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What to do next · Hot flashes & night sweats

Hot flashes and night sweats: what to do next

Evidence-checked · sources listedSources

Information for better conversations, not a diagnosis. This is research with sources, not medical advice. Talk to your clinician about your situation.

What this often points to

Hot flashes and night sweats are the most commonly reported symptoms of the menopause transition. In one large, diverse US study, up to 80% of women had them at some point during the transition 1. A night sweat is a hot flash that happens during sleep 1.

The hormone picture, as the authorities describe it

  • Estrogen and progesterone. In perimenopause, The Menopause Society says period changes come from "the ovaries' erratic production of hormones and less-frequent release of an egg (ovulation)" 1. It also describes estrogen levels that fluctuate during perimenopause 1. Across menopause, the FDA says the body "slowly produces less of the hormones, estrogen and progesterone" 2. In other words, the levels swing before they settle lower.
  • Testosterone. It follows a different path. The Global Consensus Position Statement, endorsed by The Menopause Society, says testosterone levels decline during the reproductive years 3. The Menopause Society notes that removing both ovaries causes "a significant decrease in testosterone that does not occur with natural menopause" 4. Testosterone isn't a hot-flash treatment. The same consensus finds insufficient data to use it for any symptom other than low desire with distress (HSDD) after menopause 3.

Can a blood test confirm it? Usually not. The American College of Obstetricians and Gynecologists (ACOG) says: "You probably don't need hormone testing." An ob-gyn can usually tell from your age, your symptoms and changes in your periods. If you're under 45 with changes in bleeding, and especially under 40, you may be offered a blood test to check for early or premature menopause 5. NICE (the UK guideline body) advises against using hormone and ovarian tests to identify perimenopause in people 45 or over. It also advises against the FSH test for anyone using combined hormonal contraception 6.

How long it can last. In SWAN, which followed 1,449 women with frequent hot flashes, the median total duration was 7.4 years. Women whose hot flashes started while they still had regular periods or were in early perimenopause had the longest stretch: a median of more than 11.8 years 7. That's why it's worth planning, not just waiting.

What to track for 2 weeks

Use the free tracker or a notes app. Write it down the same day, because memory blurs fast.

  • Hot flashes per day and night sweats per night. A tally is enough.
  • How much they bother you, 0–10, once a day.
  • Wake-ups at night, and whether a sweat woke you.
  • Your period: start and stop days, flow, and any spotting between periods.
  • Anything you notice before a flash (a warm room, alcohol, stress). Note it without judging it.
  • Medicines and supplements, including any breast cancer medicines such as tamoxifen.
  • Health history to have ready: blood clots, stroke, heart disease, liver disease, breast or uterine cancer, seizures, and whether pregnancy is possible.

Questions to ask your clinician

Copy these word for word:

  1. "Based on my age, my symptoms and my periods, does this look like perimenopause, or is there anything else we should rule out?"
  2. "Am I a candidate for hormone therapy, given my history? If I'm still having periods, what would that look like for me?"
  3. "If hormones aren't right for me, which non-hormone options fit my health history, and what monitoring would each one need?"
  4. "Could CBT for hot flashes work for me, and can you point me to a program?"
  5. "How will we decide whether a treatment is working, and when should we check?"

The options on the table

These are the authorities' own grades and words. They describe how strong the evidence is. They aren't a ranking for you. Your history decides what fits.

