Is There Anything for Hot Flashes That Isn’t Hormones?

Body  ·  The Reading Room  ·  9 min read  ·  What the prescription options are now, including two drugs that did not exist five years ago, and which popular fixes the evidence does not back

Based on the published work of Chrisandra L. Shufelt, MD, MS, FACP, Professor of Medicine and Chair of the Division of General Internal Medicine, Mayo Clinic, past president of The Menopause Society, and chair of the advisory panel behind its 2023 nonhormone therapy position statement. Mayo Clinic research profile  ·  Mayo Clinic biography  ·  the statement on PubMed

The list of things that work is shorter than the internet suggests. It is also longer than most women have been told.

The quarterly review, slide nine. The heat starts at the collarbone and climbs, and you are aware of every face in the room while you keep talking about margin.

You have tried the fan on the desk, the layers, the cold water, the evening primrose oil a friend swore by. You have also, quietly, decided that hormones are not for you, or been told they are not for you, and assumed that was the end of the menu.

It is not. The prescription options for hot flashes have changed a great deal in the last three years, and a surprising number of women still have not heard.

Informational, not medical advice, and worth taking to your clinician rather than instead of one. This is a reading of published research. We are not clinicians; the findings belong to the researchers and institutions named below, and the plain-English version is ours.

The short answer: hormone therapy is still the most effective hot flash medication, and for most healthy women under 60 or within ten years of menopause, its benefits outweigh the risks.¹ For women who cannot or prefer not to take hormones, The Menopause Society recommends several evidence-backed options: two new drugs that act on the brain’s temperature control, fezolinetant and, since October 2025, elinzanetant, plus certain antidepressants, gabapentin and oxybutynin, as well as cognitive-behavioral therapy and clinical hypnosis.²³ Herbal supplements, soy and cannabis are among the approaches it does not recommend for hot flashes.²

In this article: Hormone therapy first · The two new drugs · Every option, side by side · What the evidence does not back · The one move · FAQ

What is the most effective hot flash medication?

Hormone therapy, and it is worth saying plainly because many women were left with the opposite impression.

The Menopause Society’s 2022 hormone therapy position statement, developed under the leadership of its medical director Stephanie Faubion, states that hormone therapy remains the most effective treatment for hot flashes and night sweats, and that for most healthy women with symptoms who are under 60 or within ten years of menopause, the benefits outweigh the risks.¹

That does not make it right for everyone. Some women have a history, such as certain cancers or clotting disorders, that rules it out. Others simply do not want it. For both groups, the relevant question is what else actually works.

What are the new non-hormonal hot flash drugs?

The biggest change in years is a class of drugs that works on the part of the brain that sets your body temperature.

The short version of the mechanism: the hypothalamus acts as the thermostat, and as estrogen falls, signaling in a group of neurons there becomes overactive, which narrows the range of temperatures the body tolerates before it tries to shed heat. The new drugs block the receptors involved in that signaling.

Fezolinetant, sold as Veozah, blocks the neurokinin 3 receptor. The FDA approved it in May 2023, and The Menopause Society included it among its recommended nonhormone options that year.²⁴ In 2024 the FDA added a boxed warning, its most prominent kind, for a rare but serious risk of liver injury, prompted by a report of liver injury within 40 days of starting that resolved after the drug was stopped. The label now calls for blood tests before starting, monthly for the first three months, and again at months six and nine.⁴

Elinzanetant, sold as Lynkuet, blocks both the neurokinin 1 and neurokinin 3 receptors. The FDA approved it on 24 October 2025 for moderate to severe hot flashes due to menopause, based on three trials involving 1,423 women.³ In one of the efficacy trials, hot flashes fell by an average of 7.6 a day at week four on elinzanetant, against 4.3 on placebo.³ It is taken as capsules at bedtime. The most notable side effect is sleepiness, reported by about 5.4 percent of those treated, and the label calls for liver blood tests before starting and after three months.³⁵

Two drugs, both targeted at the mechanism rather than borrowed from another use, and both new enough that a clinician you saw two years ago may not have mentioned them.

If hot flashes are the most visible item on a list that also includes the sleep, the focus and the patience, it is worth seeing the whole list before choosing which one to treat first. Start here.

Hot flash medication and other options, side by side

This is the whole evidence-backed menu on one screen. Which row fits you is a conversation with a clinician who knows your history.

Seven rows with evidence behind them. For a woman who thought her choice was hormones or a desk fan, that is a different conversation.

