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Hot flashes and night sweats are among the most common reasons women look for help in midlife. They can disrupt sleep, work, and confidence, and there is no shortage of products promising relief. The evidence on what actually helps is unusually rich here — and it doesn't always match what's marketed.
Hot flashes
Hot flashes are a well-established, directly menopause-linked symptom, supported by guideline-level evidence and decades of hormone and nonhormone therapy trials.
Multiple high-quality studies generally point in the same direction, though no study can guarantee an individual outcome.
Night sweats
Night sweats are a well-established, directly menopause-linked symptom, treated as the nocturnal form of vasomotor symptoms in major guidelines.
Multiple high-quality studies generally point in the same direction, though no study can guarantee an individual outcome.
Trials measure average effects, so they can't tell you how any one option will work for you. Some options haven't been compared head-to-head, and "not recommended" by a guideline means the evidence doesn't show a reliable benefit — not that no one has ever felt better.
Grouped by type, not ranked. An evidence grade describes the research — it doesn't tell you whether an option is suitable, safe, or right for you.
Systemic estrogen therapy (± progestogen)
Systemic estrogen therapy remains the most effective treatment for moderate-to-severe vasomotor symptoms in appropriate candidates, per NAMS's 2022 position statement.
Multiple high-quality studies generally point in the same direction, though no study can guarantee an individual outcome.
Fezolinetant
Fezolinetant is FDA-approved (2023) for vasomotor symptoms with strong RCT evidence (Level I per NAMS), though it has not been directly compared to hormone therapy in head-to-head trials, and carries a rare but serious liver-injury warning requiring monitoring.
Multiple high-quality studies generally point in the same direction, though no study can guarantee an individual outcome.
Low-dose paroxetine / SSRIs / SNRIs
Low-dose paroxetine and related SSRIs/SNRIs have Level I evidence (per NAMS) for reducing vasomotor symptom frequency and severity.
Multiple high-quality studies generally point in the same direction, though no study can guarantee an individual outcome.
Gabapentin
Gabapentin has Level I evidence (per NAMS) for improving vasomotor symptom frequency and severity, with one trial finding high-dose gabapentin comparable to low-dose estrogen for symptom severity, at the cost of more side effects (dizziness, disorientation).
Multiple high-quality studies generally point in the same direction, though no study can guarantee an individual outcome.
Cognitive behavioral therapy (CBT)
CBT has Level I evidence (per NAMS) for reducing how bothersome vasomotor symptoms feel, with 65-78% of women in trials reaching clinically meaningful improvement; supporting evidence for sleep and mood benefits is real but comes from smaller, secondary analyses.
Multiple high-quality studies generally point in the same direction, though no study can guarantee an individual outcome.
Black cohosh
Evidence on black cohosh for hot flashes is mixed. A 2012 Cochrane review of 16 trials (2,027 women) found no clear benefit over placebo, while a 2023 meta-analysis of 22 trials (2,310 women), including black cohosh combined with other ingredients, found a small improvement in hot flashes and overall menopause symptoms, but not in anxiety or low mood. Studies used different extracts and doses, so a result from one product may not apply to another, and the Menopause Society does not recommend herbal remedies as an established treatment for hot flashes.
Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.
What does this grade mean?Soy isoflavones / phytoestrogens
Evidence on soy isoflavones is mixed. A 2025 meta-analysis of 12 studies found a small improvement in overall menopause symptoms but no significant effect on hot flashes, sweating, or other vasomotor symptoms, and the Menopause Society does not recommend soy foods, soy extracts, or the soy metabolite equol for hot flashes. A 2019 meta-analysis of small trials found that equol supplements lowered hot-flash scores in women who don't naturally produce equol, but that is too limited to predict who will benefit or to recommend a product.
Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.
What does this grade mean?Red clover
Specific standardized red clover isoflavone extracts may modestly reduce hot flashes: a 2021 meta-analysis of 8 trials found about 1.7 fewer hot flashes a day than placebo on average, with results varying widely between studies and clearer effects at higher isoflavone doses over 12 weeks. Products differ in the amount and type of isoflavones they contain, so a result from one extract may not apply to another, and the Menopause Society does not recommend herbal remedies for hot flashes.
Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.
What does this grade mean?Evening primrose oil
Evening primrose oil hasn't been shown to reliably reduce hot flashes. A 2025 meta-analysis of 6 small trials (450 women) found no significant change in how many hot flashes women had or how intense they were, though episodes were shorter, and one 2021 trial found fewer night sweats but no change in hot flashes. The quality of this evidence was rated moderate to low.
Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.
What does this grade mean?Vitamin E
Vitamin E hasn't been shown to reliably reduce hot flashes: in a 2022 meta-analysis, vitamin E alone made no significant difference to how often hot flashes happened compared with placebo, and a 2022 systematic review concluded that more good-quality data are needed. A small benefit was seen only when vitamin E was combined with omega-3, in two studies.
Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.
What does this grade mean?Omega-3 (fish oil)
Omega-3 (fish oil) supplements didn't reduce hot flashes in a large randomized trial: among 355 peri- and postmenopausal women, 12 weeks of omega-3 made no difference to how often hot flashes happened or how bothersome they were — or to sleep or mood — compared with placebo. A 2022 meta-analysis also found no significant effect of omega-3 alone on hot flashes.
There is reasonably consistent research, but important limitations or unanswered questions remain.
