Hormone therapy is the most effective treatment for hot flashes and night sweats. Here’s what it is, its common side effects, how long they last, and what changed on the FDA label in 2025.
HRT (hormone replacement therapy), also called menopausal hormone therapy, replaces the estrogen your body makes less of at menopause. Its main use is to relieve hot flashes and night sweats, and it also helps vaginal dryness and protects against bone loss. Women who still have a uterus also take a progestogen to protect its lining. The most common HRT side effects are breast tenderness, bloating, headaches, nausea and irregular spotting, and they usually settle within about three months. The more serious risks, such as blood clots, are small for most healthy women who start before 60 or within 10 years of menopause. In November 2025, the FDA removed most of the strong “boxed” warning from HRT labels.
What is HRT, and what is it for?
What it treats:
- Hot flashes and night sweats, its main purpose
- Vaginal dryness and discomfort, often treated with low-dose vaginal estrogen; see our vaginal dryness guide
- Bone loss, helping prevent osteoporosis
- Sleep, mood and energy, often improved indirectly when night sweats settle; see menopause fatigue
The main types:
- Estrogen alone: for women who have had a hysterectomy.
- Combined estrogen and progestogen: for women with a uterus. Estrogen alone can thicken the uterine lining and raise the risk of uterine cancer, so the progestogen protects against that.
- Vaginal estrogen: low-dose creams, tablets or rings that treat dryness locally, with very little absorbed into the body.
The forms: pills, skin patches, gels and sprays. The progestogen can be a pill or a hormonal IUD.
A note on “bioidentical” hormones: FDA-approved body-identical hormones are available on prescription. Custom-mixed “compounded bioidentical” hormones aren’t FDA-approved and aren’t checked for dose or purity.
Common side effects
From estrogen:
- breast tenderness or swelling
- bloating
- nausea
- headaches
- leg cramps
From progestogen:
- mood changes, like PMS
- bloating
- acne
- irregular bleeding or spotting
How long do HRT side effects last?
Most side effects ease within about three months as your body adjusts. If they don’t, your doctor can usually help by changing the dose, the form (for example, from a pill to a patch), or the type of progestogen. Irregular bleeding is common in the first months, but bleeding that starts after six months, or that is heavy, should be checked.
The more serious risks
For most healthy women who start HRT before 60 or within 10 years of menopause, the serious risks are small. They include:
- Blood clots and stroke: higher with estrogen pills than with patches or gels.
- Breast cancer: a small increase with combined HRT, which rises the longer it’s used.
- Uterine cancer: a risk with estrogen alone in women who have a uterus, which is why a progestogen is added.
- Gallbladder problems.
HRT is usually not recommended if you have had breast cancer, a blood clot or stroke, liver disease, or unexplained vaginal bleeding.
What changed in 2025
For 22 years, all estrogen products carried the FDA’s strongest “boxed” warning about heart disease, breast cancer and dementia, based mainly on a large study from 2002. In November 2025, the FDA removed those warnings, saying the risks had been overstated for women who start HRT early, and kept a boxed warning only about uterine cancer for estrogen-alone products. It now advises starting within 10 years of menopause or before age 60.
Not every expert agrees with the change, and some note it wasn’t based on new trial data. What everyone agrees on is that the decision should be made with your doctor, based on your own health history.
When to call your doctor
Get urgent care for:
- pain or swelling in one leg
- chest pain or sudden breathlessness
- a sudden severe headache, or changes in vision or speech
Book an appointment for:
- bleeding after six months on HRT, or bleeding after stopping
- a new breast lump
- side effects that last beyond three months
If HRT isn’t for you
Non-hormonal medicines for hot flashes are available, and the FDA approved a new one in 2025. Lifestyle changes help too: dressing in layers, a cool bedroom, regular exercise and limiting alcohol. If your hair is thinning as well, see menopause hair loss, and for drier, thinner skin, see menopause skin changes.
The Chinese medicine view
Chinese medicine describes menopause as a natural decline of Kidney essence around the age of 49. Hot flashes and night sweats are traditionally linked to Kidney yin deficiency, a lack of the cooling, moistening side of the body. These are traditional descriptions, not a diagnosis.
Another option for this stage of life
Not every woman wants another prescription. Feminine Vitality is a sealed herbal pouch worn over the navel, with nothing to swallow and no hormones, following the traditional whole-body approach to the menopause years. It is not a replacement for hormone therapy and doesn’t treat hot flashes or other menopause symptoms, but some women choose it as part of their wellness routine. Your first course is covered by our 90-Day Satisfaction Guarantee.
See Feminine Vitality’s directions →
Reviewed October 2026. Author: Qingcai Wang, MD, PhD, developer of the Five Essences external herbal-pouch formulations, with a commercial interest in their sale. General education only; continue your medical care.
Sources: FDA, removal of boxed warnings on menopausal hormone therapy (November 2025); The Menopause Society: patient education; NHS: side effects of HRT.