Patient guide
Non-hormonal options for hot flushes and night sweats
Not everyone can or wants to take HRT. Several non-hormonal approaches can reduce hot flushes and night sweats, from cognitive behavioural therapy to specific medicines. This guide explains the options, their limits and the cautions, including interactions with breast cancer treatment.
Last checked: 2026-10-03
Key facts
At a glance.
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CBT
NICE recommends cognitive behavioural therapy to help manage vasomotor symptoms and low mood in menopause.
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Antidepressants and clonidine
NICE advises against offering SSRIs, SNRIs or clonidine as first-line treatment for vasomotor symptoms alone.
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Newer medicines
At least one non-hormonal medicine that targets the brain pathway of hot flushes has been licensed in the UK; check current availability and NHS position.
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Interactions
Some options interact with tamoxifen and other medicines, so a clinician should check.
Why people seek alternatives
Reasons include a history of breast cancer, blood clots or other contraindications to HRT, personal preference, symptoms not fully controlled on HRT or a wish to try other measures first. Non-hormonal options generally reduce hot flushes less than oestrogen does, but they can still help. A clinician can discuss expectations for each.
Cognitive behavioural therapy
CBT does not stop hot flushes but changes how much they bother you, reducing distress and helping with sleep and mood. NICE guidance supports it, and trials show benefit. It can be delivered in person, in groups, online or through self-help programmes. Hypnosis has also shown benefit in some studies, though availability is limited.
Medicines
| Option | Status and notes |
|---|---|
| Newer targeted non-hormonal medicine (neurokinin receptor blocker) | Licensed in the UK for vasomotor symptoms; product information advises liver blood tests before and during treatment; NHS availability may be limited |
| SSRIs and SNRIs (e.g. certain antidepressants) | Off-label for hot flushes; not first-line per NICE; may suit women with low mood or on breast cancer treatment, with care about interactions, especially with tamoxifen |
| Gabapentin | Off-label; may help night sweats; can cause drowsiness and dizziness |
| Clonidine | Limited benefit; side effects include dry mouth and low blood pressure |
| Oxybutynin | Off-label; some evidence; can cause dry mouth and cognitive side effects in some |
Lifestyle measures
Evidence for lifestyle changes is modest but they are low risk. Keeping the bedroom cool, wearing layers, using breathable bedding, limiting alcohol, caffeine and spicy food if they trigger flushes, stopping smoking and maintaining a healthy weight can all help. Regular physical activity supports mood and sleep, though evidence for reducing flushes directly is limited. Paced breathing has been less effective in trials than once thought.
Herbal and supplement products
Evidence is inconsistent and quality varies. Some products can interact with medicines or harm the liver. Black cohosh has been linked to liver problems, and St John's wort interacts with many drugs, including some contraceptives, anticoagulants and antidepressants. Look for products with the Traditional Herbal Registration mark and discuss with a pharmacist.
If you have had breast cancer
Tell your oncology team before starting anything new. Some antidepressants reduce the effectiveness of tamoxifen by altering its metabolism, and paroxetine and fluoxetine are particularly relevant. Specialists can advise on the safest choice and on supportive measures, including CBT and vaginal moisturisers.
Setting realistic expectations
Most non-hormonal options reduce the frequency or severity of flushes rather than abolishing them, and trials usually measure average improvements across groups. It is reasonable to agree with your clinician what a good response would look like, for example fewer night sweats or less distress, and to review after a defined trial. If one option does not help, others may. Combining a medicine with CBT and practical measures often works better than relying on any single approach.
Frequently asked
Questions people ask.
Quick, plain-English answers to the questions we hear most.
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Are non-hormonal options as effective as HRT?
Generally less so for hot flushes, but they can help and are useful when HRT is unsuitable.
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Can I get CBT on the NHS?
Some NHS services and menopause clinics offer it, and online programmes exist. Ask your GP.
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Will antidepressants help hot flushes?
Some can, but NICE does not recommend them first-line for flushes alone. A clinician may consider them if mood is also affected.
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Is the new non-hormonal medicine available on the NHS?
Availability depends on current NICE and local decisions. Ask your prescriber.
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Does acupuncture work?
Evidence is mixed, and effects may relate partly to placebo. It is generally low risk with a qualified practitioner.
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Are there foods that help?
Evidence is limited. A balanced diet supports general health, but no specific food is proven to stop flushes.
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Do cooling products help?
They may provide comfort though evidence is limited.
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What if flushes are severe and I have had breast cancer?
Discuss options with your oncology team. They can advise on non-hormonal medicines and CBT.
Where this comes from
Sources and checking.
This guide is for information, not medical advice.
Your GP or consultant knows your history and can tell you which parts apply to you. If your symptoms are severe, rapidly worsening, or come with red-flag features, seek urgent medical care. Figures and availability change, so treat them as a guide and confirm with the provider.
Published 2026-10-03, next review 2027-10-03.
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NICE guideline NG23, Menopause: identification and management (nice.org.uk)
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British Menopause Society, patient and clinician consensus resources (thebms.org.uk)
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MHRA drug safety updates and Yellow Card scheme information (gov.uk/mhra)
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NHS website, Menopause and Hormone replacement therapy (HRT) pages (nhs.uk)