Quick answer: If you cannot use hormone therapy, or simply prefer not to, you still have real options for hot flashes. The approaches with the strongest research behind them are cognitive behavioral therapy (CBT), clinical hypnosis and, for some women, weight loss. Several prescription non-hormonal medicines are also available through your doctor. Everyday comfort strategies and botanical supplements are popular too, though the evidence for them is more limited.
Key takeaways
- Hot flashes affect about 80% of women during the menopause transition, and frequent ones last a median of 7.4 years.
- The Menopause Society's 2023 statement recommends CBT, clinical hypnosis and weight loss as non-drug options.
- Prescription non-hormonal options include certain antidepressants (SSRIs and SNRIs), gabapentin and fezolinetant.
- Cooling strategies and botanicals have weaker evidence but are low effort, and many women find them helpful as part of a routine.
What causes hot flashes?
A hot flash is a sudden wave of heat, usually across the face, neck and chest, often followed by sweating, flushing and sometimes chills. When it happens at night, it is called a night sweat.
The root cause lies in the brain's thermostat, the hypothalamus. As estrogen levels change, the comfortable temperature range your brain tolerates becomes narrower. A tiny rise in core temperature that you would not have noticed before can now trigger the body's cooling response: blood vessels in the skin widen, your heart beats faster and you start to sweat. Researchers have also identified a group of brain cells, known as KNDy neurons, that become more active when estrogen falls and help drive this response. That discovery led to a new class of non-hormonal medicine.
Why look for non-hormonal hot flash relief?
Hormone therapy is an effective option for many women, and your provider can tell you whether it suits you. Still, there are many reasons women look for non-hormonal approaches:
- A personal or family history of breast cancer or other hormone-sensitive conditions
- A history of blood clots, stroke or certain heart and liver conditions
- Side effects from hormone therapy
- A personal preference for a more natural approach
Non-drug approaches with the strongest evidence
In 2023, The Menopause Society (formerly the North American Menopause Society) published a position statement reviewing non-hormonal options for hot flashes. These were the non-drug approaches it recommended:
Cognitive behavioral therapy (CBT)
CBT is a structured, short-term form of talk therapy. For hot flashes, it teaches practical skills: relaxed breathing, ways to respond calmly during a flash and strategies to reduce the stress and sleep disruption that come with them. Studies show CBT helps women feel that hot flashes are less bothersome and less disruptive, and it can improve sleep and mood at the same time. It is available in person, online and through self-guided books.
Clinical hypnosis
Clinical hypnosis uses guided relaxation and mental imagery, such as picturing a cool mountain stream, delivered by a trained practitioner or recordings. Research shows it can reduce how often and how intensely hot flashes occur. It is drug-free and can be practiced at home once learned.
Weight loss
Body fat acts as insulation and can influence how the body regulates heat. For women carrying extra weight, losing some of it may help reduce hot flashes, particularly early in the transition. It also brings broader benefits for heart and metabolic health.
Prescription non-hormonal options
If hot flashes are frequent or severe, your doctor may discuss prescription medicines that do not contain hormones. These are medical decisions to make together with your provider:
- SSRIs and SNRIs. Low doses of certain antidepressants, such as paroxetine, escitalopram or venlafaxine, are associated with mild to moderate improvement in hot flashes. A low-dose paroxetine product was approved specifically for hot flashes in 2013.
- Gabapentin. Originally used for nerve pain and seizures, it can reduce hot flashes and is sometimes taken at bedtime when night sweats disrupt sleep.
- Fezolinetant. Approved by the FDA in 2023, it is the first medicine designed to target the KNDy neurons involved in hot flashes. Your provider will discuss its benefits, side effects and any monitoring needed.
- Oxybutynin. A bladder medicine that can ease hot flashes, though long-term use may carry cognitive risks in older adults.
Everyday strategies for comfort
The 2023 review did not find enough evidence that the following strategies reduce how often hot flashes happen. That said, they are simple, low-risk and help many women feel more comfortable in the moment:
- Dress in layers you can remove quickly, and choose breathable fabrics like cotton or moisture-wicking sleepwear.
- Keep your bedroom cool with a fan, lighter bedding or a cooling pillow.
- Keep cold water nearby and sip at the first sign of a flash.
- Notice your triggers. Alcohol, caffeine, spicy food, hot drinks and stress commonly set off flashes for some women. A short symptom diary helps you spot your own patterns.
- Try slow, paced breathing when a flash starts. Even if it does not prevent the next one, it can make the moment easier.
- Stay active. Exercise has not been shown to reduce hot flashes directly, but it supports sleep, mood, bone and heart health during midlife.
What about natural supplements for hot flashes?
Botanicals are among the most searched topics for natural hot flash relief. The two with the most research are black cohosh and red clover:
- Black cohosh: reviews disagree. A 2023 review of 22 studies, summarized by the U.S. National Center for Complementary and Integrative Health, was favorable for overall menopause symptoms, while a 2012 Cochrane review found no clear difference from placebo. Read the full breakdown in What Does Black Cohosh Do? What the Evidence Says.
- Red clover: a 2021 meta-analysis found red clover extracts were associated with modestly fewer hot flushes per day than placebo, with a call for more research.
The Menopause Society did not recommend herbal supplements for hot flashes, citing insufficient evidence. Many women still include a botanical supplement in their routine because they want a gentle, hormone-free option alongside lifestyle strategies. If that is your choice, look for clearly labeled amounts and talk with your provider first.
That is the thinking behind She+, a hormone-free menopause support jelly stick that combines black cohosh and red clover with ginger extract and konjac glucomannan. It is designed to support comfort during hot flashes and night sweats, along with sleep, mood and digestion, in one apple and blueberry stick a day.*
When to talk to your doctor
Talk with your healthcare provider if hot flashes are disrupting your sleep, work or relationships, or if they start suddenly alongside other symptoms such as weight loss, a racing heart or fever. Those can point to causes other than menopause, such as thyroid changes. Before your visit, read what to ask your doctor about menopause supplements, and if night sweats are the main problem, see Sleep Changes During Perimenopause.
Frequently asked questions
What is the best non-hormonal approach to hot flashes?
The Menopause Society’s 2023 statement recommends cognitive behavioral therapy, clinical hypnosis and, for some women, weight loss as non-drug options. Prescription non-hormonal medicines are also available through your doctor.
How can I cool down quickly during a hot flash?
Remove a layer, sip cold water, use a fan and try slow, paced breathing. These strategies help comfort in the moment, even though research has not shown they reduce how often hot flashes happen.
Do natural supplements help with hot flashes?
Evidence is mixed. Red clover showed a modest effect in pooled trials, and black cohosh reviews disagree. Many women include a botanical as part of a broader routine after checking with their provider.
How long do hot flashes last?
Individual hot flashes usually last a few minutes. Over the transition, frequent hot flashes and night sweats last a median of 7.4 years, according to the SWAN study.
When should I see a doctor about hot flashes?
See your provider if hot flashes disrupt your sleep or daily life, or if they come with other symptoms such as weight loss, a racing heart or fever.
References
- The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. Summary: Breastcancer.org
- Avis NE, et al. Duration of menopausal vasomotor symptoms over the menopause transition (SWAN). JAMA Intern Med. 2015;175(4):531-539.
- National Center for Complementary and Integrative Health. Black Cohosh.
- Kanadys W, et al. Red clover extract for hot flushes and menopausal symptoms: systematic review and meta-analysis. Nutrients. 2021;13(4):1258.
*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. This article is for general education and is not medical advice. Talk with your healthcare provider before starting a supplement, especially if you are pregnant, nursing, take medication or have a medical condition.