Why they happen
Falling oestrogen changes signalling in the hypothalamus, the part of the brain that controls body temperature. A group of nerve cells called KNDy neurons becomes overactive. The brain misreads normal temperature as too hot and triggers cooling: blood vessels open, sweat flows, heart rate rises.
Menopausal hormone therapy
The most effective treatment. It reduces how often and how hard hot flushes hit by about 75 percent. Relief usually starts within four weeks. See the hormone therapy page for benefits and risks.
Prescription treatments without hormones
Fezolinetant and elinzanetant block the overactive brain signal directly. They are taken as a daily tablet and are approved in some countries.
Low dose paroxetine, venlafaxine, desvenlafaxine and escitalopram reduce hot flushes by about half. Gabapentin at night helps night sweats and sleep. Oxybutynin, a bladder medicine, also reduces hot flushes.
Treatments without medicine
Cognitive behavioural therapy and clinical hypnosis both have good trial evidence. They reduce how much hot flushes bother you, and hypnosis also reduces how often they happen. Weight loss helps some women.
What the evidence does not support
Black cohosh, red clover, evening primrose oil, other herbal remedies, supplements, paced breathing, yoga and acupuncture have not shown a reliable effect in good trials. Some interact with medicines. Some affect the liver. Tell your practitioner about anything you take.
Triggers
Alcohol, hot drinks, spicy food, heat and stress set off hot flushes for some women. Avoiding them eases discomfort but does not treat the cause.
See a practitioner if
- Hot flushes wake you most nights
- They disrupt work or social life
- You have hot flushes with fever, weight loss or diarrhoea, which can point to another cause
Common questions
Are hot flushes dangerous?
Not directly. Frequent, severe hot flushes are linked with higher heart disease risk and poorer sleep and mood, which is one more reason to treat them.
Can I use treatments without hormones after breast cancer?
Yes. The prescription options without hormones, cognitive behavioural therapy and hypnosis are all used after breast cancer. Some antidepressants interact with tamoxifen, so your oncology team should choose.
Will they come back when I stop treatment?
Some women find hot flushes return for a while. Stopping gradually or at a later age does not change the long term outcome much. Decide with your practitioner.
- The Menopause Society, 2023 Nonhormone Therapy Position Statement
- The Menopause Society, 2022 Hormone Therapy Position Statement
- Avis and colleagues, JAMA Internal Medicine, 2015, Study of Women's Health Across the Nation
This page is education, not medical advice. Talk to your doctor or menopause practitioner about your own care. In an emergency, call your local emergency number.