Nonhormonal Therapies

Neurokinin receptor antagonists are a newer class of non-hormonal medications developed specifically to treat moderate to severe vasomotor symptoms such as hot flashes and night sweats.

These medications target pathways in the brain involved in temperature regulation that become disrupted as estrogen levels change during menopause.

Examples include: fezolinetant, which targets the NK3 receptor, and elinzanetant, which targets both NK1 and NK3 receptors.

These medications do not contain estrogen or other hormones. As with any prescription medication, potential side effects, interactions, and monitoring requirements should be discussed with a healthcare provider.

Certain selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can reduce the frequency and severity of hot flashes in some women.

These medications affect neurotransmitters involved in temperature regulation and may also be helpful when mood symptoms occur alongside menopause symptoms.

Examples include: paroxetine, escitalopram, citalopram, venlafaxine, and desvenlafaxine.

Paroxetine is available in a low-dose formulation specifically approved in the United States for moderate to severe vasomotor symptoms. Other antidepressants may be prescribed off-label for this purpose. 

Gabapentin, a medication originally developed to treat seizures and also used for nerve pain, can reduce hot flashes and night sweats.

Because it can cause drowsiness, it may be particularly useful for some women whose hot flashes interfere with sleep. Possible side effects include dizziness, drowsiness, and fatigue.

Gabapentin is used off-label for menopausal vasomotor symptoms.

Oxybutynin is primarily used to treat overactive bladder but has also been shown to reduce hot flashes in some women.

It is an anticholinergic medication and may cause side effects such as dry mouth, constipation, and difficulty urinating. Because anticholinergic medications can have additional risks, particularly with longer-term use and in older adults, the potential benefits and risks should be discussed with a healthcare provider.

Its use for menopausal hot flashes is off-label.

Clonidine is a blood-pressure medication that has sometimes been used off-label to treat hot flashes. Its benefit tends to be modest, and side effects can include dizziness, dry mouth, constipation, and low blood pressure.

Because other nonhormonal treatments are generally more effective, clonidine is used less commonly for menopausal vasomotor symptoms.

Medication is not the only nonhormonal approach to managing menopause symptoms. Lifestyle and behavioral strategies may also play a role, either alone or alongside medical treatment.

Depending on the symptom, approaches may include:

May help women cope with bothersome hot flashes and can also support mood and wellbeing. 

A structured approach to improving persistent sleep problems. 

Supports cardiovascular health, bone health, mood, sleep, and overall wellbeing. 

Consistent sleep routines and other healthy sleep habits may help when menopause disrupts sleep. 

Relaxation techniques, mindfulness, and other approaches may help support emotional wellbeing. 

Nonhormonal options that can help relieve vaginal dryness and discomfort. 

For hot flashes and night sweats, systemic hormone therapy is generally the most effective treatment for eligible women. However, several nonhormonal medications can significantly reduce vasomotor symptoms and may be appropriate when hormone therapy is not recommended or preferred. 

Yes. A range of prescription medications, behavioral approaches, lifestyle strategies, and symptom-specific treatments can be used without hormone therapy. The best approach depends on which symptoms are most bothersome. 

Some are FDA-approved specifically for menopausal vasomotor symptoms, while others are prescribed off-label. An off-label prescription means that an FDA-approved medication is being used for a condition or symptom that is not included in its approved labeling. 

In some circumstances, treatments may be combined, but this should be determined with a healthcare provider based on symptoms, medical history, medications, and potential interactions. 

Treatment should be individualized. Your symptoms, health history, other medications, potential side effects, treatment goals, and personal preferences can all influence which option is most appropriate. 

Nonhormonal medications provide several options for managing menopause symptoms, particularly hot flashes and night sweats. Some were developed specifically for vasomotor symptoms, while others were originally used for different conditions and have also been found to provide symptom relief.

Understanding what each treatment is designed to address can help you have a more informed conversation with your healthcare provider and identify an approach that fits your individual needs.

✓          Nonhormonal medications can provide effective relief from certain menopause symptoms without using estrogen. 

✓          Neurokinin receptor antagonists are specifically designed to target the brain pathways involved in menopausal hot flashes and night sweats. 

✓          Certain SSRIs, SNRIs, gabapentin, and oxybutynin may also help reduce vasomotor symptoms. 

✓          Different medications have different benefits, side effects, interactions, and monitoring considerations. 

✓           Treatment should be individualized based on your symptoms, medical history, other medications, and preferences. 

The information on this page is provided for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment.

The benefits and risks of menopause treatments vary from person to person. Always consult your healthcare provider before starting, stopping, or changing any medication or other treatment.

Seek prompt medical attention for severe or unusual symptoms or any medical emergency.