Hot Flashes Treatment: What Works, From Hormone Therapy to Nonhormonal Options

Key takeaways

• Hot flashes and night sweats are the most common symptoms of the menopause transition, and for many women they last for years, not months.
• Menopausal hormone therapy is the most effective treatment for hot flashes, and for most healthy women under 60 or within 10 years of menopause, the benefits are considered to outweigh the risks.
• Several nonhormonal options have good evidence, including two newer FDA-approved medicines that act on the brain's temperature control center, low-dose paroxetine and other antidepressants, gabapentin, cognitive behavioral therapy (CBT), and clinical hypnosis.
• Many popular remedies, including herbal supplements, soy, cooling tricks, and paced breathing, have not been shown to work well enough to recommend.
• The best choice depends on how much symptoms bother you, your health history, and your preferences, so it is worth working through the options with a clinician.

What causes hot flashes?

A hot flash is a sudden feeling of heat in the upper body, usually the face, neck, and chest, often followed by sweating and sometimes chills. One episode typically lasts one to five minutes. When it happens during sleep, it is called a night sweat, and frequent night sweats can lead to ongoing sleep loss (Mayo Clinic).

Hot flashes are linked to falling estrogen levels, which affect the hypothalamus, the part of the brain that acts as the body's thermostat. As estrogen drops, a group of temperature-regulating nerve cells becomes overactive, so small changes in body temperature can set off a full heat-release response. That brain pathway is exactly what the newest nonhormonal medicines target.

Hot flashes are very common. The FDA estimates they occur in around 80% of menopausal women (FDA). In the long-running SWAN study, frequent hot flashes and night sweats lasted a median of 7.4 years in total, and about 10 years for Black women, who tend to have the longest-lasting symptoms (Avis et al., 2015). If you are just starting to notice changes, our guide to perimenopause symptoms covers the wider picture.

Less often, something other than menopause causes hot flashes or night sweats, including medication side effects, thyroid problems, some cancers, and cancer treatments (Mayo Clinic). If your symptoms do not fit the usual pattern, mention this to your clinician.

About the research in this article

About the research: The medication evidence described below comes from studies and labeling of FDA-approved products, including Veozah (fezolinetant), Lynkuet (elinzanetant), Brisdelle (paroxetine 7.5 mg), and FDA-approved estrogen and progestogen products. Compounded medications are not FDA-approved, and the FDA does not review compounded drugs for safety, effectiveness, or quality before they are marketed (FDA). The results described here cannot be assumed to apply to compounded versions (FDA).

Hormone therapy: the most effective option

The Menopause Society's position statement says hormone therapy "remains the most effective treatment" for hot flashes and night sweats. For most healthy women with symptoms who are younger than 60 or within 10 years of menopause, it concludes that the benefits outweigh the risks (The Menopause Society, 2022).

A few points matter when weighing it:

• Systemic estrogen treats hot flashes. Pills, patches, gels, and sprays deliver estrogen throughout the body. Low-dose vaginal estrogen is designed for vaginal and urinary symptoms and is not a treatment for hot flashes.
• A uterus changes the regimen. Women who still have a uterus need a progestogen along with estrogen to protect the uterine lining. Women who have had a hysterectomy can usually take estrogen alone.
• Risk depends on the person. Age, time since menopause, personal and family history (especially of breast cancer, blood clots, stroke, or heart disease), dose, and route all affect the balance of benefits and risks. Some women should not use hormone therapy at all.

In November 2025, the FDA began the process of removing the broad boxed warnings about heart disease, breast cancer, and probable dementia from menopausal hormone therapy labels, while keeping the endometrial cancer warning on systemic estrogen-alone products. The updated labeling recommends starting systemic therapy before age 60 or within 10 years of menopause onset (HHS). Label updates are rolling out product by product, and the decision still rests on an individual conversation with a clinician.

For a full walk-through of formulations, routes, and who is and is not a good candidate, see our guide to hormone therapy for menopause.

Nonhormonal prescription treatments

Nonhormonal medicines are an important option for women who cannot take hormones, such as many breast cancer survivors, and for those who simply prefer not to. The Menopause Society's 2023 nonhormone therapy position statement reviewed the evidence for each (The Menopause Society, 2023).

Neurokinin receptor blockers: Veozah and Lynkuet

These are the newest class of hot flash medicines. Instead of replacing estrogen, they block signals in the overactive temperature-control pathway in the brain.

• Veozah (fezolinetant) was approved by the FDA in May 2023. It is a 45 mg tablet taken once daily that blocks the neurokinin-3 (NK3) receptor. In two 12-week trials, Veozah reduced moderate to severe hot flashes more than placebo (FDA). In December 2024, the FDA added a boxed warning about rare but serious liver injury. Liver blood tests are required before starting and periodically during the first months of treatment, and anyone who develops symptoms such as unusual tiredness, itching, dark urine, light-colored stools, or yellowing of the skin or eyes should stop the medicine and contact their prescriber (FDA).
• Lynkuet (elinzanetant) was approved by the FDA in October 2025 for moderate to severe hot flashes due to menopause. It blocks both NK1 and NK3 receptors and is taken as 120 mg once daily at bedtime. Approval was based on three phase 3 trials, OASIS 1, 2, and 3 (Healio). Its label warns about sleepiness, fatigue, and dizziness that can affect driving, requires liver tests before starting and again at three months, warns about use in people with a history of seizures, and says it must not be used during pregnancy. Grapefruit and certain other medicines can raise its levels (Lynkuet prescribing information).

