Menopause supplements or hormone therapy: what to expect from each for hot flushes

If you want relief from hot flushes, hormone therapy and supplements are not on the same level. In a Cochrane review of 24 trials, oral hormone therapy reduced the frequency of hot flushes by 75% compared with placebo. The most popular supplements, such as soy, isoflavones and black cohosh, have not shown a conclusive effect in their own Cochrane reviews. There is also a third group that many people don't know about: prescription non-hormonal drugs.

Below, we compare the options point by point: what their trials show, how they are used, what is known about their safety, how much they cost and how you can get them in Spain.

What we are comparing, and why the data don't come from a head-to-head trial

This article compares four options for hot flushes and night sweats: hormone therapy, phytoestrogens (soy, isoflavones and similar extracts), black cohosh, and the non-hormonal drugs that act on the brain, such as fezolinetant (Veoza) and elinzanetant (Lynkuet).

A note on method before the figures: no large trial has compared hormone therapy directly with soy or with black cohosh. Each figure comes from a different review, each one against placebo, with different participants, durations and ways of measuring. They tell you how much each option differs from taking nothing, but you can't subtract one figure from another as if they came from the same study.

Effectiveness for hot flushes: what the trials show

Oral hormone therapy is the option with the strongest evidence. Cochrane review CD002978, which pooled 24 trials with 3,329 participants, found that it reduced the frequency of hot flushes by 75% compared with placebo (95% confidence interval: 64.3–82.3%). It also significantly reduced their severity, with an odds ratio of 0.13 (95% CI: 0.07–0.23). This means a much lower chance of severe symptoms.

The picture is different for phytoestrogens. Cochrane review CD001395, with 43 trials and 4,084 participants, concluded that there is no conclusive evidence that they reduce the frequency or severity of hot flushes and night sweats. There was one caveat: extracts high in genistein appeared to reduce daily hot flushes, but the authors call for more research before this can be considered proven. If you'd like to look at the different products in more detail, we cover them in what works and what doesn't among phytoestrogens, isoflavones and other supplements.

Black cohosh does worse. Its Cochrane review (16 trials, 2,027 women, with a median dose of 40 mg a day for about 23 weeks) found no significant difference from placebo in hot flush frequency. In the three trials where this could be measured (393 women), the difference was 0.07 hot flushes a day, with a confidence interval from −0.43 to 0.56. The authors conclude that there is not enough evidence to recommend it.

The Menopause Society, the leading North American scientific society in this field, reached the same conclusion in its 2023 position statement on non-hormonal treatments. It does not recommend soy foods, soy extracts or equol because the evidence is mixed, and it rates black cohosh as not recommended because of a lack of evidence.

Non-hormonal drugs work differently. Fezolinetant stops a substance called neurokinin B from binding to its targets in the part of the brain that regulates temperature. According to the European Medicines Agency (EMA), it reduces the number and intensity of hot flushes and night sweats. Elinzanetant blocks two receptors, NK-1 and NK-3. We don't give effectiveness percentages for these two drugs here because we haven't checked them against their summaries of product characteristics. What is established is that both have passed the European assessment for this indication, which no supplement has done.

How they are used and how to get them in Spain: prescription or over the counter

Soy, isoflavone and black cohosh supplements are sold without a prescription as food supplements, in pharmacies, health food shops and online. This makes them easy to get, but it also means they have not been through the effectiveness assessment that a medicine must pass.

Hormone therapy is a prescription treatment tailored to each woman. It may be oestrogen alone or combined with a progestogen, depending on whether she has a uterus, and taken orally or through the skin depending on her profile. We explain how hormones are combined today in modern hormone therapy with estradiol and micronised progesterone.

Veoza (fezolinetant 45 mg) received its first marketing authorisation in the European Union on 7 December 2023. Its summary of product characteristics is published in CIMA, the database of the Spanish Agency of Medicines and Medical Devices (AEMPS). It is a prescription-only medicine. Lynkuet (elinzanetant) is authorised in the EU for moderate to severe vasomotor symptoms caused by the menopause or by endocrine therapy for breast cancer, but there is no confirmation that it is marketed or reimbursed in Spain.

Safety: what is known and what isn't

For phytoestrogens, the Cochrane review notes that they showed no harmful effects on the endometrium in short-term use. That is not the same as proving they are safe in the long term. Robust enough data on that don't exist, and a product being natural doesn't make it harmless.

Hormone therapy has known risks that vary from woman to woman. That is why the decision is made after a medical assessment that looks at your history, including thrombosis, high blood pressure or breast cancer. A development in November 2025 caused a lot of confusion. On 10 November, the US Food and Drug Administration (FDA) announced that it was removing references to cardiovascular disease, breast cancer and probable dementia from its boxed warning. It kept the warning about the risk of endometrial cancer in women with a uterus who don't use a progestogen. This is a US measure: it doesn't mean hormone therapy is risk-free, and there is no record of the EMA or the AEMPS changing their position. We explain who it is suitable for and what its real risks are in what menopausal hormone therapy is and who it is for.

As for the non-hormonal drugs, Lynkuet has been on the EMA's list of medicines under additional monitoring since December 2025. These medicines carry the black triangle, which is used for newer drugs so their safety can be closely watched in real-world use. The side effects and precautions for Veoza are set out in its summary of product characteristics, and we summarise them in the non-hormonal pill for hot flushes.

Cost and reimbursement

We don't give prices for supplements or hormone therapy because they vary a lot by product and presentation, and we haven't checked them. There is one relevant piece of information on reimbursement. According to the Spanish Ministry of Health's search tool (national code 763922), Veoza has been reimbursed since 1 September 2026 for certain indications or conditions only, meaning it has restricted reimbursement. It's best to confirm the exact conditions with your doctor or pharmacy. Supplements are not medicines, so they receive no public funding.

When each option is considered, in general terms

In clinical practice, hormone therapy is usually considered when hot flushes affect quality of life and the assessment finds no reason to avoid it. Non-hormonal drugs are mainly considered when hormones are contraindicated or the woman doesn't want to use them. Elinzanetant's European authorisation specifically includes hot flushes caused by endocrine therapy for breast cancer. Many women try supplements because they are easy to get, but the available reviews don't support the idea that they will reliably relieve hot flushes.

So the idea that natural remedies are your only choice if you don't want hormones is out of date. There are prescription alternatives that have been assessed by the European agencies. Which one is right for you depends on your medical history, and that assessment is for a doctor to make.

Key points and where to start

For hot flushes, hormone therapy is the option with the most evidence. Prescription non-hormonal drugs are an authorised alternative. Soy and black cohosh supplements have not shown a clear benefit in their reviews. In Spain there is now a structured route: menopause treatment with a medical assessment first, a prescription only when appropriate from a registered doctor, and ongoing follow-up to make any adjustments needed. This is what we offer at AiON. If hot flushes are affecting you, you can:

Check in a few minutes whether menopause treatment is right for you