What Helps Hot Flashes Without Hormones?

You’ve tried the fan, the layers, the ice water, the cold pillow. You’ve stopped drinking wine at dinner because it sets off a flush. Your doctor mentioned hormone therapy, and you’re not sure it’s for you, or you’ve been told it’s not an option. So you’re standing in the supplement aisle in front of a bottle with a woman on it who looks perfectly calm.

What the NHS lists

The NHS¹ says cognitive behavioural therapy (CBT) can help with hot flushes and night sweats. It says antidepressants can help with mood, depression, anxiety or persistent hot flushes, and that clonidine is another medicine option. It recommends talking to a GP about what’s suitable for you. For the hormone side of the question, see whether hormone therapy is safe.

What the evidence says on supplements and mind-body options

The National Center for Complementary and Integrative Health (NCCIH)² summarizes research on a few:

• Soy. Soy isoflavone supplements or soy protein may reduce the frequency and severity of hot flashes, but the effect may be small. The long-term safety of phytoestrogens such as soy, red clover and flaxseed hasn’t been established.
• Yoga. There’s some evidence it may reduce menopausal symptoms, but the effect is similar to other exercise.
• Hypnosis. There’s some evidence suggesting hypnosis may help certain symptoms, such as hot flashes.
• Acupuncture. Studies have been inconsistent about whether it’s beneficial.

The NCCIH’s² bottom line is that evidence for mind and body practices is limited, and that there’s little evidence natural products are helpful.

Black cohosh: the safety flag

Black cohosh is the best-known herbal pick, and the evidence is mixed. A 2023 analysis found products were potentially beneficial for menopause symptoms as a group, with improvements in hot flashes but not anxiety or depression, per the NCCIH³. Guidelines have noted a lack of steady evidence for any benefit.

The NCCIH³ also says cases of liver damage, some of them severe, have been reported in people taking products labeled as black cohosh. It says these problems are rare, and it’s uncertain whether black cohosh was responsible. It adds that some commercial products have been found to contain the wrong herb or mixtures not listed on the label. It says to see a provider if you develop symptoms of liver damage such as dark urine and fatigue.

The NCCIH³ says to avoid it or ask first if you have a hormone-sensitive cancer, are pregnant or breastfeeding, or take medicines, because of possible interactions.

Related reading

Our articles on hot flashes, night sweats, sleep and mood cover the rest of the picture.

The play

Try this: a hot flash log

For two weeks, write down when each hot flash happens, how long it lasts, how bad it is from 1 to 10, and what came before it: caffeine, alcohol, a hot room, stress, a meal.

Add how many wake you at night.

Bring the log to a clinician. It lets you compare options with the facts of your own days.

When to get checked

The NHS¹ says to talk to a GP about how to improve your symptoms and what medicines may be suitable. The NCCIH³ says to discuss black cohosh with a healthcare provider before starting.

Book an appointment if any of these fit:

• Hot flashes or night sweats are disrupting sleep or work
• You can’t use hormone therapy, or don’t want to, and want to know what else is available
• You’re thinking of starting an herbal supplement
• You take other medicines and want to check for interactions
• You have a history of liver problems or hormone-sensitive cancer
• You’ve started a supplement and notice dark urine or unusual fatigue

A bottle with a calm woman on it isn’t evidence. A list of options and a conversation is.