an appointment if you feel cold constantly rather than in waves, if it comes with fatigue, weight change, hair loss, dry skin, constipation or a slow heart rate, or if it started fairly suddenly. Ask for thyroid function, a complete blood count and a ferritin level as a minimum.
Seek same day care for shivering with a fever, since that is a chill of a different kind and points to infection rather than hormones. Fingers or toes that change color in the cold, numbness in the extremities, or cold affecting only one limb also need looking at rather than managing with an extra sweater.
Related perimenopause and menopause symptoms
If you're experiencing this symptom, you may also find these related guides helpful: hot flashes, chills, and night sweats. You can also browse our full guide to other perimenopause and menopause symptoms.
Frequently Asked Questions
Are cold flashes a sign of perimenopause?
They are widely reported by women in perimenopause and fit the known physiology of a narrowed thermoneutral zone, but they have never been formally studied as a symptom, so no researcher has established them as a diagnostic sign. Feeling cold constantly, as opposed to in waves, is more likely to point at thyroid or iron than at hormones.
Can you have cold flashes without hot flashes?
Women report that they can. Since cold flashes have not been studied, there is no data on how often they occur alone. Cold that arrives without any hot flashes at all makes it more worthwhile to check thyroid function and iron stores.
Do cold flashes mean my hormones are low?
Not in any way that a blood test can confirm. Hormone levels in perimenopause swing so widely from day to day that a single measurement tells you very little, which is why menopause is diagnosed from symptoms and cycle history rather than from a hormone panel in most women.
How long do cold flashes last?
Individual episodes are usually seconds to a few minutes, similar to a hot flash. As a phase of life, vasomotor symptoms typically run for several years around the final period, though the range between women is very wide.
Morphus shares educational information, not medical advice. Speak with your doctor about what's right for you.
