Medically reviewed by Michelle Forcier, MD, MPH — Licensed in Massachusetts | Last reviewed: June 2026
Menopause hormone therapy is the most effective treatment for many menopause symptoms. But it is not right for everyone, and not everyone wants it.
Maybe you have a contraindication — a history of hormone-receptor-positive breast cancer, a clotting disorder, or another medical reason your provider has flagged. Maybe you have tried HRT and it did not work well for you. Maybe you just do not want to take hormones. Maybe you are on testosterone for gender-affirming reasons and adding estrogen does not fit your goals.
Whatever the reason, you still deserve effective care.
The non-hormonal menopause treatment landscape has changed meaningfully in the past few years. Newer medications like Veozah (fezolinetant) target menopause symptoms at their neurological source. GLP-1 medications are showing promising results for menopause-related weight changes. And several well-studied options remain effective for hot flashes, mood, and sleep.
This article covers what is actually available, what the evidence says, and how to work with a clinician to figure out what might help you.
If you are still deciding whether hormone therapy might be right for you, start with our companion article: Is HRT Safe?. It addresses the decades of fear-driven misinformation that led many people to avoid HRT unnecessarily.
Veozah (fezolinetant): a medication designed for the biology of hot flashes
FDA-approved in 2023, Veozah represents a fundamentally different approach to treating menopause symptoms. Unlike SSRIs or gabapentin — which were developed for other conditions and later found to help with menopause — Veozah was designed from the ground up to target the specific brain mechanism that causes hot flashes and night sweats.
How it works
Hot flashes are triggered by a group of neurons in the hypothalamus called KNDy neurons. These neurons help regulate your body's internal thermostat. When estrogen declines during menopause, KNDy neurons can become overactive. They misread normal body temperature as too warm and trigger a cascade of vasodilation, sweating, and flushing to cool you down. That is a hot flash.
Veozah is a neurokinin-3 (NK3) receptor antagonist. It blocks the receptor that drives this overactivity, calming the thermoregulatory system without affecting estrogen levels. It is a 45mg tablet taken once daily.
What the evidence shows
The SKYLIGHT clinical trials (1, 2, and 4) showed significant results. After 6 months of treatment, participants went from an average of about 10.6 hot flash events per day to about 2.6, compared to about 4.7 with placebo. That is roughly a 75% reduction in hot flash frequency — a meaningful difference in daily quality of life, sleep, and the ability to function without being blindsided by a wave of heat every hour.
Most people notice improvement within a few weeks. Side effects in trials were generally mild to moderate, with headache and fatigue being the most commonly reported.
Who it may be a good fit for
Veozah may be particularly relevant for people who cannot take hormone therapy due to a history of breast cancer, blood clots, or other contraindications. It may also be a good fit for people who prefer to avoid hormonal treatment, trans men on testosterone who are experiencing vasomotor symptoms and do not want to add estrogen, and anyone whose hot flashes and night sweats are the primary symptoms affecting quality of life and sleep.
One important note: Veozah requires liver function monitoring. Your clinician will want baseline liver tests before starting and follow-up tests during treatment.
Elinzanetant (Lynkuet): the newest option in this category
Elinzanetant, sold under the brand name Lynkuet, is the newest non-hormonal medication for hot flashes. It works on the same KNDy-neuron pathway as Veozah, but it blocks an additional receptor tied to sleep — so it may ease nighttime waking along with hot flashes and night sweats. It is taken once daily and does not affect hormone levels. It tends to be expensive, and insurance coverage is still catching up. As with Veozah, your clinician can help you weigh whether it fits your symptoms, your sleep, and your budget.
GLP-1 medications for menopause-related weight changes
Weight gain during perimenopause and menopause is one of the most frustrating symptoms people report — and one of the hardest to address with lifestyle changes alone. This is not a willpower issue. Declining estrogen shifts fat distribution toward the abdomen, changes metabolism, and increases insulin resistance. The body is doing something different, and the old rules may not apply.