Magnesium (oxide) for hot flashes
Magnesium oxide didn't reduce hot flashes in a placebo-controlled trial of 289 postmenopausal women with a history of breast cancer, and diarrhea was more common with magnesium. That trial doesn't address sleep (see "Magnesium for sleep") or muscle cramps, which M-1 hasn't yet reviewed.
Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.
What does this grade mean?Pollen extracts
Purified pollen extracts, sold under several brand names, haven't been shown to beat placebo for hot flashes: a 2024 meta-analysis found large improvements in uncontrolled studies, but when only controlled studies were pooled the improvements were no longer significant, suggesting the earlier results may reflect a placebo effect. No significant side effects were reported.
Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.
What does this grade mean?Maca, ginseng and dong quai
Maca, ginseng, and dong quai are different plants with limited evidence for menopause symptoms. Reviews of small trials found some favorable results for maca and Korean red ginseng, but too few rigorous studies — and, for ginseng, a high risk of bias — to draw firm conclusions. In a placebo-controlled trial of 71 women, dong quai didn't reduce menopause symptoms, and NIH notes it may interact with the blood thinner warfarin.
Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.
What does this grade mean?Flaxseed and sage
A large placebo-controlled trial found that flaxseed lignans (410 mg a day) didn't reduce hot flashes, though a 2016 review of smaller studies suggested some benefit. A few small studies suggest common sage might reduce how often hot flashes happen; sage is likely safe in food amounts and larger amounts have been used for up to 8 weeks in studies, but it contains thujone, which can be toxic in large amounts.
Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.
What does this grade mean?Turmeric (curcumin)
Evidence on curcumin (from turmeric) for menopause symptoms is limited and mixed: a 2025 meta-analysis of 14 trials in postmenopausal women reported a small improvement in hot flashes, while another 2025 review found conflicting results for hot flashes and no effect on physical, psychological, or sexual symptoms. Products vary in purity and dose, and NIH reports liver damage in some people taking highly absorbable curcumin formulations.
Insufficient or very uncertain research for a health-effect claim. It's included because people ask about it, not because it's established care.
What does this grade mean?Regulation
In the US, the FDA does not approve dietary supplements before they're sold — manufacturers are responsible for their safety and labelling. In the UK and EU, supplements are regulated as foods and can't be sold as treatments for disease. Being on sale doesn't show that a product works for menopause symptoms.
There is reasonably consistent research, but important limitations or unanswered questions remain.
Label accuracy
What's in a supplement doesn't always match the label. A 2024 review of published product testing found a substantial share of samples of several popular herbs, including black cohosh, were adulterated or mislabelled — with lower risk among licensed herbal medicines than dietary supplements — and NIH notes some black cohosh products have contained the wrong herb.
Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.
What does this grade mean?Liver injury and interactions
"Natural" doesn't mean risk-free. NIH reports rare cases of liver injury linked to black cohosh, ashwagandha, highly absorbable turmeric or curcumin products, and green tea extracts, though it isn't always certain the supplement was responsible. St John's wort can weaken the effect of many medicines, including birth-control pills, warfarin, and some antidepressants, heart, and cancer drugs. M-1 can't check whether a supplement is safe with your medicines — a pharmacist or clinician can.
There is reasonably consistent research, but important limitations or unanswered questions remain.
Soy after breast cancer
Long-term observational studies haven't shown harm from soy in women after breast cancer — including women taking tamoxifen — and some link higher soy intake with lower recurrence. But these studies looked at intake, evidence on red clover is limited, and they can't show whether a particular concentrated supplement suits you. If you've had breast cancer, it's worth discussing phytoestrogen supplements with your oncology team.
Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.
What does this grade mean?Both sides are independently sourced and graded — read the grades, not just the labels.
Some real trials report a benefit
Several smaller randomized trials report reduced hot flash frequency and severity with black cohosh compared to placebo, including benefit shown for tamoxifen-associated hot flashes in breast cancer patients.
Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.
What does this grade mean?The largest, most rigorous trial found no effect
The HALT trial — a large, multi-site randomized trial of 351 perimenopausal women — found black cohosh no more effective than placebo, consistent with a 2012 Cochrane review of 16 RCTs (2,027 women) and NAMS's own "not recommended" position.
There is reasonably consistent research, but important limitations or unanswered questions remain.
Evidence does not show exercise reduces hot flash frequency (consensus view)
A Cochrane systematic review (5 RCTs, 733 women) and NAMS's 2023 position statement both conclude exercise is not an effective treatment for hot flash frequency or severity — despite exercise's other well-documented benefits for mood, sleep, and cardiovascular health during menopause.
Multiple high-quality studies generally point in the same direction, though no study can guarantee an individual outcome.
Exercise is commonly believed to help hot flashes (widespread misconception)
Popular belief and some smaller studies suggest exercise reduces hot flashes, but this isn't supported by rigorous trials — associations found in observational data are inconsistent between self-reported and objectively measured symptoms, and no systematic review currently supports exercise as an effective hot-flash treatment.
Early, limited, mixed, or indirect research. Some people may find this useful, but we can't be confident about the average effect.
What does this grade mean?Questions you save go to Your Record and can be added to your next Doctor Prep.
My hot flashes or night sweats are affecting my sleep or daily life. What options would make sense for me?
Is hormone therapy a reasonable option for me, given my health history?
If hormone therapy isn't right for me, what non-hormonal options could we consider?
I'm taking (or thinking about) a supplement for hot flashes — is it worth it, and is it safe with my other medicines?
Want to keep track over time? Record what you've noticed in Today