Are there non-hormonal options?

Summary

Hormone therapy is not suitable for everyone, and not everyone wants it. The good news: there are hormone-free options with strong evidence for hot flashes, sleep and mood, and that list has widened considerably in recent years. The bad news: the things that are advertised most — herbal mixtures, supplements, "detoxes" — have the weakest evidence behind them. This article separates what international guidelines say they "recommend" from what they "do not recommend". Which option suits you is your doctor's decision.

What is happening?

Hot flashes arise because the brain's temperature regulation center becomes oversensitive when estrogen is withdrawn (see the separate article on how hormones change). Non-hormonal approaches break that chain at different links:

• Targeting the trigger in the brain directly: The newer NK3 receptor antagonists (fezolinetant, elinzanetant) block the neuropeptide that overstimulates the temperature center. They contain no hormones and carry no breast or clot risk profile.

• Acting on the serotonin/norepinephrine system: Some antidepressants (certain SSRIs and SNRIs) reduce hot flashes at low doses. This effect is independent of their effect on depression.

• Other medicines: Gabapentin (particularly for night sweats and sleep) and oxybutynin appear in the guidelines.

• Behavioral approaches: Cognitive behavioral therapy (CBT) and clinical hypnosis reduce how much the symptom bothers you more than how often it happens, and they improve sleep.

• Lifestyle: Weight loss can reduce symptoms; stopping smoking helps in every respect.

What do we know?

• NK3 antagonists are effective: In phase 3 trials, fezolinetant significantly reduced both the frequency and the severity of moderate-to-severe hot flashes compared with placebo, with the effect beginning within a few weeks ³. Because rare rises in liver enzymes have been reported, regulators recommend liver tests at the start and during follow-up. Elinzanetant showed similar effectiveness along with a positive result for sleep; after the UK, Canada, Australia, Switzerland and the European Union, it was licensed in the US in October 2025, and in the EU it is also approved for hot flashes caused by breast cancer treatment ⁴. The licensing, availability and reimbursement status of these medicines in Türkiye change over time; ask your doctor for the current position.

• Some antidepressants help: Paroxetine (low dose), venlafaxine, desvenlafaxine, citalopram and escitalopram reduce hot flashes moderately; the Menopause Society recommends them for women who cannot use HRT ¹. Side effects (nausea, changes in sexual function) and drug interactions (paroxetine is not used alongside tamoxifen) call for a doctor's assessment.

• CBT is evidence-based: In the UK MENOS trials, both group and self-help CBT significantly reduced how problematic hot flashes were and how disturbed sleep was ⁵. NICE recommends CBT for hot flashes, sleep and mood, alongside or instead of hormone therapy ². Clinical hypnosis has also shown an effect in randomized trials ^{1 7}.

• Losing weight has an effect: Weight loss has been shown to reduce hot flashes in women carrying excess weight; exercise and yoga, while good for general health, do not directly reduce hot flashes ¹.

• Where the evidence is insufficient or negative: The Menopause Society's 2023 statement does not recommend the following for hot flashes: paced breathing exercises (on their own), cooling techniques, avoiding triggers (insufficient evidence), exercise, yoga, acupuncture (inconsistent evidence), cannabinoids, herbal products and dietary supplements ¹. For black cohosh, a Cochrane review found no difference from placebo, and there are rare reports of liver injury ⁶. Results for soy isoflavones are inconsistent. Most of these may be harmless; but "spending money and time on something that doesn't work" is a cost in itself, and some of them interact with medicines.

• Where breathing and relaxation exercises fit: They may not reduce how often hot flashes happen, but they can help with anxiety and sleep and make the episodes easier to cope with. So the "not recommended" label means "not enough evidence as a treatment for hot flashes", not "doesn't work".

What does this give you?

• You are not without options: For women left outside HRT because of a history of breast cancer, a past clot or personal preference, there are both medicinal and non-medicinal routes with demonstrated effectiveness.

• "Natural" and "evidence-based" are not the same thing: A product being herbal does not make it safe or effective. Tell your doctor about every supplement you take, especially if you are on a blood thinner, thyroid medication or an antidepressant.

• CBT is not an "it's all in your head" treatment: It is a structured, short program that reduces the effect a physiological symptom has on your life. The relaxation tools in Lumia are based on the principles of those programs; they do not replace clinical CBT.

• Monitoring matters with newer medicines: With newer options such as the NK3 antagonists, your doctor may ask for blood tests; that is part of the treatment.

Sources

1. The Menopause Society. The 2023 Nonhormone Therapy Position Statement. Menopause. 2023;30(6):573-590.
2. NICE. Menopause: identification and management (NG23). 2015; updated November 2024.
3. Lederman S, et al. Fezolinetant for treatment of moderate-to-severe vasomotor symptoms (SKYLIGHT 1). Lancet. 2023;401(10382):1091-1102.
4. Pinkerton JV, et al. Elinzanetant for the treatment of vasomotor symptoms (OASIS 1 and 2). JAMA. 2024;332(16):1343-1354.
5. Ayers B, et al. Effectiveness of group and self-help CBT for menopausal hot flushes and night sweats (MENOS 2). Menopause. 2012;19(7):749-759.
6. Leach MJ, Moore V. Black cohosh for menopausal symptoms. Cochrane Database Syst Rev. 2012;(9):CD007244.
7. Panay N, et al. International Menopause Society (IMS) recommendations and key messages on women's midlife health and menopause. Climacteric. 2025;28(6):634-656.

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