Verbatim response from Perplexity
The best non-hormonal treatment for hot flashes is usually a prescription medication, and the strongest current evidence and FDA approvals are for paroxetine and fezolinetant.[4][6][10]
If you want the most practical answer by situation:
- Best overall evidence among older non-hormonal options: paroxetine (low-dose paroxetine mesylate is FDA-approved for hot flashes, and other SSRIs/SNRIs such as venlafaxine also reduce symptoms).[4][5][1]
- Often very effective when hot flashes are frequent or severe: fezolinetant is a newer FDA-approved non-hormonal option for vasomotor symptoms.[6]
- Good alternatives if antidepressants are not suitable: gabapentin and oxybutynin both have randomized-trial evidence showing meaningful reductions in hot flashes.[1][18]
- If you want the simplest non-drug approach: cooling strategies, avoiding triggers like alcohol/spicy foods, weight loss if needed, and stress-reduction techniques can help, but they are usually less effective than medication.[4][15]
In terms of overall symptom reduction, hormone therapy remains the most effective treatment, but among non-hormonal options, paroxetine or fezolinetant are the leading choices to discuss with a clinician.[4][6][16]
One important caveat: if you take tamoxifen, paroxetine and fluoxetine should generally be avoided because they can interfere with tamoxifen metabolism.[2]
If you want, I can also compare paroxetine vs fezolinetant vs gabapentin based on effectiveness, side effects, and cost.