Background  Natural and treatment-induced menopause and perimenopause can cause bothersome vasomotor symptoms (VMS), including hot flashes and night sweats. Similar symptoms occur in men receiving androgen deprivation therapy for prostate cancer. This Fast Fact reviews non-hormonal treatments for VMS. (Assessment and hormonal treatment of VMS are covered in Fast Fact #1 and Fast Fact #262).

Complementary and alternative medicine (CAM): Lots of use, limited evidence. CAM is commonly used for VMS, particularly among breast cancer survivors seeking nonhormonal treatment options. However, benefits are often modest, and evidence quality is variable. Clinicians should set realistic expectations and openly discuss the limited evidence supporting many CAM approaches. The best-studied CAM approaches for VMS include soy isoflavones, red clover, black cohosh, flaxseed, vitamin E, omega-3 fatty acids, and magnesium. Overall, evidence suggests modest and inconsistent benefits, and these interventions are generally considered adjunctive rather than first-line treatments (1,2).

Behavioral and mind-body interventions: Limited benefit, stronger support for CBT and hypnosis. While behavioral and mind-body treatment options are commonly pursued for VMS symptoms, available data suggest that most of these interventions do not meaningfully reduce VMS (2).  

• Cognitive behavioral therapy (CBT) and clinical hypnosis have the strongest evidence (2). Multiple trials demonstrate improvements in VMS severity, mood, and sleep, and quality of life with CBT. Clinical hypnosis also reduced hot flash frequency and severity in randomized trials. The North American Menopause Society (NAMS) recommends CBT and clinical hypnosis as Level 1 evidence-based treatment options.
• Lifestyle modifications such as cooling the environment or avoiding perceived triggers, relaxation therapies, yoga, exercise, acupuncture, and homeopathy have shown inconsistent or limited benefit for VMS and are not currently recommended by NAMS. Weight loss represents a notable exception, with Level II–III evidence supporting its effectiveness in some patients.

Pharmacologic and procedural interventions  

• Level I evidence supports the use of SSRIs/SNRIs, gabapentin, and fezolinetant for the treatment of vasomotor symptoms. Levels I–II evidence support oxybutynin for VMS. Levels II–III evidence also support stellate ganglion block, a procedural intervention for patients with refractory VMS (2).
• Fezolinetant is a recently approved nonhormonal therapy that acts as a neurokinin-3 receptor antagonist, targeting hypothalamic pathways involved in thermoregulation and reducing hot flashes without exposing patients to estrogen (3). It may be a particularly attractive option for patients with breast cancer or those who wish to avoid hormone therapy, although long-term safety data in cancer populations remain limited. Early evidence suggests benefit for quality of life- and VMS-related distress, nocturnal awakenings, and sleep quality (2).

VMS treatment summary  

• The most effective treatment for VMS is hormonal therapy, particularly transdermal estrogen in combination with progesterone (See Fast Fact #262). However, its use in patients with hormone sensitive cancer is poorly studied and could come with risk. Close collaboration with the patient’s cancer specialists is necessary.
• SSRIs, SNRIs, gabapentin, and oxybutynin are additional pharmacologic options for VMS with Level 1 supporting evidence.
• CAM therapies for VMS are widely used, though they yield, at best, modest and inconsistent symptom relief and may pose important safety and drug‑interaction concerns.
• CBT and clinical hypnosis are the most evidence‑based nonpharmacologic options.
• Neurokinin receptor antagonists, including fezolinetant, reflect a growing understanding of VMS physiology and offer possible benefits.

References 

1. Franco OH, Chowdhury R, Troup J, Voortman T, Kunutsor S, Kavousi M, et al. Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. JAMA. 2016;315(23):2554-63.
2. New Collective A. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-90.
3. Lederman S, Ottery FD, Cano A, Santoro N, Shapiro M, Stute P, et al. Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study. Lancet. 2023;401(10382):1091-102.

Version History: first published in 2012; reviewed and updated in 2015, 2024, and July 2026.
Conflicts of Interests: None to report.
Author Affiliations: 1Icahn School of Medicine at Mount Sinai, New York, NY; 2University of Colorado, Denver CO, 3Kaiser Permanente San Francisco, CA; 4Lund University, Lund Sweden; 5Harvard Medical School Boston MA.