Hormonal

Menopause Society: Level I
Hormone therapy (estrogen, plus a progestogen if you have a uterus) The Menopause Society's 2022 position statement says hormone therapy "remains the most effective treatment for vasomotor symptoms" 4 and "remains the gold standard for relief of VMS" 4. Estrogen alone can be used by women without a uterus (Level I). For women with a uterus, estrogen plus a progestogen protects against endometrial cancer (Level I) 4. For women under 60, or within 10 years of menopause, with no contraindications, "the benefit-risk ratio is favorable for treatment of bothersome VMS" 4. On its patient page, the Society calls hormone therapy "FDA-approved as a first-line therapy for the relief of bothersome hot flashes" 8. The American College of Physicians' 2026 guideline also places it first-line, as a strong recommendation with high-certainty evidence 9.
If you're still having periods The Menopause Society says hormone therapy works but can cause breakthrough bleeding. Continuous-combined hormonal contraceptives (pill, patch or ring) are often used, especially when you also need birth control. A levonorgestrel IUD plus estrogen is another route 1. You can still get pregnant in perimenopause, so the Society advises birth control until a full year after your last period 1.
Who generally shouldn't use it In general, women who have breast cancer, uterine cancer, unexplained uterine bleeding, liver disease, a history of blood clots, or cardiovascular disease should not use hormone therapy, per The Menopause Society 8.
Label status In November 2025 the FDA began removing boxed warnings about heart disease, breast cancer and probable dementia from menopausal hormone therapy labels. The boxed warning on endometrial cancer stays for systemic estrogen-alone products. The FDA's list of updated labels still showed six products when we checked on Oct 15, 2026 10.
Compounded "bioidentical" hormones The FDA "does not have evidence that compounded 'bioidentical hormones' are safe and effective, or safer or more effective than FDA-approved hormone therapy" 2. The Menopause Society says they "are not safer or more effective" than approved bioidentical hormones 8.

Non-hormonal

The Menopause Society's 2023 nonhormone position statement grades these 11:

Menopause Society: Level I
Non-hormone options with the strongest evidence Recommended, Level I, include cognitive behavioral therapy (CBT), gabapentin and fezolinetant (Veozah). Elinzanetant (Lynkuet) was approved after this statement; the Society hasn't issued a position on it 1112.
Menopause Society: Levels II–III
Weight loss Recommended, Levels II–III: weight loss.

Label warnings to know (FDA labels on DailyMed, checked Oct 22, 2026)

  • Veozah (fezolinetant). It carries a boxed warning, the FDA's most prominent kind, for liver injury. The label calls for liver blood tests before starting, monthly for the first 3 months, and at 6 and 9 months. Stop it and get medical care if you notice new tiredness, loss of appetite, nausea, vomiting, itching, yellowing of the skin or eyes, pale stools, dark urine or belly pain 13.
  • Lynkuet (elinzanetant). No boxed warning. Its label says:
    • It must not be used in pregnancy, because it can cause pregnancy loss.
    • It can cause sleepiness and other nervous system effects (11.9% of women on it vs 3.5% on placebo in trials). Don't drive or do hazardous activities until those effects have passed.
    • It calls for liver blood tests before starting and during treatment.
    • Since August 2026, it warns of a potential risk of seizure. Grapefruit juice and some medicines interact with it 14.
  • Gabapentin (Neurontin). It isn't FDA-approved for hot flashes, so using it for them is off-label. The label has no boxed warning but warns about sleepiness and dizziness that can affect driving, serious breathing problems when taken with opioids or other sedating drugs, suicidal thoughts and behavior, severe allergic and multi-organ reactions, and a higher seizure risk if it's stopped suddenly 15.

What the research tested

How long hot flashes last (SWAN, JAMA Internal Medicine, 2015). 1,449 women in the Study of Women's Health Across the Nation who reported frequent hot flashes or night sweats were followed through the menopause transition, with symptoms recorded at repeat visits over more than a decade 7.

  • The median total duration was 7.4 years.
  • After the final period, symptoms went on for a median of 4.5 years.
  • Women whose symptoms began while they still had regular periods, or in early perimenopause, had the longest run: a median of more than 11.8 years. Women whose symptoms began after menopause had the shortest, a median of 3.4 years 7.

What it tested: how long frequent hot flashes and night sweats last, not what treats them. Limitation: it's observational, it only counted women who already had frequent symptoms, and a median means half of women had a shorter run and half a longer one.

Elinzanetant (OASIS 1 and 2, JAMA, 2024). Two placebo-controlled trials enrolled 796 women aged 40 to 65 (mean age 54.6) with moderate to severe hot flashes, about 13 to 16 a day at the start. After 12 weeks, women on elinzanetant had about 3 fewer hot flashes a day than women on placebo, and the difference in severity was small. Sleep and menopause-related quality of life also improved 16.

Limitation: 12 weeks of data; the trials were run by the manufacturer.

