Remedies for menopause night sweats, ranked by evidence

What are the best remedies for menopause night sweats?

The best-supported remedies for menopause night sweats are hormone therapy first, then cognitive behavioral therapy (CBT), clinical hypnosis and several non-hormone drugs. Night sweats are hot flashes that happen in sleep. Trials measure them together as vasomotor symptoms, so the evidence below covers both.

The Menopause Society reviewed the literature again in 2023 and sorted nonhormone options into “recommended” and “not recommended” by level of evidence. Its position statement is the backbone of the table below.

Which night sweats remedies have trial support? An evidence ladder

Menopause night sweats remedies range from a 75% cut in hot flushes (hormone therapy) to no significant effect over placebo (black cohosh). This table pairs the Menopause Society 2023 verdict with the trial behind each option.

Remedy	Menopause Society 2023	Trial or review checked	Result
Hormone therapy (oral)	Called the most effective treatment (separate from the nonhormone list)	Cochrane review, 24 placebo-controlled trials (2004)	Hot flush frequency down 75% versus placebo
CBT	Recommended, Level I	MENOS 2, 140 women (2012)	Problem rating 2.12 points lower than no treatment at 6 weeks
Clinical hypnosis	Recommended, Level I	Self-administered audio trial, 250 women (2025)	Hot flash score down 53.4% versus 40.9% for sham hypnosis
SSRIs and SNRIs	Recommended, Level I	Escitalopram, 205 women (2011)	1.41 fewer hot flashes a day than placebo at 8 weeks
Fezolinetant	Recommended, Level I	SKYLIGHT 1 and 2, 1,022 women (2024 analysis)	2.51 fewer hot flashes a day than placebo (45 mg)
Gabapentin	Recommended, Level I	Position statement review	Recommended on Level I evidence
Oxybutynin	Recommended, Levels I-II	Position statement review	Recommended on Level I-II evidence
Weight loss	Recommended, Levels II-III	Position statement review	Recommended on Level II-III evidence
Black cohosh and other herbal supplements	Not recommended, Levels I-II	Cochrane review, 3 placebo-controlled trials, 393 women (2012)	0.07 flushes a day versus placebo, not significant
Cooling techniques, exercise, yoga, soy, acupuncture	Not recommended, Level II	Position statement review	Evidence limited or inconsistent

The trials used different outcomes (frequency, a combined score, a problem rating) and different comparison groups, so the ladder ranks the level of evidence, not a head-to-head winner.

Does hormone therapy treat menopause night sweats?

Hormone therapy is the most effective treatment for night sweats, according to the Menopause Society, which says it should be considered within 10 years of the final period. A Cochrane review of 24 trials found weekly hot flush frequency fell by 17.92 more than on placebo (95% CI 12.99 to 22.86).

That is about 2.6 fewer flushes a day (17.92 ÷ 7), which the review expressed as a 75% reduction. Placebo groups also improved by 57.7%, which can reflect placebo response, symptom fluctuation and natural decline.

If you have an estrogen-dependent cancer or cardiovascular disease, the Menopause Society points you to the nonhormone options below. The HRT and sleep guide covers how hormone therapy affects the rest of your night.

Which non-hormone treatments for night sweats work best?

The nonhormone treatments with Level I support are CBT, clinical hypnosis, SSRIs and SNRIs, gabapentin and fezolinetant. Each has a different cost, speed and side-effect profile.

CBT. In MENOS 2, 140 women with at least 10 problematic hot flushes or night sweats a week did group or self-help CBT. Group CBT lowered the problem rating 2.12 points more than no treatment at 6 weeks. CBT changes how much the symptom bothers you and how you cope with it. The measured effect is on the problem rating, not only on counts.

Clinical hypnosis. A 2025 trial of 250 postmenopausal women compared six weeks of self-administered hypnosis audio with sham white noise. Hot flash scores fell 53.4% with hypnosis and 40.9% with sham, a gap of 12.5 percentage points (P = .04). Both groups improved, which shows how strong the placebo response is.

Escitalopram. In a 205-woman trial, baseline frequency was 9.78 hot flashes a day. Escitalopram gave 1.41 fewer a day than placebo at week 8. That is about 14% of the baseline (1.41 ÷ 9.78). The effect is modest, and it is a prescription antidepressant.

Fezolinetant. In SKYLIGHT 1 and 2, pooled across 1,022 participants, the 45 mg dose gave 2.51 fewer hot flashes a day than placebo. The US label says to check liver blood tests before starting and at months 1, 2, 3, 6 and 9, and not to start it if aminotransferases or bilirubin are at least twice the upper limit of normal. The label lists hepatotoxicity as a postmarketing report.

Do natural remedies for night sweats work?

Natural remedies for night sweats mostly lack trial support. The Menopause Society 2023 statement does not recommend supplements or herbal remedies, and it rates soy foods, soy extracts and equol as not recommended on Level II evidence.

Black cohosh has the largest trial record. A Cochrane review of 16 trials covering 2,027 women used a median 40 mg a day for an average of 23 weeks. In the three placebo-controlled trials with usable data (393 women), it gave 0.07 more flushes a day than placebo, with a confidence interval of -0.43 to 0.56. No statistically significant difference.

“Not recommended” at Level II means the evidence is limited or inconsistent. For sage, red clover and other herbs, no trial data overrides the Menopause Society’s position. In the US, dietary supplements do not need FDA approval before sale the way prescription drugs do, so check any supplement with a pharmacist for interactions. For a wider look at herbs and sleep, see natural remedies for menopause sleep problems.

Does cooling the bedroom help with night sweats?

The Menopause Society does not recommend cooling techniques to reduce hot flashes, because Level II evidence was limited or inconsistent. That verdict is about the number of episodes, not comfort.

Lighter bedding makes an episode easier to sleep through, so use it for comfort. See breathable bedding for night sweats and the best room temperature for sleep. The article on why hot flashes are worse at night covers what happens in the body overnight.

What should you do if night sweats are wrecking your sleep?

If night sweats wake you most nights, book a clinician visit and start with the top of the ladder rather than trying supplements one by one. Bring this checklist.

• Note how many nights a week you wake drenched, for two weeks.
• Note your age, the date of your last period and any history of breast cancer, blood clots or heart disease.
• List every medicine and supplement you take.
• Ask whether hormone therapy is an option for you, and if not, which Level I nonhormone treatment fits.
• Mention any fever, unexplained weight loss, cough or diarrhoea. Those need assessing, per the NHS.

For the sleep side of the problem, see sleep aids for menopause compared, perimenopause insomnia and progesterone for sleep.