Hot flushes are probably the most common symptom resulting in medical consultation in relation to the menopause and, when severe, they can affect quite dramatically women's quality of life. Hormone (estrogen) replacement therapy (HRT) is the most effective treatment for this symptom and in the ideal setting of clinical trials, under optimal selection of patients and compliance, it reduces hot flushes by about 70-80%. Recently, however, a series of 'scares' has had large resonance in the lay press about possible adverse effects of HRT. These have undermined both doctors' and women's confidence in the use of these compounds. This has been witnessed by the recent fall in HRT sales. A number of compounds, both pharmacological and herbal in origin, have been used for the treatment of neurovegetative symptoms in menopausal women. The present article critically reviews evidence of the efficacy of some of the most commonly used compounds and assesses their effect in relation to that of HRT.