Menopause: Managing Hot Flashes


Most women have hot flashes at some point before or after menopause. Hot flashes happen when estrogen levels drop. While some women have few to no hot flashes, others have them many times each day.

Hot flashes can be uncomfortable and upsetting. They can lower the quality of your sleep and daily life. But they aren't a sign of a medical problem. They are a normal response to natural changes in your body.

Hot flashes usually get better or go away after the first or second year after menopause. At that point, estrogen levels usually stay at a low level.

You can make some lifestyle changes to reduce your hot flashes. And if those don't help, you may want to try medical treatment.

  • Avoid using tobacco or drinking a lot of alcohol. They tend to make hot flashes worse.
  • Manage stress. Stress can make hot flashes worse.
  • Exercise regularly, and eat a healthy diet.
  • Try rhythmic breathing exercises. This is called paced respiration. It can help you meditate and relax, and it may reduce your hot flashes.

You also can talk to your doctor about treatments that may either reduce or stop your hot flashes. These include taking low-dose estrogen (hormone therapy) for a short time, taking certain medicines, and taking the herb black cohosh.

How can I manage hot flashes?

You can manage hot flashes by making certain lifestyle choices. You can also take daily medicine. Some measures help prevent or reduce hot flashes. Others can make you more comfortable when you're having a hot flash.

Lifestyle choices

Eat and drink well, and avoid smoking

  • Limit alcohol.
  • Drink cold liquids rather than hot ones.
  • Eat smaller, more frequent meals. Digesting a lot of food can make you feel hotter.
  • Eat healthy foods.
  • Do not smoke or use other forms of tobacco.

Stay cool

  • Keep your area cool. Use a fan.
  • Dress in layers. Then you can remove clothes as needed.
  • Wear natural fabrics, such as cotton and silk.
  • Sleep with fewer blankets.

Reduce stress

  • Get regular exercise.
  • Use relaxation techniques, such as breathing exercises, yoga, or biofeedback. A breathing exercise called paced respiration may reduce hot flashes and emotional symptoms.

Medical treatment

  • Short-term, low-dose hormone therapy (HT) can reduce or stop hot flashes and other menopause symptoms. It raises your estrogen level. Use the lowest dose needed for the shortest possible time, and have regular checkups. This is because HT may increase the risk of problems in a small number of women. These problems include blood clots, stroke, heart disease, breast cancer, ovarian cancer, and dementia. Risk varies based on when you start HT in menopause and how long you take it. Using HT for a short time in early menopause has less risk than when it is started later in menopause.footnote 1 If you have a history of heart disease or breast cancer, avoid using estrogen for hot flashes. There are other options.
  • Estrogen-progestin birth control pills (before menopause) can reduce or stop hot flashes and other symptoms. They can keep your hormones from going up and down. Don't use estrogen if you are older than 35 and smoke; have diabetes, heart disease, or breast cancer; or have a family history of breast cancer.
  • Antidepressant medicine can reduce the number of hot flashes and how bad they are. It improves the brain's use of serotonin, which helps control body temperature. Side effects are possible. This type of medicine is a good choice if your only menopause symptoms are having hot flashes and mood swings and feeling irritable.footnote 2
  • Clonidine may relieve hot flashes for some women. But studies have not shown that it makes hot flashes less severe or less frequent.footnote 3 This type of medicine is a good choice if hot flashes are your only symptom, especially if you have high blood pressure.
  • Gabapentin, an antiseizure medicine, may lower the number of hot flashes each day. It also may make hot flashes less severe.footnote 2
  • Black cohosh may reduce or prevent hot flashes, depression, and anxiety. As with HT, have regular checkups when you take black cohosh.
  • Some women eat and drink a lot of soy to even out hot flashes and other symptoms. So far, studies have used many different soy sources and different measures of how well they work. So this makes it hard to compare them. Soy isoflavone (rather than soy protein) has shown the most promise to treat hot flashes.footnote 4



  1. North American Menopause Society (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause, 19(3): 257–271. Also available online:
  2. Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839–855.
  3. Burbos N, Morris EP (2011). Menopausal symptoms, search date June 2010. Online version of BMJ Clinical Evidence:
  4. North American Menopause Society (2011). The role of soy isoflavones in menopausal health: Report of the North American Menopause Society. Menopause, 18(7): 732–753.

Other Works Consulted

  • U.S. Preventive Services Task Force 2012. Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement. Available online:


ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerCarla J. Herman, MD, MPH - Geriatric Medicine

Current as ofFebruary 20, 2015