Non-hormonal treatments for hot flushes: what the evidence supports

HRT is the treatment guidelines reach for first when hot flushes and night sweats are a problem. But some people cannot take it, some have been advised against it, and some would simply rather not. For them, the question is what else has evidence behind it.

This article describes what that guidance says. It is not advice about your own treatment, which is a conversation for you and your clinician.

The short version

NICE recommends offering HRT for hot flushes and night sweats ¹. For people who cannot or prefer not to take it, NICE supports two options: menopause-specific cognitive behavioural therapy (CBT) ¹, and fezolinetant, a non-hormonal medicine, when HRT is unsuitable ¹².

The Menopause Society, in its 2023 review, rates CBT, clinical hypnosis, some antidepressants (SSRIs and SNRIs), gabapentin and fezolinetant as having the strongest evidence among non-hormonal options ⁴. It does not recommend herbal supplements for hot flushes ⁴.

Fezolinetant

In March 2026, NICE recommended it as an option for moderate to severe hot flushes and night sweats when HRT is unsuitable, and the NHS in England must fund it for that group ².

NICE's committee found that trials show it reduces how often hot flushes happen and how severe they are compared with a placebo ². It has not been compared directly with other non-hormonal treatments, and indirect comparisons suggest similar effectiveness, with uncertainty ².

The UK medicines regulator has warned that fezolinetant can cause liver injury, which generally reversed when the medicine was stopped ³. It advises liver blood tests before starting, monthly for the first three months, and periodically after that, and avoiding it in people with liver disease or at higher risk of it ³.

Menopause-specific CBT

NICE recommends considering menopause-specific CBT for hot flushes and night sweats, either alongside HRT, or for people who cannot or prefer not to take it ¹. It can be face to face or remote, individual or in a group, or a self-help programme ¹.

Antidepressants, clonidine and gabapentin

Some antidepressants are also used for hot flushes. The Menopause Society lists SSRIs and SNRIs among its recommended options, along with gabapentin ⁴. The NHS mentions antidepressants and clonidine as medicines sometimes used for hot flushes and night sweats ⁵.

NICE is more cautious about where they fit: it advises not routinely offering SSRIs, SNRIs or clonidine as first-line treatment for hot flushes alone ¹. The Menopause Society does not recommend clonidine ⁴.

Herbal and complementary remedies

NICE says there is some evidence that isoflavones or black cohosh may relieve hot flushes, but that preparations vary, their safety is uncertain, and interactions with other medicines have been reported ¹. The NHS says there is very little evidence on how well herbal remedies work or how safe they are, and that some can cause serious side effects when taken with other medicines ⁵.

For people with a history of breast cancer, NICE flags St John's wort specifically: there is uncertainty about its dose, its potency, and serious interactions with medicines including tamoxifen ¹.

What the evidence does not support

The Menopause Society's review lists approaches it does not recommend for treating hot flushes, including paced breathing, supplements and herbal remedies, cooling techniques, avoiding triggers, exercise, yoga, soy, and acupuncture ⁴. That is a statement about hot flushes specifically. Exercise, for example, has plenty of other benefits.

Get checked: if you have had breast cancer

NICE recommends that people with a personal history of breast cancer, or at high risk of it, are offered information on all options and referral to a healthcare professional with expertise in menopause ¹.

Guidance in the US and Europe

In the US, where they are usually called hot flashes, the FDA approved elinzanetant (Lynkuet) in October 2025 to reduce moderate to severe hot flashes due to menopause, after trials showed it reduced how often and how severely they happened compared with a placebo ⁶. Fezolinetant is sold in the US as Veozah. In December 2024 the FDA added a boxed warning about rare but serious liver injury, with liver blood tests before starting, monthly for the first three months, and then at months 6 and 9 ⁷. It advises stopping and contacting a doctor with signs such as unusual tiredness, nausea, itching, yellowing of the skin or eyes, or dark urine ⁷.

In Europe, the European Medicines Agency requires liver tests before starting fezolinetant (Veoza) and monthly for the first three months, and says it should not be started if certain liver results are raised ⁸.

What is still uncertain

Most non-hormonal options have not been compared head to head. Which one suits a person depends on their health, their other medicines and what they want to avoid.

Keeping a record

Whatever you try, the useful measure is how many hot flushes and night sweats you have in a week, and how bad they are, before and after. Halcyon counts them by day and marks the date a treatment starts, so a review can see whether anything changed.