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Hot Flash Treatment Without Hormones: What the Evidence Shows

By Mehmet Şişoğlu (developer of Pausa), based on the sources below · Updated 27 October 2026

Hormone therapy is the most effective treatment for hot flashes, but it isn’t right for everyone. Some people can’t take it for medical reasons; others prefer not to. In 2023, The Menopause Society reviewed the evidence for non-hormonal options and sorted them into recommended and not recommended.

This page summarizes that review. It is not a treatment plan: which option suits you depends on your health, your other medicines and what matters most to you, so it is a conversation for your clinician.

Quick answers

Which non-hormonal options are recommended?

With the strongest evidence: cognitive behavioral therapy (CBT), clinical hypnosis, and several prescription medicines, namely certain antidepressants (SSRIs and SNRIs), gabapentin and fezolinetant, a newer medicine that acts on the brain’s temperature-control center. Oxybutynin, weight loss and a procedure called stellate ganglion block were also recommended, with less evidence.

What is not recommended for hot flashes?

Paced breathing, herbal remedies and supplements, soy foods and extracts, cooling techniques, avoiding triggers, exercise, yoga, mindfulness, relaxation, acupuncture, cannabinoids and several others were not recommended to treat hot flashes. Some, such as exercise, may still be good for your general health or make you more comfortable; they just weren’t shown to reliably reduce hot flashes.

Is CBT really an option for hot flashes?

Yes. Menopause-specific CBT is not about imagining symptoms away; it helps make hot flashes less bothersome. The NICE guideline also lists it as an option alongside hormone therapy, or on its own if hormone therapy isn’t suitable or wanted.

Are these medicines available everywhere?

Not always. Approval and availability differ by country, and some are used ‘off label’ for hot flashes. Your clinician or pharmacist can tell you what is available where you live.

When to talk to a clinician

• Hot flashes or night sweats are disrupting your sleep, work or mood.
• You have been told hormone therapy isn’t suitable for you, or you would prefer to avoid it.
• You take other medicines or supplements, since some can interact.
• You have had breast cancer or another hormone-sensitive condition.

How logging helps

Before and after starting any treatment, a simple record of how often hot flashes happen and how much they bother you can help you and your clinician judge whether it is helping. With Premium, Pausa can compare the weeks before and after a medication change, and everything stays on your iPhone and in its own backup, never on a Pausa server.

For personal awareness only. Not a substitute for medical advice.