No head-to-head trial has compared Veozah with Lynkuet or with hormone therapy, so it is not possible to say from current evidence that one is better than another.

Low-dose paroxetine and other antidepressants

Certain selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can reduce hot flashes. The Menopause Society describes the improvement as mild to moderate (The Menopause Society, 2023).

Brisdelle (paroxetine 7.5 mg, taken at bedtime) is the only antidepressant FDA-approved specifically for menopausal hot flashes. It was approved in 2013 after two placebo-controlled trials in postmenopausal women. The most common side effects were headache, fatigue, and nausea, which mostly eased within the first weeks. Like all antidepressants, it carries a boxed warning about suicidal thoughts in young people, and paroxetine can make tamoxifen less effective, which matters for women being treated for breast cancer (Contemporary OB/GYN). Other antidepressants, including higher doses of paroxetine, are sometimes prescribed for hot flashes off-label.

Gabapentin and oxybutynin

• Gabapentin, a medicine used for nerve pain and seizures, reduces hot flashes in trials. It can cause drowsiness and dizziness, so it is often taken at night, which may help women whose main problem is night sweats (The Menopause Society, 2023).
• Oxybutynin, an overactive bladder medicine, has also been shown to reduce moderate to severe hot flashes. Long-term use raises concerns about cognitive decline in older adults (The Menopause Society, 2023).

Both are used off-label for hot flashes.

Nondrug approaches with good evidence

Some of the best-supported nonhormonal options are not medicines at all (The Menopause Society, 2023):

• Cognitive behavioral therapy (CBT). CBT does not necessarily make hot flashes less frequent, but it reliably makes them less bothersome and less disruptive to sleep and daily life. It has been studied in both menopausal women and breast cancer survivors, and can be delivered in groups, individually, or through guided self-help.
• Clinical hypnosis. Hypnosis with a trained practitioner has been shown to reduce how often hot flashes happen and how severe they feel.
• Weight loss. The evidence is more limited, but losing weight may help with hot flashes for women carrying extra weight. Our article on menopause weight gain explains why weight often shifts during this stage.
• Stellate ganglion block. This injection of local anesthetic near a cluster of nerves in the neck may help some women with moderate to very severe symptoms, but it is a procedure with its own risks and is used selectively.

Smoking is also linked to more hot flashes (Mayo Clinic), which is one more reason to get support to quit if you smoke.

What does not help, or is unproven

After reviewing the research, The Menopause Society does not recommend the following for treating hot flashes, either because studies found no benefit or because the evidence is too weak (The Menopause Society, 2023):

• Herbal and dietary supplements, including black cohosh
• Soy foods, soy extracts, and the soy compound equol
• Cannabinoids
• Paced breathing, yoga, mindfulness, and relaxation techniques
• Exercise, cooling techniques, and avoiding triggers
• Acupuncture and chiropractic treatment
• Clonidine and pregabalin

That does not mean these things are useless for your overall health. Exercise, for example, has clear benefits for sleep, mood, bone, and heart health, and a fan or layered clothing can make you more comfortable. They just have not been shown to reliably reduce hot flashes themselves.

How to choose a hot flash treatment

There is no single right answer. These questions can help frame a conversation with your clinician:

• How much are symptoms affecting you? Occasional mild flashes may need nothing more than reassurance. Frequent night sweats that wreck your sleep may justify medication.
• Are you a candidate for hormone therapy? Your age, time since menopause, and personal history, especially of breast cancer, blood clots, stroke, heart disease, or liver disease, shape the options.
• Do you have other symptoms to treat at the same time? Hormone therapy also helps vaginal dryness and protects bone. An antidepressant may make sense if mood symptoms are also a concern.
• What other medicines do you take? Tamoxifen, grapefruit, and certain other drugs interact with some options.
• What monitoring are you comfortable with? The neurokinin blockers require liver blood tests, and hormone therapy should be reviewed regularly.

It is reasonable to try one approach, check in after a few weeks to months, and adjust. Many women combine strategies, such as medication plus CBT.

The bottom line

Hot flashes are common and can last for years, but you do not have to simply wait them out. Hormone therapy is the most effective treatment and is a reasonable option for many healthy women in their 40s and 50s. For women who cannot or prefer not to use hormones, there are now several evidence-based alternatives, including two newer brain-targeted medicines, low-dose paroxetine, gabapentin, CBT, and clinical hypnosis. Many popular supplements and lifestyle tricks have not held up in research.

If hot flashes or night sweats are affecting your sleep, work, or quality of life, Stone Health's clinician-guided menopause care starts with a licensed clinician who reviews your symptoms and health history and helps you decide whether a hormonal or nonhormonal treatment may be appropriate for you. You can also browse our frequently asked questions.