Hot flashes and night sweats
Sudden sensation of heat in the upper body with flushing, sweating and palpitations. Linked to instability of the hypothalamic thermoregulatory centre against fluctuating estradiol. The most common menopausal complaint.
ICD-10 N95.13 drugs
Also known as: Vasomotor symptoms, Hot flushes
Drugs used for this condition
- ATiboloneSecond line · Synthetic steroid with estrogenic, progestogenic and weak androgenic activityReduces the frequency and severity of hot flushes and night sweats. According to Cochrane, tibolone is somewhat less effective than combined estrogen-progestogen MHT for symptom control, but it is convenient as a single tablet: women with an intact uterus need no separate progestogen and take 2.5 mg once daily continuously. In women over 60 it is not recommended because of an increased stroke risk (LIFT trial).
- CBlack cohosh (Cimicifuga racemosa)Case-by-case decision · Herbal product for menopausal symptoms (food supplement under Spanish RD 1487/2009)Black cohosh is a herbal product used in Europe for menopausal vasomotor symptoms. EMA HMPC recognises well-established use of standardised extracts (Remifemin, Klimadynon). Cochrane Leach 2012 reviewed 16 RCTs and concluded the effect on hot flashes is inconsistent and on average small. NICE NG23 (2015, updated 2024) mentions black cohosh as an option when a patient declines or has contraindications to menopausal hormone therapy. SEGO 2024 is cautious because of hepatotoxicity. If hot flashes are moderate and the patient prefers a herbal option, discuss with the gynaecologist treatment duration and liver enzyme checks at 2–3 months.
- DRed clover (Trifolium pratense)Case-by-case decision · Herbal source of isoflavones (food supplement under Spanish RD 1487/2009)Red clover isoflavones are used as a herbal option for moderate hot flashes. Cochrane Lethaby 2013 pooled phytoestrogen data and concluded that the reduction in flash frequency does not, on average, differ from placebo in a clinically meaningful way. Some RCTs with Promensil showed a small advantage, but effect sizes remain small. NICE NG23 does not recommend isoflavones as a first-line standard. SEGO 2024 lists them as options with debatable benefit. If hot flashes are moderate and the patient prefers a herbal option, discuss a 2–3 month trial with the gynaecologist and reassess.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit