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Cognitive behavioral therapy (CBT) is a form of psychotherapy well studied in mental health conditions such as depression and anxiety, and health conditions such as chronic pain.94,95 Relatively risk-free, it offers women a non-pharmaceutical option that has shown effectiveness in alleviating VMS.83 In an RCT assessing CBT for menopausal symptoms (CBT-Meno), symptomatic women who received CBT reported a significant improvement in their VMS symptom interference and bother compared to no active intervention.96 Early observational studies showed that physically active women had less severe hot flashes compared to those who were less active or sedentary.87,88 However, Cochrane review of studies on the impact of physical activity on VMS severity suggests that there is insufficient evidence supporting the efficacy of exercise in management of VMS.89 The overall quality of evidence is poor due to inconsistent exercise interventions as well as inconsistent comparisons between intervention and no intervention and lack of direct comparison with HT use.89 As such, the current evidence does not support physical activity as a treatment for VMS.90 It is important to choose gummies with minimal or no added sugars in order to align with the principles of the ketogenic diet. 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