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Symptoms — often called vasomotor symptoms (VMS) — include:

• Sudden warmth in the face and upper body
• Flushed appearance on the skin
• Upper-body perspiration
• Elevated heartbeat
• Chills as the hot flash goes away

“When you’re not sleeping well, your body feels constantly under stress from the deficit, and stress hormones are not good for overall health,” says Carolyn N. Mills, MD, a gynecologist at »ªÌå»á. “There is a connection between severity of vasomotor symptoms and worse long-term cardiovascular health, so it is important to find effective treatment.”

Common Treatment Options

Because they are caused by a decrease in estrogen levels, hot flashes are most often treated with:

• Hormone therapy, also known as menopausal hormone therapy and hormone replacement therapy (HRT)
• Non-hormone prescription medication, including some antidepressants
• Lifestyle changes

Here’s a closer look at each treatment type:

Hormone Therapy

The primary goal of hormone therapy is to restore the hormones that your body no longer produces adequately — particularly estrogen and sometimes progesterone — to help manage symptoms caused by their decline. There are estrogen receptors in most organs and tissues in the body, including the brain, joints and skin.

Hormone therapy can be administered in the following ways, depending on your preferences and medical history:

• Pill
• Skin patch
• Spray or gel (topical)
• Vaginal ring

The symptoms that occur with the decline in estrogen are many, but hormone therapy can help in the following ways:

• Temperature regulation: Regulates your brain’s thermostat to help prevent hot flashes.
• Vaginal health: Maintains moisture, elasticity and thickness of vaginal tissues.
• Bone health: Promotes bone density and prevents osteoporosis, a condition that weakens bones and increases the risk of fractures.
• Mood and sleep: Influences neurotransmitters that affect emotional well-being and sleep patterns.

“In most women under the age of 60 and within the years around the menopause transition, the benefits of hormone therapy greatly outweigh the risks,” says Dr. Mills. “It is the only option that can also benefit bone health and sexual well-being.”

If you are considering hormone therapy, it is important to talk with your physician about the potential risks, which vary depending on the type of therapy, dosage, duration of use and your health history. Risks may include:

• Blood clots
• Stroke
• Breast cancer
• Endometrial cancer
• Gallbladder disease

However, the absolute risk of these conditions is extremely small in healthy women under the age of 60.

Non-hormone Prescription Medication

For people who cannot or choose not to take hormone therapy, there are non-hormonal prescription oral medications that have been approved by the U.S. Food and Drug Administration (FDA) for treating moderate-to-severe hot flashes:

• Paroxetine (Brisdelle®). This low-dose selective serotonin reuptake inhibitor (SSRI) was specifically FDA approved for the treatment of hot flashes in 2013. It works by affecting your body’s serotonin levels, which are believed to play a role in body temperature regulation. (Note: Even though the active ingredient, paroxetine, in Brisdelle is used as an antidepressant, this medication is not approved by the FDA for treating mental health conditions.)
• Fezolinetant (Veozah®). Approved by the FDA in 2023, works by targeting the receptors in the hypothalamus that help regulate body temperature. If you are considering taking fezolinetant, know that bloodwork should be done before you take it and every three months for the first nine months of using the medication. This is to monitor your liver’s health and make sure that the medication is not causing any damage.

Other non-hormonal treatment options have shown effectiveness, but they aren’t specifically FDA-approved for hot flashes. This is known as “off-label use.” The decision to use a medication off-label is typically based on your physician’s clinical judgement, available scientific evidence, your specific needs and your medical history.

Some non-hormonal prescription medications that fall into this category include:

• Gabapentin (Neurontin®, Gralise®). This medication is used to control epilepsy and treat nerve pain. It is thought to reduce hot flashes by affecting neurotransmitters in the brain involved in temperature regulation.
• Pregabalin (Lyrica®). Similar to gabapentin, this is an anti-seizure medicine that alters neurotransmitter activity to help regulate temperature.
• Clonidine (Catapres®, Kapvay®). Primarily used to treat high blood pressure, clonidine affects small blood vessels and the brain’s temperature control center, potentially reducing the occurrence of hot flashes.
• Oxybutynin (Oxytrol®). Intended to treat overactive bladder, oxybutynin can reduce hot flashes by affecting the sweat glands and decreasing the amount of sweat your body produces.
• Antidepressants, such as citalopram (Celexa®), escitalopram (Lexapro®) and paroxetine (Paxil®), are prescribed off-label for hot flashes. Similar to Brisdelle, Paxil’s active ingredient is paroxetine, but at a higher dose.

Non-hormonal treatments are generally not effective for other menopause-related conditions, such as vaginal dryness or osteoporosis. Before taking a non-hormonal medication, talk with your physician about the potential risks and benefits.

Lifestyle Changes

If you have mild hot flashes that do not significantly impact your daily life, there are several lifestyle changes you can make to help relieve symptoms:

• Lower your room temperature.
• Use a portable cooling fan.
• Invest in a pillow or mattress cover with a cooling gel.
• Wear lightweight clothing with breathable fabrics (such as linen, rayon and cotton).
• Avoid spicy foods, hot drinks and alcohol.
• Reduce stress with relaxation and breathing techniques.
• If you smoke, try to quit.

When to Seek Medical Treatment

Menopause does not have to be miserable. If you find that hot flashes are interfering with your daily activities or nighttime sleep, talk to your physician about treatment options.

“Nobody should have to suffer with disruptive menopausal symptoms when we really have so many different treatments that we can offer now,” says Dr. Mills.

Learn about menopause and your skin.