GLP-1 receptor agonists — semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro) — have emerged as effective options for menopause-related weight changes, particularly the visceral abdominal fat associated with increased cardiovascular and metabolic risk.
What the latest research shows
A study published in The Lancet Obstetrics, Gynaecology and Women's Health in January 2026 from Mayo Clinic found that postmenopausal people receiving both HRT and tirzepatide lost approximately 35% more weight than those taking tirzepatide alone. The combination appeared to address both the hormonal and metabolic drivers of menopause-related weight gain more effectively than either treatment on its own.
Tirzepatide, a dual GIP/GLP-1 agonist, generally delivers greater weight loss than semaglutide, which is GLP-1 only. Semaglutide has stronger long-term safety data. Both reduce appetite, improve insulin sensitivity, and target visceral fat.
Practical considerations
- Cost: Branded GLP-1 medications remain expensive — roughly $1,000 to $1,600 per month without insurance. Compounded versions through licensed telehealth providers may be available at lower cost. Insurance coverage varies significantly.
- Administration: Both semaglutide and tirzepatide are weekly injections. Oral semaglutide (now available as a Wegovy pill) may be a lower-cost, needle-free option than the branded injections for some people — worth asking your clinician about, though it has specific dosing requirements.
- Side effects: GI side effects, including nausea, constipation, and diarrhea, are common during dose titration. Most people find them manageable, and they often decrease over time.
- Not a standalone menopause treatment: GLP-1 medications address weight and metabolic health. They do not treat hot flashes, brain fog, mood changes, or other menopause symptoms directly. They work best as part of a broader care plan.
SSRIs and SNRIs
Low-dose selective serotonin reuptake inhibitors remain a solid option for several menopause symptoms, especially when hot flashes and mood changes coexist.
Paroxetine (Brisdelle) is the only SSRI FDA-approved specifically for menopausal vasomotor symptoms. At low doses, around 7.5mg, it reduces hot flash frequency and severity without the sexual side effects that can come with higher antidepressant doses.
Citalopram is effective for both vasomotor symptoms and mood changes during menopause. It can be a reasonable choice when hot flashes and anxiety or depression are part of the same picture.
Venlafaxine, an SNRI, and desvenlafaxine also have evidence for reducing hot flashes, though they are not FDA-approved for this specific use.
If you are already taking an SSRI or SNRI for mental health reasons, your clinician can help you think about whether your current medication may also be helping with menopause symptoms, or whether adjustments might be worth considering.
Gabapentin
Originally developed for seizures and nerve pain, gabapentin is effective for night sweats and sleep disruption during menopause. It is particularly useful when nighttime symptoms are the primary complaint, since it has sedative properties that can support sleep onset.
Typical doses range from 300 to 900mg at bedtime. Side effects can include drowsiness — which is often a feature rather than a problem for nighttime dosing — dizziness, and fluid retention.
Gabapentin may be a good option if your biggest issue is being woken up by night sweats or lying awake with restless, disrupted sleep. Better sleep often means better daytime cognitive function, mood, and energy.
Oxybutynin and clonidine
Two older non-hormonal medications can also reduce hot flashes. Oxybutynin, typically used for overactive bladder, has good evidence for cutting hot flash frequency and severity. Clonidine, a blood pressure medication, is a longer-standing option, though side effects like dry mouth, drowsiness, and low blood pressure mean it is used less often now that newer medications exist. Either may be worth discussing with your clinician, especially if you also have a related condition that one of them treats.
Local vaginal estrogen: the exception that is not really "HRT"
This deserves its own section because many people who have been told they "cannot take HRT" can actually use local vaginal estrogen.
Local vaginal estrogen delivers small amounts of estrogen directly to vaginal and urinary tract tissue. Systemic absorption is minimal — so minimal that many oncologists consider it appropriate even for people with a history of breast cancer.
If vaginal dryness, painful sex, urinary urgency, or recurrent UTIs are part of your menopause picture, local vaginal estrogen may be an option even if systemic hormone therapy is not. It is available as a cream or insert, and at FOLX, your clinician will use whatever anatomical language you are most comfortable with.
