The short version
- The Menopause Society's 2023 position statement recommends cognitive behavioral therapy and clinical hypnosis for hot flashes, with its highest level of evidence.
- Several prescription medicines that are not hormones are also recommended. Your doctor can tell you whether one suits you.
- Weight loss is recommended too, with a lower level of evidence.
- Supplements, herbal remedies, cooling products, avoiding triggers, yoga and exercise are not recommended as treatments for hot flashes.
- Exercise is still one of the best things you can do in menopause. It just does not reliably reduce hot flashes.
Who this is for
Hormone therapy remains the most effective treatment for hot flashes and night sweats, which doctors call vasomotor symptoms.2 Some women are advised against it because of their medical history. Others prefer not to use it. If you are in either group, you still have options with good evidence.
In 2023 The Menopause Society, then called The North American Menopause Society, asked a panel of clinicians and researchers to review everything published on non-hormone treatments since its previous statement in 2015. The panel graded each option by the strength of the evidence.1,3
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What the specialists recommend
| Treatment | Type | Evidence level |
|---|---|---|
| Cognitive behavioral therapy (CBT) | Mind-body | Level I, the highest |
| Clinical hypnosis | Mind-body | Level I |
| SSRI and SNRI medicines | Prescription | Level I |
| Gabapentin | Prescription | Level I |
| Fezolinetant | Prescription | Level I |
| Oxybutynin | Prescription | Levels I to II |
| Weight loss | Lifestyle | Levels II to III |
| Stellate ganglion block | Procedure | Levels II to III |
Source: 2023 nonhormone therapy position statement.1
Cognitive behavioral therapy
CBT is a structured talking therapy. For menopause it teaches you to notice the thoughts and reactions that make a hot flash feel worse, such as embarrassment or dread, and to replace them with responses that calm the body. It also covers sleep habits and stress.
Studies show CBT helps women experience hot flashes as less of a problem.4 Courses are short and can be delivered in a group, one to one, online or from a self-help workbook. Ask your doctor for a referral or look for a therapist with menopause training.
Clinical hypnosis
Clinical hypnosis is delivered by a trained health professional. Sessions guide you into deep relaxation and use mental images, often of cool places, that you then practice at home. It shares the top evidence rating with CBT in the position statement.1
Prescription medicines
Several medicines that are not hormones reduce hot flashes. The list includes certain antidepressants (SSRIs and SNRIs), gabapentin, oxybutynin, and fezolinetant, which was approved in the United States in 2023 to treat hot flashes.1,4 Each has its own side effects and reasons not to use it. For example, the position statement notes that long-term use of oxybutynin in older adults may be linked to cognitive decline.1 Your doctor can match an option to your health history.
Weight loss
Weight loss is on the recommended list, with a lower evidence rating than the options above.1 If you are carrying extra weight, the habits in our guide to menopause belly fat may help your hot flashes as well as your waist.
What is not recommended for hot flashes
The panel also listed approaches it could not recommend, either because studies found no benefit beyond placebo or because the research was too weak to judge.1,3
- Supplements and herbal remedies, including soy extracts
- Paced breathing
- Cooling techniques and products
- Avoiding triggers
- Exercise and yoga
- Acupuncture
- Cannabinoids
- Chiropractic treatment
Why the placebo effect matters here
Hot flash studies have unusually strong placebo responses. Many women improve while taking a dummy pill, partly because hot flashes naturally rise and fall over time. This is why a friend's glowing report about a supplement is not good evidence, and why the panel based its recommendations on controlled trials.1
How to raise this with your doctor
- Keep a simple diary for two weeks: how many hot flashes by day and by night, and how much they disrupt sleep or work.
- Say what matters most to you, for example sleeping through the night or getting through meetings.
- Ask directly: "Am I a candidate for hormone therapy? If not, which non-hormone options would you consider for me?"
- Ask for a CBT referral, or whether a self-guided CBT program is suitable.
- List every medicine and supplement you take, so interactions can be checked.
When to get help sooner
See your doctor promptly if sweats come with fever, unexplained weight loss or a racing heart, if hot flashes begin many years after your periods stopped, or if low mood or anxiety is making daily life hard. These can have causes other than menopause, and they deserve a proper check.
Common questions
Does CBT make hot flashes stop?
CBT mainly changes how much hot flashes bother you and disrupt your day and night. Studies show women who complete it find their hot flashes less of a problem. That shift is why specialists recommend it.4
Is clinical hypnosis the same as stage hypnosis?
No. Clinical hypnosis is a structured treatment delivered by a trained health professional. It uses deep relaxation and guided mental imagery, often of coolness, and usually includes practice at home between sessions.
If exercise does not help hot flashes, why bother?
Because it helps almost everything else. In more than a hundred trials, exercise reduced body fat and waist size and increased muscle in postmenopausal women. It was left off the hot flash list only because studies have not shown a reliable effect on that one symptom.1,5
Can I use these alongside hormone therapy?
Often, yes. CBT and clinical hypnosis have no drug interactions. For prescription medicines, your doctor will advise on combinations.
References
- The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. https://pubmed.ncbi.nlm.nih.gov/37252752/
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. https://pubmed.ncbi.nlm.nih.gov/35797481/
- The North American Menopause Society. Press release: NAMS releases its 2023 nonhormone therapy position statement. June 1, 2023. https://menopause.org/wp-content/uploads/press-release/nonhormone-therapy-position-statement-release.pdf
- Breastcancer.org. NAMS releases statement on non-hormone therapy for hot flashes, night sweats. June 28, 2023. https://www.breastcancer.org/research-news/non-hormone-therapy-hot-flashes
- Khalafi M, Habibi Maleki A, Sakhaei MH, et al. The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis. Front Endocrinol. 2023;14:1183765. https://pubmed.ncbi.nlm.nih.gov/37388207/
Every health claim above links to its source. Before publication the article was read and approved by Claudia Muresian, health psychologist, fitness coach and healthy nutrition specialist. It is general information and cannot take your personal history into account, so use it to prepare for a conversation with your own clinician.
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