Hot flashes & night sweats
The most recognized sign of menopause — and one of the most disruptive. If a wave of heat is hijacking your meetings and your sleep, there's real science here, and there are real options.
What's happening
Hot flashes and night sweats (clinically, vasomotor symptoms or VMS) affect up to 80% of women during the transition. As estrogen becomes erratic, the brain's temperature-regulating center overreacts to small shifts, triggering a sudden flush, sweating, and sometimes heart palpitations. Night sweats are the same event during sleep — which is why they wreck your rest.
What the evidence says helps
Options to discuss with a provider — not recommendations.
- Hormone therapy is described in clinical guidelines as the most effective treatment for moderate-to-severe hot flashes, and is generally favorable for healthy women under 60 or within 10 years of their last period. How it's delivered matters — a skin patch or gel is considered safer for clot risk than a pill.
- Non-hormonal options with good evidence: cognitive behavioral therapy (CBT), clinical hypnosis, certain antidepressants (SSRIs/SNRIs), gabapentin, and the newer drug fezolinetant.
What the evidence does not support
This is where we differ from a lot of the internet. Most supplements and botanicals — black cohosh, soy, maca, dong quai, evening primrose — haven't been shown to reduce hot flashes, and for symptom relief specifically, neither have paced breathing, yoga, or mindfulness. They can still be great for stress and overall health — they just don't reliably cool the flashes, and some supplements carry safety concerns (for example, black cohosh and liver toxicity). We'd rather tell you that than sell you a myth.