Stellate Ganglion Block for Hot Flashes: What the Neck Injection Trials Show

If you can’t or don’t want to take hormones, you may come across clinics offering a stellate ganglion block (SGB) for hot flashes. It’s an injection of numbing medicine next to a bundle of nerves in the lower front of the neck, usually guided by ultrasound or X-ray imaging.¹²

Where it stands

The Menopause³ Society’s 2023 nonhormone statement lists SGB among recommended options, but at its lowest evidence levels: limited or inconsistent studies plus expert opinion.³ Treatments with stronger support include CBT, clinical hypnosis, certain antidepressants, gabapentin and fezolinetant.³ Hormone therapy remains the most effective treatment.³

What the trials found

The U.S. sham-controlled trial (2014). Forty postmenopausal women with moderate to severe hot flashes got either an imaging-guided block or a saline injection under the neck skin, then kept diaries for 6 months.¹

• Total hot flashes: no significant difference between groups.¹
• Moderate to very severe hot flashes: cut about in half compared with the sham.¹
• Safety: no serious study-related side effects.¹
• The authors said a larger trial is needed.¹

A 2023 perimenopause trial. Forty women aged 48 to 52 received six blocks or six saline injections; 35 finished.² Hot flash, menopause symptom and sleep scores improved more with the block.² Two women in the block group had temporary hoarseness.² A successful block causes visible signs on that side, such as a droopy eyelid, so the doctors couldn’t be blinded; only the women were.²

Both trials were small, and long-term results are unknown.¹²

Who may want to ask about it

• Women who can’t use hormones, such as after some cancers
• Women who tried the better-studied nonhormone options without enough relief

Our guides to fezolinetant monitoring, gabapentin, low-dose paroxetine and CBT for night sweats cover those options.

Questions to ask before booking

1. Who performs it, and is it done with ultrasound or X-ray guidance?
2. Is it safe with my medicines? Blood thinners were a reason for exclusion in one trial.²
3. What side effects should I expect, such as hoarseness or a droopy eyelid?
4. How long might relief last, and will I need repeat injections?
5. What will it cost, and does my insurance cover it for hot flashes?

Try: “I can’t take hormones and gabapentin didn’t help. Is a stellate ganglion block a reasonable next step for me, and what are the risks?”

My Body Changed. Now What? includes a Visit Brief. Use it to list the treatments you’ve tried and how many severe hot flashes you have each day. See the book.