Menopausal hot flushes and night sweats are the most common symptoms of the menopause, and a minority of women find them distressing and seek treatment. Hormone replacement therapy (HRT) is the most effective treatment for managing these symptoms. HRT is also beneficial in the treatment of other symptoms associated with menopause such as urogenital atrophy and psychological symptoms, and in protecting against the early metabolic changes associated with premature ovarian failure (Rees et al 2009). This article discusses the use of HRT and alternative treatment approaches to manage menopausal hot flushes and night sweats.