A hot flash is a sudden wave of intense heat, usually in the face, neck, and chest, followed by flushing, sweating, and sometimes chills. Night sweats are hot flashes that happen during sleep and can seriously disrupt rest. Both happen because falling estrogen affects the hypothalamus — the brain's thermostat — which briefly 'thinks' the body is overheating and tries to cool it down.

What works best: hormones

Hormone replacement therapy (HRT) is the most effective treatment for hot flashes, reducing their frequency by roughly 75% and usually improving sleep as well. For most women under 60, or within 10 years of menopause, the benefits of HRT outweigh the risks. Many types and doses exist, so talk to a doctor about what fits your history.

Non-hormonal prescription options

If you cannot or prefer not to take hormones, several prescription treatments help:

  • Fezolinetant — a newer non-hormonal pill, around 50-60% reduction
  • SSRIs and SNRIs — medicines like paroxetine and venlafaxine, 25-69% reduction
  • Gabapentin — 40-60% reduction, and notably helpful for night sweats
  • Oxybutynin — another non-hormonal option
  • Clonidine — a modest help for some women

What research says about non-drug approaches

The strongest evidence is for:

  • Cognitive behavioural therapy (CBT) — reduces how much flashes bother you, even though it does not stop them
  • Clinical hypnosis — several trials show meaningful relief
  • Paced breathing — slow, deep breathing as a flash starts can shorten it
  • A low-fat, plant-heavy diet with soy — one small trial showed benefit, though dietary change overall has limited evidence

Supplements: proceed with caution

Over-the-counter supplements marketed for hot flashes — black cohosh, evening primrose oil, and similar — are not recommended by major menopause societies because of weak evidence and inconsistent product quality. Spending on them is usually better directed at approaches with stronger support.

Lifestyle and practical cooling

Small habits add up:

  • Dress in layers so you can remove one the moment a flash starts
  • Keep the bedroom cool; a fan and a cool pillow help with night sweats
  • Test whether alcohol, caffeine, or spicy food triggers your flashes
  • Keep a cold drink nearby and sip slowly
  • Lower stress — stress makes flashes more frequent and more intense

When to see a doctor

If hot flashes are frequent, severe, or disrupting sleep, see a doctor. Many effective treatments exist, and there is no reason to simply 'put up with' them. For most women, a combination of medical treatment, cooling habits, and stress management works best.