# Hot flash relief finder: which options have evidence · Unpaused > Source: https://unpaused.cc/articles/hot-flash-relief-finder-which-options-have-evidence-from-cooling-and-cbt-to-pres Hot flashes ## Hot flash relief finder HRT is the most effective treatment for hot flushes if you can take it. People often try cooling, soy and black cohosh at home. The Menopause Society leaves those three off its recommended treatments. By Ines Kovac. Published 20 October 2026\. 8 minute read. [NICE NG23](https://www.nice.org.uk/guidance/NG23/chapter/Recommendations) says to offer hormone replacement therapy for vasomotor symptoms, the sudden heat and sweating of menopause. When HRT is unsuitable, or you would rather not take it, that chapter says to consider menopause-specific cognitive behavioural therapy. For moderate to severe flushes in that situation, it names fezolinetant. The [November 2024 update](https://www.nice.org.uk/news/articles/discussion-aid-to-support-clinical-conversations-about-hrt-published-alongside-updated-guidance) calls HRT the most effective treatment for those symptoms. In the UK these episodes are usually called hot flushes. US pages call the same sudden heat hot flashes. At night, both are night sweats. What to raise with a GP depends on whether HRT is possible, and on whether you want to stay off prescription medicines. Tablets, patches, gel and spray, and who is usually offered each, are explained in the guide to [hormone replacement therapy for menopause](/articles/hormone-replacement-therapy-for-menopause). The [hot flashes topic hub](/topics/hot-flashes) explains why these episodes start. [Show the options](#finder) ### How the options are grouped The [Menopause Society 2023 nonhormone statement](https://journals.lww.com/menopausejournal/Abstract/2023/06000/The%5F2023%5Fnonhormone%5Ftherapy%5Fposition%5Fstatement%5Fof.4.aspx) sorts treatments that are not hormones into a recommended list and a not-recommended list. Recommended, and marked Level I, are cognitive behavioural therapy, clinical hypnosis, SSRIs and SNRIs, gabapentin, and fezolinetant. Paced breathing used on its own is also Level I, on the not-recommended list. Supplements and herbal remedies are graded Level I to II in that group. Cooling techniques, avoiding triggers, exercise, yoga, soy foods and extracts, acupuncture, and clonidine are in that group as well. NICE adds three rules of its own. HRT, menopause-specific CBT and fezolinetant are already stated above. A further line in that chapter says not to routinely offer SSRIs, SNRIs or clonidine as the first treatment when flushes are the only problem. The society still lists SSRIs, SNRIs and gabapentin among recommended medicines, so a prescriber has to weigh that list against the NICE caution. The [NHS self-help page](https://www.nhs.uk/conditions/menopause-and-perimenopause/things-you-can-do/) still suggests cooling and cutting triggers. [NICE clinical knowledge summaries](https://cks.nice.org.uk/topics/menopause/management/management-of-menopause-perimenopause-or-premature-ovarian-insufficiency/) say lifestyle suggestions for flushes rest on limited and conflicting evidence, and they cite the society: there is no strong evidence that cooling or avoiding triggers improves vasomotor symptoms. The form keeps those NHS comfort steps in their own note. A fan can still be worth using while an episode is happening. The [NHS treatment page](https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/) says you may be offered CBT, or clonidine or an antidepressant if CBT does not help. A GP may still mention clonidine if CBT has not helped. The 2023 statement places clonidine with the options that lack support as a flush treatment. The form follows these documents. It is not a personal risk figure, and it is not a prescription. ### Sort your options Answer both questions. The third box is optional, and it only changes whether fezolinetant is spelled out when HRT is unsuitable. Can you take HRT, or are you willing to discuss it? Yes, I am open to discussing HRT No, HRT is not suitable or I do not want it I am not sure yet Do you want to avoid prescription medicines? Yes, I want non-drug options first I am open to a prescription if the evidence supports it How disruptive are the flushes? Flushes are frequent, or disruptive enough to wreck sleep or the working day Leave this unticked if you are unsure. It is used only when HRT is unsuitable and you are open to a prescription. Show