Hormone replacement therapy (HRT), now more commonly called menopausal hormone therapy (MHT), is the most effective treatment available for hot flashes and night sweats. Multiple large-scale studies consistently show estrogen therapy reduces hot flash frequency by 75-90% in most women.
This article is informational only — not medical advice.
What the Evidence Shows
Beyond hot flash reduction, estrogen therapy improves sleep architecture, reduces nighttime cortisol spikes associated with estrogen withdrawal, and addresses vaginal dryness that can independently disrupt sleep.
Combined estrogen-progesterone therapy adds progesterone, which has mild sedative properties that may further improve sleep quality.
The WHI Study — What It Actually Said
The 2002 Women’s Health Initiative study created concern about HRT. Subsequent analysis showed results were heavily influenced by participant age (average 63) — significantly older than typical menopause onset.
Women who start hormone therapy within 10 years of menopause onset or before age 60 show a different risk profile. Current major medical societies — including the Menopause Society and British Menopause Society — now consider HRT appropriate for most healthy women under 60 within 10 years of menopause.
Non-Hormonal Options
SSRIs and SNRIs — reduce hot flash frequency by 40-60%.
Fezolinetant (Veozah) — newer non-hormonal medication specifically approved for menopause hot flashes.
Gabapentin — reduces hot flashes and improves sleep in menopausal women.
CBT-I — addresses sleep disruption without targeting hot flashes directly.
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