Verbatim response from Perplexity
The best non-hormonal treatment for moderate to severe hot flashes is fezolinetant (brand name Veozah), a daily pill that blocks a specific brain pathway involved in triggering hot flashes, reducing their frequency by more than 50% with rapid onset and sustained effects [5][8]. The only FDA-approved non-hormonal medication specifically for this purpose is paroxetine (low-dose, brand name Brisdelle), an SSRI antidepressant that effectively reduces hot flash frequency and severity [3][4][8].
For women who cannot use or prefer not to take prescription medications, venlafaxine (Effexor) and gabapentin (Neurontin) are highly effective alternatives supported by multiple trials, reducing hot flash frequency by 54% or more [1][5][7]. Mind-body approaches like cognitive behavioral therapy (CBT) and clinical hypnosis are also strongly recommended by the North American Menopause Society to reduce how much hot flashes bother you, with hypnosis showing benefits in both frequency and severity [3][8].
Lifestyle modifications including wearing loose cotton clothing, dressing in layers, sipping ice water, lowering room temperature, and avoiding alcohol, spicy foods, and caffeine can provide relief for mild hot flashes [2][3][7].
Note on herbal supplements: Soy isoflavones (9–40% reduction) and black cohosh (similar to placebo in most trials) show inconsistent or limited evidence compared to prescription options [1][3].
If you are considering starting Veozah or Brisdelle, consult your healthcare provider to determine the best option based on your health history and symptom severity.