the options Nothing you choose is sent or stored. This is general information, not a personal recommendation. Your groups appear here after you submit. ### Two worked examples #### HRT ruled out, and non-drug steps first Someone who cannot take HRT, and who wants non-drug steps first, sees menopause-specific CBT and clinical hypnosis at the top. Cooling stays in the comfort note. Black cohosh and soy fall in that group, and black cohosh comes with a warning about the liver. #### A prescription is acceptable, and the flushes are severe Someone who cannot take HRT, who will consider a prescription, and whose flushes are severe still sees CBT and hypnosis. Fezolinetant is added to the GP conversation, including the liver monitoring described in the next sections. SSRIs, SNRIs and gabapentin are named as medicines the society recommends and a prescriber has to judge, with the NICE caution on antidepressants and clonidine as a routine first treatment for flushes alone. When the answers leave HRT on the table, read [how to start HRT with your GP](/articles/how-to-start-hormone-replacement-therapy) and [HRT risks in plain numbers](/articles/hrt-risks-in-plain-numbers-breast-cancer-clots-and-stroke-per-1-000-women), and print a week from the [hot flush and night sweat diary](/articles/hot-flush-and-night-sweat-diary-log-episodes-and-triggers-for-your-gp). ### CBT for hot flashes Menopause-specific CBT is a course aimed at flushes, night sweats and the thoughts that go with them. The [NICE note on access to CBT](https://www.nice.org.uk/guidance/ng23/resources/access-to-cognitive-behavioural-therapy-cbt-13553197309) says waits can be long, and that therapists may not know this menopause-specific course. If it is not available locally, that note mentions the self-help book Living Well Through the Menopause. In CBT trials, women mostly rated the flushes as less of a problem. The trials do not necessarily show that hot flashes happen less often ([evidence synthesis, PubMed Central](https://pmc.ncbi.nlm.nih.gov/articles/PMC11773179/)). The NHS self-help page says CBT can help you manage hot flushes. If low mood arrives with the flushes, the separate guide to [HRT, anxiety and low mood](/articles/depression-and-hormone-replacement-therapy) sets out what NICE says about depressive symptoms. ### Fezolinetant as a non-hormonal treatment NICE reserves it for flushes that are hard to live with, and only when HRT is unsuitable, as the first section says. It is a prescription medicine, and that chapter points to the technology appraisal for this use. The [FDA](https://www.fda.gov/news-events/press-announcements/fda-approves-novel-drug-treat-moderate-severe-hot-flashes-caused-menopause) approved Veozah (fezolinetant) 45 mg on 12 May 2023 for moderate to severe hot flashes caused by menopause. That is the US name. [The Pharmaceutical Journal](https://pharmaceutical-journal.com/article/news/non-hormonal-treatment-for-menopause-vasomotor-symptoms-approved-for-use-in-the-uk) reported an MHRA licence for fezolinetant in Great Britain in December 2023\. The [GOV.UK drug safety update](https://www.gov.uk/drug-safety-update/fezolinetantv-veoza-risk-of-liver-injury-new-recommendations-to-minimise-risk) in April 2025 uses the UK name Veoza, says fezolinetant is associated with drug-induced liver injury, and asks for liver monitoring before and during treatment. ### Natural remedies for hot flashes and night sweats Soy foods and soy extracts are in that group. For black cohosh, the [full 2023 statement](https://menopause.org/wp-content/uploads/professional/2023-nonhormone-therapy-position-statement.pdf) says there is insufficient evidence to support it for vasomotor symptoms, and it notes possible harm to the liver. Cooling and cutting triggers, used as the only plan, are on that list too. The NHS cooling suggestions above are for comfort during an episode. Paced breathing on its own was already graded in the grouping section. Meals, weight, bones and heart are a separate question, covered in [diet and menopause](/articles/diet-and-menopause). ### Sources * [NICE NG23: recommendations](https://www.nice.org.uk/guidance/NG23/chapter/Recommendations) * [NICE: HRT is the most effective treatment for vasomotor symptoms (November 2024)](https://www.nice.org.uk/news/articles/discussion-aid-to-support-clinical-conversations-about-hrt-published-alongside-updated-guidance) * [Menopause Society 2023 nonhormone therapy position statement (abstract)](https://journals.lww.com/menopausejournal/Abstract/2023/06000/The%5F2023%5Fnonhormone%5Ftherapy%5Fposition%5Fstatement%5Fof.4.aspx) * [Menopause Society 2023 nonhormone therapy position statement (PDF)](https://menopause.org/wp-content/uploads/professional/2023-nonhormone-therapy-position-statement.pdf) * [NICE clinical knowledge summaries: managing menopause](https://cks.nice.org.uk/topics/menopause/management/management-of-menopause-perimenopause-or-premature-ovarian-insufficiency/) * [NHS: things you can do](https://www.nhs.uk/conditions/menopause-and-perimenopause/things-you-can-do/) * [NHS: menopause treatment](https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/) * [NICE NG23: access to CBT](https://www.nice.org.uk/guidance/ng23/resources/access-to-cognitive-behavioural-therapy-cbt-13553197309) * [PubMed Central: CBT and vasomotor symptom bother](https://pmc.ncbi.nlm.nih.gov/articles/PMC11773179/) * [FDA: approval of Veozah (fezolinetant)](https://www.fda.gov/news-events/press-announcements/fda-approves-novel-drug-treat-moderate-severe-hot-flashes-caused-menopause) * [Pharmaceutical Journal: UK licence for fezolinetant](https://pharmaceutical-journal.com/article/news/non-hormonal-treatment-for-menopause-vasomotor-symptoms-approved-for-use-in-the-uk) * [GOV.UK: fezolinetant (Veoza) and liver injury](https://www.gov.uk/drug-safety-update/fezolinetantv-veoza-risk-of-liver-injury-new-recommendations-to-minimise-risk) ### My take I would start with whether HRT is possible, and I would skip black cohosh and soy until that is settled. If hormones are an option, the first appointment should include the plain-numbers risk guide and a week of the diary. With HRT off the table, I would choose menopause-specific CBT, and a fan only for comfort during an episode. If the flushes are frequent and a prescription is still acceptable, I would ask the GP about fezolinetant and the liver checks above. [Show the options](#finder) ### Questions about hot flash relief Do cooling fans stop hot flashes? A fan is still on the NHS self-help list for the minutes an episode lasts. The 2023 nonhormone statement put cooling with the approaches that lack strong evidence of fewer episodes. Is black cohosh a natural alternative? Herbal products in this group, black cohosh included, sit outside the recommended list. Possible harm to the liver is why a GP should hear about it before you buy a bottle. Does CBT stop hot flashes? A course built for menopause can make the episodes easier to live with. Trials measured that bother more than they measured a drop in how often flashes occur. Ending them is not what those trials promised. What is fezolinetant? A prescription medicine, not a shop supplement, for flushes that are hard to live with when hormone therapy is unsuitable. Liver tests are part of taking it. The UK name is Veoza and the US name is Veozah. Written by Ines Kovac Menopause guides: symptoms, HRT, sleep and everyday changes Ines Kovac writes the practical guides on Unpaused: perimenopause, symptoms, hormone therapy, sleep, hot flushes and weight. She builds each piece from NHS and NICE pages, The Menopause Society's position statements and the studies behind them, and links every claim a reader might want to check. She says plainly what the evidence supports and where it runs out, and she never tells a reader to start or stop a medicine. Corrections are added to the page that had the error. [ikovac@unpaused.cc](mailto:ikovac@unpaused.cc) Last checked 2026-10-20 --- Plain, practical menopause advice Plain, practical guides to perimenopause and menopause: symptoms, hormone therapy, sleep, hot flashes, weight and food, each checked against health services and medical societies. [desk@unpaused.cc](mailto:desk@unpaused.cc) ### Topics * [Perimenopause](/topics/perimenopause) * [Symptoms](/topics/symptoms) * [Hormone therapy (HRT)](/topics/hrt) * [Hot flashes](/topics/hot-flashes) * [Sleep](/topics/sleep) * [Weight and diet](/topics/weight-and-diet) * [Mood and mind](/topics/mood-and-mind) * [All guides](/articles) ### About us * [About](/about) * [Authors](/authors) * [Editorial policy](/editorial-policy) * [How we make money](/how-we-make-money) ### Legal * [Terms](/terms) * [Privacy](/privacy) * [Contact](/contact) Unpaused © 2026 Unpaused. General health information, written from sources we link. It does not replace advice from your own doctor, nurse or pharmacist. 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