Limitation

Most of this evidence comes from trials of 12 weeks or less, in women who signed up because their symptoms were frequent. Your own pattern, your history and your goals matter more than any average.

Supplements

Supplements are the first thing many of us reach for, and the shelf is crowded with menopause blends. Here is what the trials found for hot flashes and night sweats, one ingredient at a time.

How we label evidence: Studied, some benefit means at least some randomized trials found a benefit, usually small or short. Mixed results means trials disagree. Little evidence means few studies, or no clear benefit over placebo. The labels describe the research. They are not recommendations, and the list is not a ranking.

The Menopause Society does not recommend supplements or herbal remedies for hot flashes 11, and the FDA doesn't approve supplements for safety before they're sold 17.

Black cohosh

Mixed results

What the research found

A Cochrane review pooled 16 randomized trials with 2,027 women. In the trials that counted hot flashes, black cohosh did no better than placebo, about 0.07 flushes a day apart, and hormone therapy did better than black cohosh 18. The reviewers called the evidence "insufficient" to support its use. NCCIH describes the results as inconsistent 19.

Rare cases of liver damage have been reported with black cohosh products, so NCCIH suggests checking with a provider first if you have a liver condition 19.

Soy and red clover isoflavones

Mixed results

Safety: NCCIH says these appear safe short term, but long-term safety hasn't been established, and because they may act like estrogen, they may not be safe for women who shouldn't take estrogen 19.

What the research found

Isoflavones are plant compounds shaped a bit like estrogen. NCCIH says trials of soy or red clover isoflavones "have had inconsistent results" 19. A Cochrane review of 43 randomized trials (4,364 women) found "no conclusive evidence" that phytoestrogen supplements reduce how often or how hard hot flashes and night sweats hit. In the five pooled red clover trials, the difference from placebo wasn't significant 20. Flaxseed, another plant-estrogen source, did no better than placebo 19.

St John's wort

Mixed results

Safety: NCCIH warns that St John's wort "can interact in dangerous, sometimes life-threatening ways with a variety of medicines" and can weaken the effects of some 21.

What the research found

A few small trials look encouraging. In one 8-week randomized trial of 100 women in Iran, hot flashes fell more in frequency, duration and severity with St John's wort than with placebo 22. A 2014 meta-analysis also found its extracts beat placebo for menopause symptoms 23. These are small trials, many with St John's wort combined with other herbs, and The Menopause Society still doesn't recommend herbal remedies for hot flashes 11.

Evening primrose oil

Little evidence

What the research found

A 2024 meta-analysis found hot flashes were somewhat less severe on evening primrose oil than on placebo over less than 6 months, but not less frequent or shorter. The authors called the evidence "insufficient to draw firm conclusions" 24. NCCIH lists it among the products with too little research to judge 19.

Omega-3 (fish oil)

Little evidence

What the research found

A 2023 systematic review of 9 randomized trials in postmenopausal women found that 4 trials saw possible benefits for hot flashes and night sweats. Taken together, though, the studies "did not provide substantial evidence" that omega-3s help 25.

A question for your clinician: "I'm taking (or thinking about) these supplements. Could any of them interact with my other medicines, and is there a prescription or non-drug option with stronger evidence for my hot flashes?"

The honest caveat: Most supplement trials are small, short (often 8 to 12 weeks), and test different products and doses, so one product's result may not carry over to another bottle.

Worth mentioning to your provider: any vaginal bleeding after menopause. The FDA notes it can be a sign of a medical problem, so it's worth checking 2.

Information for better conversations, not a diagnosis.

This is research with sources, not medical advice. Talk to your clinician about your situation.

