What you can take for night sweats depends entirely on what’s causing them. For menopause-related sweats, hormone therapy remains the most effective option, reducing episodes by up to 83% within 12 weeks. But night sweats also stem from medications, infections, thyroid problems, and other conditions, each requiring a different approach. Here’s what works and when.
Figure Out the Cause First
Night sweats aren’t a diagnosis. They’re a symptom with a long list of possible triggers. The most common cause in women over 40 is menopause, but night sweats also happen with overactive thyroid, sleep apnea, anxiety disorders, alcohol use, infections like tuberculosis, and certain cancers including lymphoma and leukemia. Taking something to suppress the sweating without identifying the underlying cause can mask a serious problem.
Certain medications are frequent culprits that people overlook. Up to 22% of people on antidepressants experience excessive sweating as a side effect. SSRIs like sertraline, fluoxetine, and citalopram can cause it, along with SNRIs like venlafaxine and duloxetine, and even bupropion. Diabetes medications that lower blood sugar and hormone therapies are also known triggers. If your night sweats started or worsened after beginning a new medication, that connection is worth investigating.
When Night Sweats Signal Something Serious
Most night sweats are benign, but a specific pattern warrants prompt medical evaluation. Lymphoma and other blood cancers produce what oncologists call “B symptoms”: drenching sweats that soak through your bedclothes, unexplained fever above 100.4°F, and unexplained weight loss of more than 10% of your body weight over six months. If you’re experiencing two or three of those together, especially the drenching quality of sweats rather than mild dampness, get evaluated quickly.
Hormone Therapy for Menopause Sweats
If your night sweats are tied to menopause or perimenopause, estrogen therapy is the most effective treatment available. Standard-dose estrogen reduces the frequency of moderate to severe hot flashes and night sweats by roughly 83% after 12 weeks. Even low-dose estrogen (such as 0.3 mg conjugated estrogen daily or equivalent) achieves about a 63% reduction, compared to 38% for placebo.
The North American Menopause Society recommends using the lowest effective dose, preferably through the skin (patches or gel) rather than pills, and reviewing the decision regularly with your provider. Hormone therapy doesn’t need to be stopped automatically at age 60 or 65. For healthy women at low risk of cardiovascular disease and breast cancer who still have persistent symptoms, continuing longer is considered reasonable. The risks vary based on the type of hormone, the dose, how it’s delivered, and when it’s started relative to menopause onset.
Non-Hormonal Prescriptions
For people who can’t or prefer not to take hormones, several prescription alternatives exist. The newest is fezolinetant, a once-daily 45 mg tablet approved specifically for menopausal hot flashes and night sweats. It works by blocking a brain receptor involved in temperature regulation that becomes overactive when estrogen levels drop. In clinical trials, women averaging 10 to 12 moderate-to-severe episodes per day saw reductions of 6 to 7.5 fewer episodes daily after 12 weeks. Improvement began within the first week.
Oxybutynin, originally a bladder medication, has shown effectiveness for both menopausal night sweats and antidepressant-induced sweating. Doses in the range of 2.5 to 5 mg twice daily for immediate-release formulations, or 15 mg daily for extended-release, have been studied. Gabapentin is another option, often given as a single nighttime dose to minimize daytime drowsiness and fatigue.
If Antidepressants Are the Problem
When an antidepressant is causing the sweating, the first strategies are lowering the dose or switching to a different medication. If that isn’t feasible because the current antidepressant is working well for your mental health, an add-on medication can target the sweating directly. Terazosin, a blood pressure drug, significantly reduced antidepressant-induced sweating in studies of nearly 100 patients at doses of 1 to 6 mg daily. Oxybutynin at 5 mg daily also produced statistically significant reductions. Clonidine, another blood pressure medication, improved sweating by 60 to 70% in case reports at low doses.
Supplements and Botanicals
Black cohosh is the best-studied herbal option. A meta-analysis of nine randomized, placebo-controlled trials found that black cohosh preparations improved menopausal vasomotor symptoms by 26% compared to placebo. That’s modest but real, and higher doses appear to work better. The effect sizes roughly doubled at higher dosages or when combined with St. John’s wort, suggesting some dose-dependency. The 26% reduction does slightly exceed what placebo alone typically achieves (20 to 30% in most hot flash trials), so the benefit, while genuine, is subtle compared to hormone therapy’s 63 to 83% reduction.
Soy isoflavones, evening primrose oil, and other plant-based supplements are widely marketed for night sweats, but the clinical evidence for them is considerably weaker and less consistent than for black cohosh. If you’re looking for a supplement to try before pursuing prescription options, black cohosh has the strongest track record.
Night Sweats in Men
Men get night sweats too, and low testosterone is one of the more common hormonal causes. Testosterone levels naturally decline with age, and when they drop low enough to cause symptoms (a condition called hypogonadism), night sweats, sleep disruption, and fatigue often follow. Testosterone replacement therapy can relieve these symptoms and is available as topical gels, skin patches, tablets, or injections. The choice of delivery method depends on convenience, insurance coverage, and how steady a hormone level each option provides.
Of course, the same non-hormonal causes that affect women apply to men as well. Infections, medications, thyroid disease, sleep apnea, lymphoma, and alcohol use are all on the list regardless of sex.
Practical Steps That Help Tonight
While sorting out the underlying cause and treatment, a few changes can reduce how disruptive night sweats feel. Keep your bedroom cool, ideally around 65°F. Use moisture-wicking sheets and sleepwear rather than cotton, which holds sweat against the skin. A fan or cooling mattress pad provides immediate relief for many people. Avoid alcohol, spicy food, and hot drinks in the two to three hours before bed, as all of these can trigger or worsen sweating episodes.
Layering your bedding so you can easily kick off a blanket is more practical than using one heavy comforter. Some people keep a change of clothes and a towel beside the bed to avoid fully waking up during an episode. These measures won’t fix the root problem, but they can make the difference between a tolerable night and a miserable one while you work with your provider on a longer-term solution.