Cold Sensitivity & Chills

What It Is

Cold sensitivity and chills during perimenopause and menopause describe feeling persistently cold, experiencing chills or shivering, or being unable to warm up—even when others are comfortable or the environment is objectively warm.

Women describe:

• "I'm freezing all the time. I layer clothes and still can't get warm."
• "I have chills that come in waves, just like hot flashes but the opposite."
• "My hands and feet are ice cold. They're painful to touch."
• "I shiver uncontrollably, even under blankets."
• "I alternate between freezing and sweating. My thermostat is broken."

This isn't just "being cold-natured"—it's a physiological shift in thermoregulation, metabolism, circulation, and potentially thyroid function, driven by hormonal changes.

Why It Happens

1. Thermoregulation Dysfunction (Hypothalamus Dysregulation)

The hypothalamus is the brain's thermostat—it regulates body temperature:

Normal thermoregulation:

• Hypothalamus receives input from temperature sensors throughout the body
• If body temperature drops → hypothalamus triggers warming responses (shivering, vasoconstriction, increased metabolism)
• If body temperature rises → hypothalamus triggers cooling responses (sweating, vasodilation)

Estrogen's role:

• Estrogen modulates hypothalamic function and thermoregulation
• Estrogen stabilizes the temperature set point

When estrogen declines or fluctuates:

• Hypothalamus becomes dysregulated → temperature set point becomes erratic
• Result: The brain misinterprets normal body temperature as "too hot" (hot flashes) or "too cold" (chills)
• Some women experience both hot flashes and cold spells, sometimes in rapid alternation

Why this causes chills:

• The hypothalamus signals "body is too cold" (even when it's not) → shivering, vasoconstriction, chills
• "I'm freezing, then suddenly hot, then freezing again" reflects the chaotic thermoregulation

2. Vasomotor Instability (Blood Vessel Reactivity)

Estrogen affects blood vessel function:

What estrogen does:

• Estrogen promotes vasodilation (blood vessels widen → blood flow increases → warmth)
• Estrogen supports healthy endothelial function (lining of blood vessels)

When estrogen declines:

• Vasoconstriction increases (blood vessels narrow → blood flow decreases → cold hands, feet, extremities)
• Vasomotor instability → blood vessels constrict and dilate erratically (alternating chills and hot flashes)

Why this causes cold extremities:

• Reduced blood flow to hands, feet, fingers, toes → they feel ice cold
• Raynaud's phenomenon (exaggerated vasoconstriction in response to cold or stress) can worsen during menopause

3. Thyroid Dysfunction (Hypothyroidism)

Thyroid hormones regulate metabolism and body temperature:

What thyroid hormones do:

• Thyroid hormones (T3, T4) control basal metabolic rate (how fast the body burns energy and produces heat)
• Adequate thyroid function → normal body temperature, warmth

Perimenopause/menopause and thyroid:

• Thyroid dysfunction (especially hypothyroidism) becomes more common with age and hormonal changes
• Hypothyroidism → low metabolic rate → less heat production → feeling cold

Symptoms of hypothyroidism:

• Cold intolerance, fatigue, weight gain, dry skin, hair loss, constipation, brain fog

Why this causes cold sensitivity:

• If thyroid is underactive, the body isn't producing enough heat
• "I'm always cold and exhausted" may signal thyroid dysfunction

4. Metabolic Rate Decline

Estrogen supports basal metabolic rate:

When estrogen declines:

• Basal metabolic rate slows → less energy burned at rest → less heat produced
• Muscle mass decreases (sarcopenia) → muscle generates heat; less muscle → less heat production

Why this causes cold sensitivity:

• Lower metabolic rate → lower core body temperature → feeling cold
• "I used to run hot. Now I'm always cold." reflects the metabolic shift

5. Poor Circulation and Cardiovascular Changes

Estrogen supports cardiovascular health:

When estrogen declines:

• Blood vessels become stiffer (reduced elasticity)
• Circulation may become less efficient
• Blood pressure changes (some women develop high blood pressure)

Why this causes cold extremities:

• Poor circulation → blood doesn't reach fingers, toes, hands, feet efficiently → they're cold

