NON-HORMONAL TREATMENTS FOR SWEATS & FLUSHES

MENOPAUSAL hot flushes and night sweats – vasomotor symptoms – affect up to 75% of women going through the menopause. These symptoms can disturb sleep, impair concentration and mood, and significantly affect work and daily life. Menopause Hormone Therapy (MHT) – also known as HRT – remains the most effective treatment. But many women can’t or prefer not to take oestrogen. Fortunately, several non-hormonal prescription options are available in the UK.

This article was included in issue 106 (Autumn 2025) of The Menopause Exchange newsletter.

Clonidine
Clonidine acts on the nervous system to reduce the sudden widening of blood vessels that causes flushes.
Effectiveness: Studies show a modest 20% to 40% reduction in flush frequency. Clonidine is now often reserved for women who can’t use antidepressants or other nonhormonal options.
Side effects: Dry mouth, dizziness, drowsiness, constipation and occasional headaches. Because clonidine lowers blood pressure, it can cause light-headedness, particularly when standing suddenly. Blood pressure monitoring is advised.

Antidepressants (SSRIs and SNRIs) Antidepressants are widely used off-label for menopausal symptoms in the UK. These work by regulating levels of serotonin and noradrenaline, which are involved in temperature regulation.
Venlafaxine (Effexor XR): An SNRI that can reduce flushes by 50% to 60% at doses of 37.5 mg to 75 mg daily. Benefits often appear within one to two weeks.
Paroxetine: While a low-dose version is licensed in the USA for hot flushes, paroxetine is used off-label in the UK at 10 mg to 20 mg daily, with similar effectiveness.
Escitalopram and Citalopram: SSRIs shown to reduce flushes by around 30% to 50% at doses of 10 mg to 20 mg daily.
Other SSRIs: Sertraline and fluoxetine show variable benefit, but if one of these is ineffective, another may be tried after a short washout period.
Side effects: Nausea, dry mouth, constipation, sleep disturbance, sexual side effects and occasionally raised blood pressure (more likely with SNRIs). Most women tolerate these medicines well. Side effects often lessen after the first few weeks. SSRIs and SNRIs are often a good choice for women who also experience low mood, irritability or anxiety during the menopause.

Gabapentin
Gabapentin, originally designed to treat epilepsy and nerve pain, reduces hot flushes by calming overactive nerve signals involved in temperature regulation.
Effectiveness: Clinical trials show a 30% to 50% reduction in flush frequency and severity compared with placebo, particularly when taken at night.
Side effects: Drowsiness, dizziness, unsteady gait, mild swelling of the ankles or feet, and weight gain. Beginning with a low dose and increasing slowly helps to minimise these effects.

Pregabalin
Closely related to gabapentin, pregabalin acts on the brain in a similar way.
Effectiveness: Limited studies suggest it may help some women, but evidence is weaker than for gabapentin.
Side effects: Drowsiness, dizziness, blurred vision and concentration difficulties. Because of the limited data and potential for side effects, pregabalin is usually considered when gabapentin is unsuitable or ineffective.

Oxybutynin
Oxybutynin is licensed for the treatment of an overactive bladder. It also blocks receptors in sweat glands, which then reduces sweating.
Effectiveness: Research has shown hot flush reductions of up to 70% to 85% in women with and without breast cancer: a greater benefit than many other non-hormonal treatments.
Side effects: Dry mouth and eyes, constipation, urinary retention, dizziness and blurred vision. In older adults, it may cause confusion or memory problems. Oxybutynin should be used cautiously in women over 65 or in those already taking other anticholinergic medicines.

Fezolinetant (Veozah)
Fezolinetant, a neurokinin-3 (NK₃) receptor antagonist, acts on a brain pathway that controls hot flushes, rather than replacing oestrogen. Fezolinetant was approved by the MHRA in December 2023, and is available on private prescription. (Please note: since this article was published, it is now available on the NHS).
Effectiveness: Phase 3 studies show about a 57% reduction in hot flush frequency at 45 mg daily compared with 30% for placebo.
Side effects: Abdominal discomfort, diarrhoea, insomnia, back pain and occasionally elevated liver enzymes. Liver function should be monitored, and the drug shouldn’t be used in active liver disease.

Elinzanetant (Lynkuet)
Elinzanetant, a neurokinin (NK3 and NK1) receptor antagonist, was approved for moderate to severe vasomotor symptoms by the MHRA in July 2025. It blocks brain receptors that control body temperature. Elinzanetant isn’t yet available on the NHS but can be prescribed privately in the UK.
Effectiveness: Large OASIS Phase 3 trials showed that elinzanetant reduced hot flush frequency by up to 65% within 12 weeks, with improvements in sleep and quality of life. Many women reported feeling benefits within the first month.
Side effects and cautions: Mild abdominal discomfort, fatigue and occasionally elevated liver enzymes. Liver function monitoring is recommended, and it should be avoided in active liver disease.

Choosing the right treatment
Each non-hormonal medicine differs in effectiveness, speed of onset and side effects. SSRIs/SNRIs and gabapentin may take one to four weeks to reach full benefit. Oxybutynin and NK₃ antagonists can work more rapidly. Health conditions such as high blood pressure, urinary issues or liver disease should guide the choice of medicine. Discuss your symptoms and medical history with your GP or menopause specialist.

About the author
Dr Joanne Hobson is a menopause and psychosexual health specialist. She is clinical lead director of The Menopause Consortium (TMC).

Tags: Antidepressants (SSRIs and SNRIs), Clonidine, Elinzanetant (Lynkuet), Escitalopram and Citalopram, Fezolinetant (Veozah), fluoxetine, Gabapentin, non hormonal treatments for sweats & flushes, oestrogen, Oxybutynin, Paroxetine, Pregabalin, Sertraline, The Menopause Consortium (TMC), Venlafaxine (Effexor XR)