Non-Hormonal Options for Menopause Symptoms

The FDA-approved non-hormonal options for vasomotor symptoms

As of 2026, three prescription non-hormonal options are FDA-approved specifically for moderate-to-severe vasomotor symptoms of menopause:

• Paroxetine mesylate 7.5 mg (brand name Brisdelle) — the only SSRI with an FDA indication for hot flashes.
• Fezolinetant 45 mg (Veozah) — a neurokinin-3 receptor antagonist approved in 2023 that targets the thermoregulatory mechanism behind hot flashes. Important: Fezolinetant requires liver-safety screening and monitoring. The FDA added a boxed warning for rare but serious liver injury and recommends baseline liver blood tests, monthly testing for the first three months, and repeat testing at months 6 and 9.
• Elinzanetant (Lynkuet) — a dual neurokinin-1/neurokinin-3 receptor antagonist approved by the FDA in October 2025 for moderate-to-severe vasomotor symptoms due to menopause. Lynkuet is supplied as 60 mg capsules and is taken according to its prescribing information; do not start it without reviewing pregnancy status, liver history, seizure history, medication interactions, and side-effect risks with a clinician.

Other medications — some SSRIs, SNRIs, gabapentin, and oxybutynin — may be used off-label depending on symptoms, risks, interactions, and clinician judgment.

Off-label options with reasonable evidence

• Other SSRIs and SNRIs (escitalopram, citalopram, venlafaxine, desvenlafaxine) — used off-label for vasomotor symptoms with reasonable evidence and a familiar safety profile.
• Gabapentin — used off-label, particularly for night-time hot flashes that disrupt sleep.
• Oxybutynin — used off-label with some evidence for vasomotor symptoms, though with side-effect considerations.
• Cognitive behavioral therapy for menopause — structured CBT protocols have been shown to reduce the impact and distress associated with hot flashes, independent of frequency.

For sexual and genitourinary symptoms without systemic HRT

• Low-dose vaginal estrogen — generally considered a separate safety category from systemic HRT and used in many patients for whom systemic therapy is not appropriate. See vaginal estrogen.
• Vaginal moisturizers and lubricants — non- prescription and useful adjuncts, though not a substitute for local estrogen in moderate-to-severe GSM.
• Ospemifene, an oral non-estrogen selective estrogen receptor modulator (SERM) FDA-approved for moderate-to- severe dyspareunia of menopause.
• Prasterone (intravaginal DHEA, brand name Intrarosa) — a non-estrogen FDA-approved option for dyspareunia.

For sleep

Sleep in perimenopause and menopause often has multiple drivers — hot flashes waking the patient, anxiety driving early-morning awakening, a circadian shift, and in some patients undiagnosed obstructive sleep apnea. A non-hormonal sleep plan that does not address the underlying driver usually under-performs. See sleep in perimenopause and menopause.

What we do not recommend chasing

A large supplement and over-the-counter category markets itself aggressively to perimenopausal women — black cohosh, evening primrose oil, “adrenal support” complexes, salivary hormone testing kits, bioidentical creams sold without a prescription, and various wellness-branded weight-loss and libido products. Current menopause-society guidance generally finds the evidence either thin or absent for the symptom claims made for most of these, and several have meaningful interaction and contamination concerns. We do not list them on this site.

If you want a clinician to talk through which non-hormonal options fit your situation, find your menopause care options. Most of the providers we cover prescribe non-hormonal options alongside HRT; Evernow in particular includes paroxetine and gabapentin in its standard formulary.