6. Anemia (Low Iron)

Iron is essential for oxygen transport and heat production:

Perimenopause and iron:

• Heavy menstrual bleeding (common in perimenopause) → iron loss → anemia
• Low iron → reduced oxygen delivery to tissues → less energy production → less heat → cold sensitivity

Symptoms of anemia:

• Fatigue, pale skin, shortness of breath, cold hands and feet, dizziness

Why this causes cold sensitivity:

• Without adequate iron, cells can't produce energy efficiently → less heat generation

7. Stress and Cortisol Dysregulation

Chronic stress affects circulation and temperature regulation:

What happens with stress:

• Stress → sympathetic nervous system activation → vasoconstriction (blood vessels narrow, especially in extremities)
• Chronic stress → cortisol dysregulation → can affect thyroid function and metabolism

Why this causes cold extremities:

• Vasoconstriction → blood diverted from hands, feet to core organs → extremities are cold

8. Low Body Weight or Rapid Weight Loss

Body fat provides insulation and helps regulate temperature:

What happens with low body fat:

• Less insulation → less ability to maintain warmth
• Rapid weight loss (especially if muscle is lost) → reduced heat production

Note: This is less common in menopause (more women gain weight), but some women experience weight loss or have naturally low body weight

9. Night Sweats Followed by Chills

Many women experience hot flashes/night sweats followed immediately by chills:

What happens:

• Night sweat → profuse sweating → skin is wet
• Evaporation of sweat → rapid cooling → shivering, chills
• "I wake up drenched, then I'm freezing and shivering"

Why this happens:

• The body overcompensates for the perceived "overheating" (hot flash) → triggers cooling (sweating)
• Once sweating stops, wet skin and rapid heat loss → body perceives "too cold" → shivering

Common Experiences

Women describe cold sensitivity and chills in these ways:

Persistent cold:

• "I'm cold all the time. I wear layers, use heating pads, and still can't get warm."
• "Everyone else is comfortable, but I'm freezing."

Cold extremities:

• "My hands and feet are ice cold. They hurt."
• "My fingers and toes go numb and white (Raynaud's)."

Chills and shivering:

• "I get chills that come in waves, like a fever but I'm not sick."
• "I shiver uncontrollably, even under blankets."

Alternating hot and cold:

• "I have a hot flash, then I'm drenched and freezing."
• "My thermostat is broken. I'm hot, then cold, then hot again."

Night chills:

• "I wake up from night sweats, and then I'm shivering and can't get warm."

What Helps

1. Hormone Therapy (HT)

Why it works:

• Estrogen stabilizes hypothalamic thermoregulation → reduces temperature dysregulation (both hot flashes and chills)
• Estrogen improves vasomotor stability → better blood flow, less vasoconstriction
• Estrogen supports metabolic rate → more heat production

Forms:

• Transdermal estradiol (patch, gel, spray)
• Oral micronized progesterone (if you have a uterus)

Evidence:

• HT is highly effective for vasomotor symptoms (hot flashes and, anecdotally, cold spells)

2. Check and Treat Thyroid Dysfunction

Get thyroid tested:

• TSH, free T4, free T3 (comprehensive thyroid panel)
• If hypothyroidism is present, treat with levothyroxine (synthetic T4) or combination T4/T3 therapy

Monitor thyroid:

• Thyroid function can change during perimenopause/menopause
• Recheck periodically

Why this helps:

• Treating hypothyroidism restores metabolic rate, heat production, and energy
• Cold intolerance often improves significantly with thyroid treatment

3. Address Anemia (Low Iron)

Check iron levels:

• Ferritin (iron storage), serum iron, hemoglobin, hematocrit
• If ferritin is low (<50 ng/mL for optimal function, <15 for deficiency), supplement with iron

Iron supplementation:

• Ferrous sulfate or iron bisglycinate (gentler on stomach)
• Take with vitamin C (improves absorption)
• Avoid taking with calcium, tea, coffee (reduce absorption)

Dietary iron:

• Red meat, poultry, fish, lentils, beans, spinach, fortified cereals

Why this helps:

