Hormone therapy is the most effective treatment for hot flashes, but it isn’t right for everyone. In 2023, The Menopause Society reviewed the evidence for non-hormonal options. Here’s what came out on top — and what didn’t.
Recommended, with good evidence
Neurokinin-3 receptor antagonists. Fezolinetant, approved by the FDA in 2023, targets the brain pathway behind hot flashes directly. In trials it reduced the frequency and severity of moderate-to-severe hot flashes within weeks. Liver function needs monitoring, and newer drugs in this class have since followed.
Certain antidepressants (SSRIs and SNRIs). Low-dose paroxetine is FDA-approved for hot flashes; venlafaxine, escitalopram and others are used off-label. They typically reduce hot flashes modestly and can help mood and anxiety at the same time. Some interact with the breast cancer drug tamoxifen, which matters for survivors.
Gabapentin. Originally a seizure medication, it reduces hot flashes and may be useful for night sweats in particular, since drowsiness is a common side effect.
Cognitive behavioral therapy (CBT). CBT doesn’t usually reduce the number of hot flashes, but it consistently reduces how much they bother you and interfere with sleep and daily life.
Clinical hypnosis. Studies show meaningful reductions in hot flash frequency and severity with structured hypnosis programs.
Weight loss. For women with overweight, losing weight has been associated with fewer hot flashes in some studies.
Not recommended, or not proven
The 2023 review did not recommend paced breathing, most supplements and herbal remedies, acupuncture, exercise or yoga as treatments for hot flashes specifically — usually because trials were small, inconsistent, or didn’t beat placebo. Several of these still have other benefits (exercise and yoga for sleep, mood and bones), so they’re worth doing for their own sake.
A note on supplements
Black cohosh, red clover and soy isoflavones are widely sold for hot flashes. Evidence is mixed, product quality varies, and some carry specific cautions — black cohosh has rare reports of liver injury, and isoflavones may not suit women with hormone-sensitive conditions. If you try one, tell your clinician and choose a third-party tested product with doses printed on the label.
Choosing between them
The best option depends on your health history, other medications, and which symptoms bother you most. A clinician familiar with menopause care can help you weigh them.