Declining estrogen levels during perimenopause throw your body’s temperature-regulating system out of whack. Enter hot flashes. 

Hormone therapy with estrogen (also called hormone replacement therapy or HRT) is the most effective option for reducing hot flashes. Estrogen therapy can cut the frequency of your hot flashes by up to 75 percent.

Two medications — fezolinetant (Veozah) and elinzanetant (Lynkuet) — are approved by the U.S. Food and Drug Administration (FDA) specifically to target hot flashes. In studies, many people taking fezolinetant or elinzanetant had at least a 50 percent reduction in hot flash frequency. 

Other nonhormonal medications that have been shown to be helpful for hot flashes are gabapentin and oxybutynin.

The same medication your doctor may recommend for mood swings could also help with hot flashes. Certain antidepressants have been shown to cut hot flash frequency by up to 60 percent by affecting brain chemicals that send the heat signals. Antidepressants may be another good option for those who can’t take hormones.

You’ve probably seen ads for various herbal remedies claiming to stop hot flashes. Study results are mixed, and The Menopause Society doesn’t endorse herbal remedies for hot flashes due to lack of evidence. 

Some herbs, like black cohosh, have more research behind them. Studies indicate it may help reduce hot flash frequency. Definitely talk to your doctor before going the herbal remedy route. 

A fan can’t stop a hot flash, but it can offer some immediate relief when your body feels like it’s going up in flames. Try keeping one in the bedroom or your office. You can also throw a portable fan (like a battery-powered stroller fan) in your purse.

The right wardrobe can make hot flashes slightly more bearable. Dressing in thin, breathable layers can make it easier to shed a layer when the heat hits. Natural fabrics like cotton and linen tend to be more comfortable since they wick moisture and have better airflow.

Sometimes the most basic option is pretty effective. Applying something cold to your skin, such as a cold water bottle, an ice pack, or a cold compress, can provide cooling relief quickly. Try putting your cold item right on your wrist or the back of your neck. Some people even wear cooling vests or use cooling pillows to keep their skin comfortable during hot flashes.

Not every hot flash is linked to a specific trigger, but some are. Some people notice that spicy food, alcohol, caffeine, or stress seem to set off hot flashes. You may want to take note of what you ate or drank, or how you were feeling when you had a hot flash. Over time, you might notice patterns, and you’ll know if you should avoid extra hot sauce or a glass of wine.

Mindfulness-based stress reduction (MBSR) is the idea that you can train yourself to sit with unpleasant physical sensations. This can be done through meditation, yoga, body scans, and mindful walking. This approach may make hot flashes feel less distressing and disruptive, even if it doesn’t prevent them. You can explore it with a therapist or group program, or find tutorials on YouTube.