Who else has measured this

Stephanie S. Faubion, MD, MBA, is the Bill and Penny George Director of the Mayo Clinic Center for Women’s Health and has served as medical director of The Menopause Society. She led the advisory panel for the 2022 hormone therapy position statement that describes hormone therapy as the most effective treatment for hot flashes.¹
Mayo Clinic biography · Mayo Clinic research profile · ResearchGate · book: Mayo Clinic The Menopause Solution · X

JoAnn V. Pinkerton, MD, Professor of Obstetrics and Gynecology and Division Director of Midlife Health at the University of Virginia, was lead investigator on OASIS 2, one of the trials behind elinzanetant’s approval. Bayer quotes her describing it as a new option that can be used first-line for moderate to severe hot flashes.⁵
UVA Health · UVA endowed professorship · MSD Manual author page · HealthyWomen articles

The U.S. Food and Drug Administration publishes the plain-language trial summaries and safety communications for both new drugs, including who was studied and what to watch for.³⁴
Drug Trials Snapshot: Lynkuet · Safety communication: Veozah

It was never hormones or a desk fan. Nobody showed you the rest of the menu.

Which hot flash remedies does the evidence not support?

This is the section that saves money.

The Menopause Society’s panel reviewed the non-drug and over-the-counter approaches too, and did not recommend paced breathing, herbal supplements, cooling techniques, exercise, yoga, acupuncture, soy products or cannabis for treating hot flashes.² Some of those are pleasant, and some are good for you in other ways. The finding is narrower: on the evidence available, they are not reliable treatments for the heat itself.

If you have spent a year cycling through supplements and feel faintly foolish, you should not. The shelf is well marketed and the prescription options were, until recently, genuinely thinner. The practical point is simply that the next dollar is better spent on an appointment.

The one move: count for seven days

The trials measured two things: how many hot flashes a day, and how severe they were.³ Your prescriber will think in the same terms, so give them the same numbers.

For one week, keep a tally in your phone. Every hot flash gets a mark. The ones that make you stop what you are doing, or wake you, get a star.

At the end of the week you have a daily average and a severity count. That turns “they are quite bad” into “nine a day, three of them waking me,” which is the sentence that moves an appointment from reassurance to a prescription, and gives you a baseline to judge whatever you try next.

Common questions

What is the best hot flash medication?

Hormone therapy remains the most effective treatment, and for most healthy women under 60 or within ten years of menopause, the benefits outweigh the risks.¹ For women who cannot or prefer not to use hormones, several non-hormonal prescriptions are recommended.²

What non-hormonal medication is there for hot flashes?

The Menopause Society recommends fezolinetant, SSRIs and SNRIs, gabapentin and oxybutynin.² Elinzanetant was also approved by the FDA in October 2025 for moderate to severe hot flashes due to menopause.³

Is Veozah safe?

The FDA added a boxed warning in 2024 for a rare but serious risk of liver injury. The label calls for blood tests before starting, monthly for the first three months and again at months six and nine, and for stopping the drug if liver symptoms appear.⁴

How is Lynkuet different from Veozah?

Lynkuet (elinzanetant) blocks both NK1 and NK3 receptors, while Veozah (fezolinetant) blocks NK3. Lynkuet is taken at bedtime, can cause sleepiness, and requires liver tests before starting and after three months.³⁵

Do supplements work for hot flashes?

The Menopause Society’s 2023 statement does not recommend herbal supplements, soy products or cannabis for hot flashes, based on the available evidence.²

You do not have to keep presenting slide nine in a fever. There is more on the menu now than there was.

Related reading: how long hot flashes actually last, handling them in the middle of a meeting, and what hormone therapy is and is not.

On the researchers. Chrisandra Shufelt and Stephanie Faubion are cited for position statements that summarize evidence for clinicians; they are not your prescribers, and the statements do not tell any individual which treatment to take. JoAnn Pinkerton is cited as an investigator on one of the elinzanetant trials, which were sponsored by the drug’s manufacturer.

References
1. The North American Menopause Society. “The 2022 hormone therapy position statement of The North American Menopause Society.” Menopause, 2022. PubMed · press release
2. “The 2023 nonhormone therapy position statement of The North American Menopause Society.” Menopause, 2023. PubMed · full text, Menopause
3. U.S. Food and Drug Administration, “Drug Trials Snapshots: LYNKUET”.
4. U.S. Food and Drug Administration, “FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant) for hot flashes due to menopause”, 2024.
5. Bayer, “Lynkuet (elinzanetant) receives FDA approval for moderate to severe hot flashes due to menopause”, October 2025. Manufacturer announcement.

Written by Nora Whitfield for Blue Leaf Journal. Updated: 16 September 2026.