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Cool Down: Non-Hormonal Treatments for Hot Flashes That Actually Work

  • waymire
  • 5 days ago
  • 4 min read

Hot flashes (also called vasomotor symptoms) are one of the most well-known — and often the most frustrating — symptoms of menopause. Some women never experience them. Others deal with them all day (and night).

They can show up randomly, or be triggered by things like:

  • Warm drinks

  • Alcohol (especially red wine)

  • Stress

  • Spicy foods

  • Sleep (night sweats are just hot flashes that love to interrupt rest)





Why Do We Care About Treating Hot Flashes?

Beyond being uncomfortable or embarrassing, frequent hot flashes — especially when they interfere with sleep — can increase your risk of:

  • Heart disease

  • Obesity

  • Diabetes

  • Anxiety and depression

  • Chronic fatigue

The good news? There are many effective treatments beyond hormone therapy for managing hot flashes.

Estrogen and progesterone remain the most effective option overall — but they aren’t always preferred or possible for everyone. Thankfully, non-hormonal options exist and can work very well.


Lifestyle Changes that May Help

Before jumping to medication, there are simple strategies that might reduce hot flashes:

  • Weight loss (even a modest amount can help)

  • Acupuncture

  • Avoiding known triggers (like alcohol or spicy foods)

  • Stress management


Medications for Hot Flashes (No Hormones Required)

Gabapentin

Originally used for nerve pain and seizures, gabapentin is one of my go-to options for night sweats and sleep disruption.

  • Pros: Works quickly, especially for night sweats

  • Cons: Can cause dizziness or fatigue (usually dose-dependent)


SSRI/SNRI Antidepressants

These medications can help both hot flashes and mood symptoms (like anxiety or depression), which often go hand in hand during menopause.

Common options:

  • Paroxetine (Brisdelle) — FDA-approved for hot flashes

  • Escitalopram (Lexapro)

  • Venlafaxine (Effexor)

Important Note: Paroxetine and escitalopram can interact with tamoxifen, so they aren’t ideal for women taking that medication for breast cancer treatment.

Venlafaxine is effective but may cause sweating as a side effect and can be difficult to stop (requiring a slow taper). That shouldn’t deter you — many women benefit from it and I have used it many times over the years with success.


Oxybutynin

This was a new option I learned about during my menopause training. Originally used for overactive bladder, it can help reduce hot flashes at low doses (2.5-5 mg).

  • Possible side effects: Dry mouth, urinary issues


Clonidine

This medication is less commonly used now because it can lower blood pressure too much — but it’s still an option in select cases.


Newest Option: Fezolinetant (Veozah)

Veozah is the newest FDA-approved non-hormonal medication specifically for treating hot flashes. It works in the brain by blocking the signal pathway thought to trigger hot flashes.

  • Effectiveness: Reduces hot flashes by about 65% — similar to hormone therapy

  • Side Effects: Diarrhea, stomach pain, back pain, sleep disruption

  • Monitoring: Baseline liver tests are required, and then repeat labs every 3 months for the first year. If liver tests remain stable, we may be able to decrease monitoring frequency after 12 months. Serious liver injury is very rare but caution is important early on.


A Note About Insurance Coverage

While Veozah is an exciting new option, insurance companies often require that you try several other non-hormonal treatments first (like gabapentin or antidepressants) before they will approve coverage.

That said, women who are breast cancer survivors — especially those with a history of hormone receptor-positive cancer — tend to have an easier time getting this medication approved, since hormone therapy is not an option for them.


Stellate Ganglion Block: A Non-Hormonal Option That Works Fast

The stellate ganglion block is an 80+ year old medical procedure traditionally used for pain conditions — but more recently it’s been found to be very helpful for treating hot flashes, night sweats, and sleep disturbances related to menopause.

It involves an injection of local anesthetic into a nerve bundle in the neck, guided carefully by ultrasound or X-ray. When done correctly, many women notice improvement the same day.

  • How long does it last? Most women experience relief for 4-6 months, and the procedure can be repeated as needed.

  • How does it work? We don’t fully understand the mechanism — but the stellate ganglion appears to play a role in the brain’s temperature regulation center. Blocking this nerve disrupts the hot flash signal pathway.

  • Cost considerations:This procedure is usually not covered by insurance and is paid out-of-pocket.

While I do not perform this procedure in my clinic, it is an option worth exploring for women seeking non-hormonal, non-medication treatment — especially if hot flashes or night sweats are severe and affecting quality of life.


Non-Medication Treatments with Proven Benefit

For women who prefer to avoid medications altogether, other treatments supported by research include:

  • Cognitive Behavioral Therapy (CBT)

  • Hypnosis

  • Stellate ganglion block (discussed above)


Final Thoughts

Hot flashes don’t have to rule your life — and you don’t have to “just live with them.”

Hormone therapy is the gold standard for many women, but there are excellent non-hormonal options available — from lifestyle changes to medications — that can significantly improve your quality of life.


If you’re struggling with hot flashes or night sweats, I’d love to help you find an approach that works for you.

 
 
 

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