Evidence-checked · sources listed

Talk to a menopause-trained provider

Sources (all rechecked 2026-10-15)

  1. The Menopause Society. Perimenopause (patient education). https://menopause.org/patient-education/menopause-topics/perimenopause
  2. US FDA Office of Women's Health. Menopause. https://www.fda.gov/consumers/womens-health-topics/menopause
  3. Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019. PMID 31498871. https://pubmed.ncbi.nlm.nih.gov/31498871/ (full text PMC6821450)
  4. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022. PMID 35797481. https://pubmed.ncbi.nlm.nih.gov/35797481/
  5. ACOG. Do I need to have testing of my hormone levels during perimenopause? (Sept 2025). https://www.acog.org/womens-health/experts-and-stories/ask-acog/do-i-need-to-have-testing-of-my-hormone-levels-during-perimenopause
  6. NICE. Menopause: identification and management (NG23), recs 1.3.4–1.3.5. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
  7. Avis NE, et al. Duration of menopausal vasomotor symptoms over the menopause transition (SWAN). JAMA Intern Med. 2015. PMID 25686030. https://pubmed.ncbi.nlm.nih.gov/25686030/
  8. The Menopause Society. Hormone Therapy (patient education). https://menopause.org/patient-education/menopause-topics/hormone-therapy
  9. American College of Physicians. Pharmacologic treatment of vasomotor symptoms of menopause: clinical guideline. Ann Intern Med. Oct 6, 2026. PMID 42832802. doi:10.7326/ANNALS-26-01205. https://www.acpjournals.org/doi/10.7326/ANNALS-26-01205
  10. FDA. Menopausal Hormone Therapies: Updated Prescribing Information (content current as of 02/12/2026; checked 2026-10-15). https://www.fda.gov/drugs/drug-safety-and-availability/menopausal-hormone-therapies-updated-prescribing-information ; FDA press announcement, Nov 2025: https://www.fda.gov/news-events/press-announcements/fda-approves-labeling-changes-menopausal-hormone-therapy-products
  11. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023. PMID 37252752. https://pubmed.ncbi.nlm.nih.gov/37252752/
  12. The Menopause Society. Position statements (newest statements are 2023 nonhormone, 2022 hormone therapy, 2021 osteoporosis and 2020 GSM; no position on elinzanetant; checked 2026-10-22). https://menopause.org/professional-resources/position-statements
  13. DailyMed. Veozah (fezolinetant) tablets, label, Boxed Warning and section 5 (revised 02/2026; checked 2026-10-22). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cae9f798-24f9-4580-a4fc-e6c710cbda3c
  14. DailyMed. Lynkuet (elinzanetant) capsules, label, sections 4 and 5, including 5.4 (revised 08/2026; checked 2026-10-22). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f42884ff-7dff-419c-8a0c-affe2ed73818
  15. DailyMed. Neurontin (gabapentin), label, Indications and section 5 (revised 04/2025; checked 2026-10-22). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=97935fd9-1d4a-43b6-a5d9-de994591187b
  16. Pinkerton JV, et al. Elinzanetant for the treatment of vasomotor symptoms associated with menopause: OASIS 1 and 2 randomized clinical trials. JAMA. 2024. PMID 39172446. https://pubmed.ncbi.nlm.nih.gov/39172446/
  17. US FDA. Questions and Answers on Dietary Supplements. https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements
  18. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012. PMID 22972105. https://pubmed.ncbi.nlm.nih.gov/22972105/
  19. NCCIH. Menopausal Symptoms: In Depth. https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth
  20. Lethaby A, et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev. 2013. PMID 24323914. https://pubmed.ncbi.nlm.nih.gov/24323914/
  21. NCCIH. St. John's Wort. https://www.nccih.nih.gov/health/st-johns-wort
  22. Abdali K, et al. Effect of St John's wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause. 2010. PMID 20216274. https://pubmed.ncbi.nlm.nih.gov/20216274/
  23. Liu YR, et al. Hypericum perforatum L. preparations for menopause: a meta-analysis of efficacy and safety. Climacteric. 2014. PMID 24188229. https://pubmed.ncbi.nlm.nih.gov/24188229/
  24. Thevi T, De S, Soe HHK. Evening primrose oil for menopause hot flashes: systematic review and meta-analysis. J Menopausal Med. 2024. PMID 39829189. https://pubmed.ncbi.nlm.nih.gov/39829189/
  25. Iqbal AZ, et al. Effects of omega-3 polyunsaturated fatty acids intake on vasomotor symptoms, sleep quality and depression in postmenopausal women: a systematic review. Nutrients. 2023. PMID 37836515. https://pubmed.ncbi.nlm.nih.gov/37836515/