Menopause Relief Without Hormones: What’s Working Now (and What’s Coming Next)

I’ve spoken a lot about hormone replacement therapy and for good reason.

When initiated early in menopause, hormone replacement therapy (HRT) is not only the most effective treatment for hot flashes and night sweats, it has preventive benefit also.

HRT can help prevent heart disease, prevent osteoporosis, and prevent dementia.

I’ve heard patients say things like, “I feel like myself again” and “I feel amazing" after starting HRT.

Should everyone use HRT?

I do have patients who, after a good discussion, do not want to use HRT. Others have reasons they can't use HRT, like a history of a hormonally-driven blood clot or hormone-sensitive cancer.

There are still options for these patients. And I’m so happy for this because we don't have to just shrug and tell them there’s nothing we can do to help.

What are non-hormonal options for menopause treatment?

• Paroxetine (brand name Paxil): this is an SSRI (selective serotonin reuptake inhibitor) which are typically anti-depressant or anti-anxiety medications.

  
  

  It certainly could be used for depression/anxiety which are common in menopause but it can be used for hot flash symptoms as well.

  
  

  I haven't seen a great effect of this for patients that have used it in my experience.

  
  

  A common side effect of these medications is low libido, so I'd steer clear of this in someone already experiencing low libido which is also common in menopause.

  
  

• Gabapentin: this is typically used for nerve pain (think diabetics and Shingles patients). It tends to have drowsiness as a side effect.

  
  

  This can be helpful particularly for nighttime symptoms and awakening. I have patients who

  have been very happy with this option.

  
  

• Oxybutynin: this is a medication actually used for overactive bladder (OAB). Because it has a drying effect (dry eye, dry mouth, less urination), it has also shown benefit for hot flash symptoms.

  
  

  It has not been studied as a direct comparison to these other non-hormonal options.

  
  

Are there any new options?

Yes. I know we're not supposed to like Big Pharma and many times I don’t.

However, Big Pharma gets it right sometimes and for that, I'm thankful.

Menopause is inevitable, at some point, for every woman blessed to live long enough.

As I said, not everyone will be willing or able to take HRT. The above non-hormonal options I mentioned are so-so in my clinical experience.

Up-and-coming non-hormonal options:

• Fezolinetant (brand name Veozah)

  
  

  Phase: on market, FDA approved

  
  

  How it works: targeting a set of neurons that usually regulate body temperature, this medication turns them down. Estrogen normally turns down those neurons, without estrogen in menopause, they are left unregulated.

  
  

  When it works: improvement is noticed within one week

  
  

  Concerns:

  1. Headache is the most common side effect

  2. A black box warning was added in 2024 by the FDA for liver damage due to one case after this went to market.

  3. Liver function should be tested monthly when the medication is started for three months, then at months 6 and 9 while taking it.

  4. Right now it's difficult to get insurance approval for someone choosing not to take HRT, easier if someone has a history of hormone-sensitive cancer who cannot take hormones.

  
  

• Elinzanetant (brand name Lynkuet)

  
  

  Phase: awaiting FDA approval

  
  

  How it works: similar to Fezolinetant but also targets an additional receptor.

  
  

  When it works: improvement is noticed within one week

  
  

  Future:

  1. Uncertain if there will also be a liver warning with similar surveillance for this medication

  2. Being studied for breast cancer survivors

The non-hormonal options whether old or new will not have the other benefits of HRT. They do not help bone health or heart health. I would guess the only way they would help brain health is by helping sleep, which fezolinetant and elinzanetant do.

Especially for breast cancer and other hormone-sensitive cancer survivors, options for treating menopausal symptoms are incredibly important and this is an area that I’m happy to see innovative therapies.

Resources:

Some of the information contained in this article is the result of my training, medical knowledge, and personal experience without a specific source to be cited.

The author can earn commissions through affiliate links.

Disclaimer: This is not medical advice. This is for educational purposes only. Discuss with your

doctor.

Liao, Caiyun MD, MPH; Pal, Lubna MBBS, MS. Novel Pharmacotherapies for Menopausal Symptoms. Obstetrics & Gynecology 146(4):p 473-486, October 2025. | DOI: 10.1097/AOG.0000000000006025