Non-hormonal treatments

If you cannot or prefer not to take hormones, there are non-hormonal treatments with strong evidence. The Menopause Society’s 2023 position statement gives its highest (Level I) recommendation to five options for hot flashes: cognitive behavioral therapy, clinical hypnosis, SSRIs and SNRIs, gabapentin and fezolinetant. Elinzanetant was approved in October 2025, and for vaginal dryness, moisturizers and lubricants are first-line. Hormone therapy is still the most effective treatment for hot flashes, so these options mainly serve women for whom estrogen is not the right fit.

Where to start

For the full menu in one place, including FDA status and how the options compare, read non-hormonal treatments for hot flashes. If you want a drug designed for hot flashes, see fezolinetant (Veozah). If you would rather avoid medication altogether, start with CBT for menopause symptoms. After breast cancer, go straight to non-hormonal options for breast cancer survivors.

The options at a glance

Option	How it works	Often a fit for	Read the guide
Fezolinetant (Veozah)	Blocks the neurokinin 3 receptor in the brain’s temperature center	Moderate to severe hot flashes; needs liver blood tests	Fezolinetant (Veozah)
SSRIs and SNRIs	Low-dose antidepressants; paroxetine 7.5 mg is the FDA-approved one	Mild to moderate relief, especially with low mood or anxiety	SSRIs and SNRIs for hot flashes
Gabapentin	Appears to act on the brain’s temperature center; sedating	Night sweats, with the largest dose at bedtime	Gabapentin for hot flashes and sleep
Cognitive behavioral therapy	Reduces how much hot flashes bother you and disrupt sleep	Women who want no medication; pairs with any drug	CBT for menopause symptoms
Clinical hypnosis	Guided, focused relaxation with cooling imagery	Women who want no medication	Clinical hypnosis for hot flashes
Moisturizers and lubricants	Moisturizers used on a schedule; lubricants at the time of sex	Mild vaginal dryness and painful sex	Vaginal moisturizers and lubricants

What does not work

The same position statement does not recommend supplements or herbal remedies, soy foods or extracts, cannabinoids or acupuncture for hot flashes, because trials have not shown a reliable benefit over placebo. Placebo improvement in hot flash trials is large, which is why so many products seem to work in reviews and anecdotes. The supplements guides look at popular ingredients one by one.

How to choose

Match the option to your whole picture. If night sweats and sleep are the main problem, gabapentin at bedtime or CBT for insomnia address both. If you also have low mood or anxiety, an SSRI or SNRI may do double duty. If you take tamoxifen, avoid paroxetine and fluoxetine. Prescription options typically start working within two weeks, and behavioral treatments have no drug interactions, so they can be combined with any medication. To weigh these against estrogen, see what is hormone therapy.

A clinician who sees a lot of menopause will know these trade-offs. Use the symptom check to summarize what bothers you most, then look for a clinician in the directory or read how to find a menopause specialist.