• Restoring iron improves oxygen delivery, energy production, and heat generation

4. Improve Circulation

Movement and exercise:

• Physical activity increases blood flow, improves circulation
• Even gentle movement (walking, stretching, yoga) helps

Warm up extremities:

• Warm socks, gloves, hand warmers
• Warm baths or foot soaks
• Heating pads or electric blankets

Avoid vasoconstriction triggers:

• Limit caffeine (can constrict blood vessels)
• Avoid smoking (profoundly impairs circulation)
• Manage stress (stress → vasoconstriction)

Massage:

• Improves circulation, especially to hands and feet

5. Layer Clothing and Adjust Environment

Dress in layers:

• Easy to add or remove as temperature fluctuates
• Thermal underwear, wool socks, fleece layers

Keep environment warm:

• Use space heaters, electric blankets, heating pads
• Warm beverages (tea, soup, broth)

Protect extremities:

• Warm gloves, thick socks, insulated boots
• Hand warmers, foot warmers (disposable or reusable)

6. Optimize Nutrition and Hydration

Eat warming foods:

• Hot meals, soups, stews, warm beverages
• Spices (ginger, cinnamon, cayenne) may increase circulation and warmth

Adequate calories:

• Undereating → reduced metabolic rate → less heat production
• Eat enough to support energy needs

Hydration:

• Dehydration can impair circulation and temperature regulation
• Drink adequate fluids (warm fluids if cold)

Protein:

• Supports muscle mass (muscle generates heat)

7. Manage Stress and Sleep

Stress reduction:

• Chronic stress → vasoconstriction, cortisol dysregulation, thyroid suppression
• Mindfulness, therapy, boundaries, rest

Sleep:

• Sleep deprivation impairs temperature regulation
• Treat insomnia, night sweats (HT, sleep hygiene, CBT-I)

8. Treat Raynaud's Phenomenon (If Present)

What is Raynaud's:

• Exaggerated vasoconstriction in fingers, toes in response to cold or stress
• Fingers/toes turn white, then blue, then red; may be painful or numb

Treatment:

• Keep hands and feet warm
• Avoid cold exposure, stress
• Calcium channel blockers (e.g., nifedipine) if severe
• Biofeedback, relaxation techniques

9. Medical Evaluation (If Severe or Concerning)

See a clinician if:

• Cold sensitivity is severe, persistent, or worsening
• Accompanied by other symptoms (fatigue, weight gain, hair loss, constipation → check thyroid)
• Accompanied by chest pain, shortness of breath, dizziness (may indicate cardiovascular issue)
• Cold extremities with pain, discoloration, or numbness (may indicate circulation problem or Raynaud's)

Duration and Recovery

Electric Cougar (early perimenopause):

• First signs—occasional chills, mild cold sensitivity

Wild Tide (mid-perimenopause):

• Cold sensitivity may increase. Alternating hot flashes and chills are common. "I'm hot, then freezing, then hot again."

Henapause and Pause (late peri, menopause):

• Cold sensitivity may persist or worsen if hormones are not treated
• Thyroid dysfunction may develop or worsen

Phoenix and Golden Sovereignty (post-menopause):

• With HT, thermoregulation stabilizes, cold sensitivity often improves
• If thyroid or anemia is treated, cold intolerance resolves

Recovery depends on:

• Hormone therapy (estrogen stabilizes thermoregulation)
• Thyroid treatment (if hypothyroidism is present)
• Iron supplementation (if anemic)
• Improving circulation (exercise, warmth, stress management)

The Bottom Line

Cold sensitivity and chills during perimenopause and menopause are not just "being cold-natured"—they reflect physiological changes in thermoregulation, metabolism, circulation, and potentially thyroid function, driven by estrogen's decline.

Hormone therapy stabilizes the hypothalamic thermostat and improves vasomotor function. Treating thyroid dysfunction, anemia, and poor circulation resolves cold intolerance in many women.

The constant cold is uncomfortable, sometimes painful, and isolating ("Everyone else is fine, but I'm freezing"). But it's real, it's biological, and it's treatable. Warmth can be restored.