Best Treatments for Hot Flashes: 6 Options Ranked by Evidence

Estrogen therapy is still the most effective treatment for hot flashes, cutting how often they happen by about three quarters compared with placebo (Cochrane review). If you cannot or would rather not take hormones, the two newest pills, fezolinetant (Veozah) and elinzanetant (Lynkuet), are the strongest non-hormone options. Low-dose paroxetine, gabapentin and cognitive behavioral therapy (CBT) also have solid trial support.

How we chose

We ranked each option on four things, checked on September 30, 2026:

• How much it reduces hot flashes in randomized, placebo-controlled trials.
• Expert backing, using The Menopause Society's 2022 hormone therapy and 2023 non-hormone position statements.
• FDA status for hot flashes.
• Safety and who should skip it, from FDA labels and safety notices.

1. Estrogen therapy (menopause hormone therapy)

Estrogen replaces the hormone your ovaries stop making, which calms the brain's temperature control center. It comes as pills, patches, gels and sprays, with progesterone added if you have a uterus.

A Cochrane review of placebo-controlled trials found oral hormone therapy reduced weekly hot flashes by 77% compared with placebo and sharply reduced their severity (Cochrane review). The Menopause Society says hormone therapy remains the most effective treatment and should be considered for women within 10 years of their last period (Menopause Society 2023 non-hormone statement). Our guide to starting hormone therapy covers who it fits.

Best for: women with frequent or severe hot flashes who are within about 10 years of menopause and have no reason to avoid estrogen.

Trade-offs: not for women with breast cancer or other estrogen-sensitive cancers, past blood clots, stroke or heart attack, or liver disease (estradiol gel label, DailyMed). Starting more than 10 years after menopause or after 60 shifts the balance toward more risk (Menopause Society 2022 hormone statement). Our gel vs patch comparison covers the skin-applied forms.

2. Fezolinetant (Veozah)

Fezolinetant is a daily non-hormone pill that blocks a brain signal (neurokinin 3) that misfires when estrogen drops and triggers hot flashes. It is FDA-approved for moderate to severe hot flashes from menopause.

In a 12-week trial of 527 women aged 40 to 65 who had at least seven moderate to severe hot flashes a day, both doses cut daily hot flashes by about two to two and a half more than placebo, with relief starting in the first week and lasting through 52 weeks (SKYLIGHT 1, Lancet 2023). The Menopause Society recommends it as a non-hormone option backed by good, consistent evidence (Menopause Society 2023 non-hormone statement).

Best for: women who want a targeted non-hormone pill, including those who cannot take estrogen.

Trade-offs: in December 2024 the FDA added a boxed warning for rare but serious liver injury. Liver blood tests are needed before starting, monthly for the first three months, then at months 6 and 9, and you should stop it if you notice signs of liver trouble (FDA safety communication). The maker offers a savings card for women with commercial insurance (Veozah savings).

3. Elinzanetant (Lynkuet)

Elinzanetant is a daily non-hormone capsule that blocks two related brain signals (neurokinin 1 and 3). The FDA approved it on October 24, 2025, for moderate to severe hot flashes from menopause (FDA approval package).

In two 26-week trials of about 800 women in total, average age 55, elinzanetant cut daily hot flashes by about three more than placebo at weeks 4 and 12. It also improved sleep and menopause-related quality of life (OASIS 1 and 2, JAMA 2024).

Best for: women whose hot flashes wreck their sleep and who want a non-hormone option.

Trade-offs: newest on the list, so there is less real-world experience. The maker says eligible women may pay as little as $25 a month through its copay card or BlinkRx pharmacy program, with terms and eligibility rules (Lynkuet cost and savings).

4. Low-dose paroxetine (Brisdelle) and other antidepressants

Paroxetine 7.5 mg is a very low dose of an antidepressant, approved specifically for hot flashes. Other SSRIs and SNRIs such as venlafaxine are used off-label.

In two randomized trials with nearly 1,200 women, paroxetine 7.5 mg reduced how often and how severely hot flashes happened compared with placebo, and the benefit held through 24 weeks (Simon 2013, Menopause). The Menopause Society recommends SSRIs and SNRIs as non-hormone options (Menopause Society 2023 non-hormone statement).

Best for: women who also deal with low mood or anxiety, or who cannot use hormones.

Trade-offs: smaller effect than estrogen. The label warns paroxetine may reduce how well tamoxifen works, which matters for some breast cancer survivors (Brisdelle label, FDA).

5. Gabapentin

Gabapentin is a nerve-pain and seizure medicine used off-label for hot flashes, often taken at bedtime.

The Menopause Society lists it among recommended non-hormone treatments with good, consistent evidence (Menopause Society 2023 non-hormone statement).

Best for: women whose worst hot flashes hit at night.

Trade-offs: it can cause drowsiness and dizziness, so ask the prescriber about timing.

6. Cognitive behavioral therapy (CBT)

CBT is a short course of talk therapy that changes how you respond to hot flashes and the stress around them. It does not stop the flashes themselves as much as it makes them less disruptive.

In a randomized trial of 140 women with frequent hot flashes and night sweats, both group CBT and a self-help CBT book reduced how much of a problem the symptoms were at 6 and 26 weeks, and reduced night sweats (MENOS 2, Menopause 2012). The Menopause Society recommends CBT and clinical hypnosis (Menopause Society 2023 non-hormone statement).

Best for: women who want a drug-free option or to add one to medicine.

Trade-offs: improves how bothersome symptoms feel more than how often they happen. Takes several weeks of practice.

What to skip

The Menopause Society does not recommend supplements and herbal remedies, soy products, cooling techniques, paced breathing or acupuncture for hot flashes, based on the trial evidence (Menopause Society 2023 non-hormone statement).

Comparison at a glance

How to choose

If you are within 10 years of menopause and estrogen is safe for you, it gives the most relief. Our hormone therapy cost guide shows what it runs without insurance. If estrogen is off the table, fezolinetant and elinzanetant are the strongest non-hormone choices, and CBT works alongside any of them.

To get a plan matched to your symptoms and health history, take the HOD quiz.