Hot flushes and night sweats: what works in the UK

SASian Anderson, Writer and editor, MyGLP. Sources checked 5 November 2026.

How long flushes last

Hot flushes and night sweats sit at the top of the NHS menopause symptom list. The NHS says menopause symptoms usually last 7 to 9 years, sometimes longer. Night sweats break sleep, and poor sleep feeds tiredness, low mood and appetite the next day. Waiting for flushes to pass on their own is one choice. You do not have to make it.

Your options at a glance

HRT

NICE guideline NG23 treats HRT as the first choice for hot flushes and night sweats. You take oestrogen as a tablet, patch, spray or gel, plus a progestogen if you still have a womb. Patches, gels and sprays carry a lower clot risk than tablets. Our HRT in numbers guide sets out each risk per 1,000 women, so this page does not repeat the figures.

CBT made for the menopause

NICE updated NG23 in November 2024 to recommend menopause-specific cognitive behavioural therapy for hot flushes, night sweats and sleep problems in women aged 40 and over. You can use CBT alongside HRT or instead of it, for example if you prefer not to take hormones or have been told HRT is not suitable. NICE found the biggest gain was in how much the flushes bothered women, alongside fewer and milder flushes and better sleep.

NICE also noted long waits for CBT in some areas and suggested group and online courses as quicker options. Ask your GP what menopause CBT is available in your area.

Fezolinetant (Veoza)

Fezolinetant blocks a brain signal (the neurokinin 3 receptor) involved in temperature control, which becomes overactive as oestrogen falls. The MHRA licensed fezolinetant in December 2023, as the British Menopause Society noted at the time.

In March 2026, NICE technology appraisal TA1143 recommended fezolinetant for moderate to severe hot flushes when HRT is unsuitable. The NHS in England must fund a NICE-recommended medicine within 90 days. In Scotland, the Scottish Medicines Consortium accepted fezolinetant for the same group in June 2026.

In the SKYLIGHT 1 and 2 trials summarised by the SMC, fezolinetant cut moderate to severe flushes by about 2.5 more per day than placebo at 12 weeks. In SKYLIGHT 1, 35% of women on fezolinetant had their flushes cut by three quarters or more, against 13% on placebo. NICE notes fezolinetant is not recommended if you have liver disease, and your liver needs blood tests before and during treatment. NICE made no recommendation for women with breast cancer or other oestrogen-dependent cancers.

Elinzanetant (Lynkuet)

The MHRA approved elinzanetant in July 2025, the first regulator in the world to do so. The OASIS trials included over 1,400 women aged 40 to 65 and found fewer and milder flushes and night sweats than placebo over 26 to 52 weeks. The MHRA says elinzanetant may also help menopause-related sleep problems.

The BMS statement on non-hormonal treatments says elinzanetant is licensed for flushes including those caused by breast cancer treatments such as tamoxifen. As of mid 2026, it was awaiting a NICE appraisal and available only on private prescription.

Older non-hormonal tablets

The BMS statement reviews the older options. Your GP picks among them based on your other health conditions and medicines.

• Paroxetine and venlafaxine have the strongest evidence among antidepressants for flushes. Venlafaxine is preferred if you take tamoxifen, because paroxetine and fluoxetine interfere with how tamoxifen works.
• Citalopram and escitalopram also help. Sertraline appears to help least.
• Gabapentin and pregabalin reduce flushes but cause drowsiness and dizziness, and both are controlled drugs with a risk of dependence.
• Clonidine is licensed for flushes, but the evidence is mixed and sleep problems are common at higher doses. You need to reduce the dose slowly when stopping.
• Oxybutynin, a bladder medicine, also reduces flushes and is used off licence.

What the evidence says on supplements

Supplement shelves promise a lot. The trials deliver less.

• Soy and red clover isoflavones: a Cochrane review of 43 trials found no conclusive evidence they reduce flushes. Many trials were small and short. Placebo groups improved by between 1% and 59%, which shows how much flushes vary on their own.
• Black cohosh: the NHS herbal remedies page says any benefit is not supported by scientific evidence. The BMS says black cohosh interferes with tamoxifen.
• St John's wort: the NHS warns of serious side effects with other medicines. The BMS says NICE advises against it and you should avoid it with fezolinetant or elinzanetant.

If you still want to try a herbal product, the BMS suggests choosing one with the Traditional Herbal Registration (THR) mark for quality, and the NHS advises asking a GP or pharmacist first. Isoflavones are not recommended after breast cancer.

Things you can change today

The NHS lifestyle page lists the triggers to cut down on and the habits to build.

• Cut down on caffeine, alcohol and spicy food, all known flush triggers.
• Stop smoking, which can reduce flushes.
• Exercise regularly. The NHS says activity can reduce flushes and improve sleep.
• Wear layers and loose clothing, and sleep in a cool, well-ventilated room.

Alcohol and food triggers get more detail in our eating well through the menopause guide. If night sweats are wrecking your sleep, the sleep guide covers the rest of the picture.

Sources

1. Menopause: identification and management (NG23) (NICE)
2. Menopause and perimenopause: symptoms (NHS)
3. Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause (TA1143) (NICE)
4. Fezolinetant (Veoza) advice (Scottish Medicines Consortium, 2026)
5. MHRA approves elinzanetant for hot flushes caused by menopause (MHRA)
6. Non-hormonal based treatments for menopausal symptoms (British Menopause Society, 2026)
7. Phytoestrogens for menopausal vasomotor symptoms (Cochrane, 2013)
8. Herbal remedies and complementary medicines for menopause symptoms (NHS)
9. BMS update: fezolinetant licensed by the MHRA (British Menopause Society, 2023)
10. Lifestyle changes to make if you're unable to take HRT (NHS)