Hot Flushes and Night Sweats: What Actually Helps

You have tried the layers, the fan, the cutting back on wine. Maybe a friend swore by a supplement that did nothing for you. Somewhere along the way you may have been left with the impression that hot flushes and night sweats are simply something to endure until they pass. However, they are among the most treatable symptoms of menopause, and the range of effective options has grown in the past few years.

MHT is the most effective treatment

Menopausal Hormone Therapy, also known as HRT, is the most effective treatment for hot flushes and night sweats. In the SWAN study, hormone therapy after the final menstrual period was associated with a 74 per cent reduction in the odds of reporting trouble sleeping, and an even larger effect on the flushes and sweats themselves (Harlow et al. 2020).

In Australia, current Australasian Menopause Society guidance favours body-identical oestradiol delivered through the skin, as a patch, gel or spray.

For women who still have a uterus, body-identical micronised progesterone, Prometrium, is taken in the evening. As well as protecting the lining of the uterus, its breakdown product acts on a calming receptor system in the brain and has a mild sedative effect, so the evening dose supports sleep at the same time (Newson 2023).

Most women feel a meaningful improvement within two to four weeks, with the full effect usually established by six to twelve weeks.

Non-hormonal medications that genuinely work

For women who cannot use MHT, there are non-hormonal options with real evidence behind them.

• Certain antidepressants, in particular venlafaxine and escitalopram, reduce the frequency of hot flushes and night sweats, often by around 40 to 60 per cent and at lower doses than those used for depression. They tend to work within two to four weeks, and they are an evidence-based choice even for women who are not depressed (Newson 2023).

• Gabapentin, an anticonvulsant medication, also reduces hot flushes and night sweats, and can be particularly useful when night-time symptoms dominate, because of its mild sedative effect (Newson 2023).

  
  

The newer treatments that target the cause

The most significant recent change is a class of medication that works directly on the brain mechanism driving hot flushes and night sweats. These are the neurokinin 3 receptor antagonists, which calm the overactive KNDy neurons in the brain's temperature centre without using hormones at all.

Elinzanetant, sold as Lynkuet, is TGA-approved and listed on the Australian Register of Therapeutic Goods. In phase 3 trials of the related medication fezolinetant, also TGA-approved, women had significant improvements in sleep disturbance and sleep-related impairment over twelve weeks (Shapiro et al. 2024). These options are especially relevant for women who cannot take MHT and want a hormone-free treatment that addresses the underlying mechanism rather than working around it.

Because these medications are newer, your GP may not yet be familiar with them. A GP with a particular interest in menopause, such as those listed by the Australasian Menopause Society, is more likely to be up to date.

Mind-body options with real evidence

Some of the most useful approaches are not medications at all, and they carry no side effects.

• Cognitive behavioural therapy designed for hot flushes does not reduce how often they happen, but it reduces the distress, the perceived severity, and the sleep disruption that follows. A UK randomised controlled trial of working women showed significant benefit from a self-help CBT-based programme (Hardy et al. 2018). In Australia it can be accessed through a Mental Health Care Plan from your GP.

• Clinical hypnotherapy is endorsed by the Menopause Society and has one of the larger effect sizes for a non-drug in the research, with structured at-home programmes now available (Hirsch 2025).

• Paced breathing, slow and with longer breaths out than in, settles the nervous system and, used in the first seconds of a flush or a night-time wake, can shorten the episode. It is free and gets easier with practice.

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What helps less than its reputation suggests

It is worth knowing what does not hold up, so you do not spend money and hope on it. Black cohosh, evening primrose oil, red clover and most herbal preparations do not consistently beat placebo in good-quality trials (NAMS 2023). Over-the-counter progesterone cream is not equivalent to prescription body-identical progesterone, because the dose is too low to do the same job. Some women feel these help, partly because the placebo response in hot flush trials is genuinely high, but they are not on the same evidence footing as the options above.

What this means for you

You have more options than you were probably ever told, and the most effective of them do require a conversation with your GP and a prescription. Book a long GP appointment, and take at least two weeks of tracking of your symptoms — the duration and frequency of your hot flushes and night sweats, and their impact on your day-to-day life. Ask whether MHT is appropriate for you and, if so, what form your GP would start with. If MHT is not right for you, ask what non-hormonal pharmaceutical options are worth considering, particularly the newer medications. If your GP is not comfortable with menopausal hormone therapy, it is reasonable to ask for a referral to a colleague who is.

Three takeaways

1. MHT, also known as HRT, is the most effective treatment, and in Australia transdermal oestradiol with evening micronised progesterone is the usual first-line approach.

2. Effective non-hormonal options exist — the newer NK3 medications elinzanetant and fezolinetant, plus venlafaxine, escitalopram and gabapentin, alongside CBT for hot flushes and clinical hypnotherapy.

3. Black cohosh and most herbal preparations do not consistently beat placebo. The step that unlocks real treatment is a long GP appointment with two weeks of tracking in hand.

This is not your body failing you. It is your body changing — and there is now more that genuinely helps than at any point in the last twenty years.

If you want more

Not sure if what you are experiencing is menopause? Work through the free Menopause Symptom Checklist and take it to your GP: https://menopausehub.com.au/mht-checklist.

This information is educational only and does not constitute personal medical advice. Always consult a qualified health professional about your individual circumstances. © Menopause Hub 2026.

REFERENCES

Harlow SD et al. Monthly variation of hot flashes, night sweats, and trouble sleeping. Menopause 2020;27(1):5-13 (SWAN). (Hormone therapy after the final menstrual period associated with 74% reduction in odds of trouble sleeping; larger effect on flushes/sweats.)

Newson L. The Definitive Guide to the Perimenopause and Menopause. Yellow Kite, 2023. (Transdermal body-identical oestradiol first-line; evening micronised progesterone; non-hormonal antidepressants and gabapentin.)

Hirsch H. The Perimenopause Survival Guide. Balance, 2025. (Clinical hypnotherapy endorsed by the Menopause Society.)

Shapiro CM et al. Effect of fezolinetant on sleep disturbance. Maturitas 2024 (pooled SKYLIGHT 1 and SKYLIGHT 2 phase 3 trials). Significant improvements in patient-reported sleep disturbance over 12 weeks. NK3 receptor antagonism on KNDy neurons. Elinzanetant (Lynkuet) and fezolinetant (Veozah) both TGA-approved.

Hardy C et al. MENOS@Work CBT randomised controlled trial. Menopause 2018;25(5):508-519. (Significant benefit for working women from a self-help CBT-based intervention for vasomotor symptoms.)

The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society. Menopause 2023;30(6):573-590. (Herbal preparations including black cohosh, evening primrose oil and red clover do not consistently outperform placebo for vasomotor symptoms.)