What actually helps hot flashes?

What the evidence says

The treatment with the strongest evidence for hot flashes is hormone therapy, meaning estrogen, usually combined with a progestogen if you still have a uterus. Canadian guidance says this is the first choice for most people under 60 or within 10 years of their last period, as long as there is no medical reason to avoid it, like a history of certain cancers or blood clots.

If hormone therapy is not right for someone, several non-hormone medicines also help. These include certain antidepressants (SSRIs and SNRIs), a nerve medicine called gabapentin, and a newer drug called fezolinetant, which works on a heat-control pathway in the brain rather than on hormones. Fezolinetant is being used in Canadian clinical practice, though it can raise liver enzymes in some people, so doctors usually check blood work while it is used.

Talk therapies also help. Cognitive behavioural therapy, which teaches ways to manage the thoughts and stress around hot flashes, and clinical hypnosis have both been shown to reduce how often and how badly hot flashes bother people, even without changing hormone levels.

Common lifestyle tips, like dressing in layers, avoiding warm rooms, exercising, or cutting out triggers like spicy food, feel logical, but the actual research evidence that they reduce hot flashes is weak. The same goes for many herbal or plant-based products like soy or black cohosh, and for acupuncture: the evidence is mixed or limited, so they may or may not help, and are not proven as reliably as the medical treatments above.

Because hot flashes and their treatments involve personal health history, like cancer risk or clotting risk, the right choice differs from person to person. A conversation with a doctor or nurse practitioner can help match the options to individual health needs.