This is worth asking about specifically, because many people do not realize it is available to them.
Note: If you have active estrogen sensitive cancer it is not recommended. You should get the OK from your oncologist if you have a history of breast cancer. This is a good patient-centered conversation to have with your health care team.
Lifestyle support that actually matters
Lifestyle changes are not a substitute for medical care when symptoms are moderate to severe. But they can be meaningful supports alongside treatment, and some have real evidence behind them.
- Regular movement: 150 minutes of moderate aerobic activity per week supports mood, sleep, bone density, cardiovascular health, and body composition. Resistance training is particularly important during and after menopause for bone and muscle preservation. Any realistic increase in activity is a good starting point.
- Sleep environment: Cool bedroom (65 to 68 degrees), moisture-wicking bedding, consistent sleep and wake times. Limiting caffeine after noon and reducing alcohol — which fragments sleep architecture and can worsen hot flashes — can also help.
- Stress reduction: CBT has specific evidence for improving menopause symptoms. Mindfulness-based stress reduction has also shown benefit.
- Nutrition: Anti-inflammatory eating patterns, like Mediterranean-style diets rich in vegetables, fruits, beans, whole grains, nuts, olive oil, and protein, support cardiovascular and cognitive health during menopause.
- Pelvic floor care: Pelvic floor physical therapy can help with urinary symptoms and sexual discomfort during menopause. It is underutilized and worth discussing.
How to figure out the right approach
The best non-hormonal plan depends on which symptoms are most affecting your daily life.
- Mostly hot flashes and night sweats? Veozah is the most targeted option. SSRIs (paroxetine) and gabapentin are also effective.
- Mostly mood changes and anxiety? An SSRI like citalopram can address both mood and vasomotor symptoms.
- Mostly sleep disruption? Gabapentin at bedtime, plus treating night sweats if they are the underlying cause.
- Mostly weight changes? GLP-1 medications alongside lifestyle support. It is also worth considering whether hormone therapy might be appropriate — the Mayo Clinic data suggests the combination is more effective than either alone.
- Mostly vaginal or urinary symptoms? Local vaginal estrogen, even if systemic HRT is not an option.
Many people benefit from combining approaches. Veozah for hot flashes plus an SSRI for mood, for example. Or gabapentin for sleep plus lifestyle changes for overall well-being. Your FOLX clinician can help you build a plan that fits your symptoms, your body, and your life.
A note on inclusive care
Most non-hormonal menopause content assumes a cisgender female audience. And most sexual health menopause content assumes a cisgender male partner. But trans men on testosterone who are experiencing hot flashes, nonbinary people managing vaginal atrophy, and queer women with non cis male partners whose providers have never discussed menopause in the context of their actual relationships all deserve non-hormonal options discussed in care that sees them.
If you have been avoiding menopause care because the available options felt exclusionary, FOLX clinicians can help. We offer menopause care that does not require you to fit into a framework that was not built for you.
Frequently Asked Questions
What is the most effective non-hormonal treatment for hot flashes?
Veozah (fezolinetant) is currently the most targeted non-hormonal medication for menopausal hot flashes, with clinical trials showing approximately 75% reduction in frequency. Low-dose paroxetine (Brisdelle) is the other FDA-approved non-hormonal option. Both are significantly more effective than placebo, though neither fully matches hormone therapy for overall menopause symptom relief.
Can I take Veozah if I have had breast cancer?
Veozah is non-hormonal and does not affect estrogen levels, which makes it a relevant option for people with a history of hormone-receptor-positive breast cancer who cannot use HRT. That said, this is a decision to make with both your oncologist and your menopause provider.
Do GLP-1 medications help with menopause symptoms beyond weight?
GLP-1 medications primarily address weight and metabolic health. They do not directly treat hot flashes, brain fog, or mood changes. However, weight loss and improved insulin sensitivity can have secondary benefits for energy, sleep quality, and overall well-being. For menopause symptom relief specifically, additional treatment is usually needed.
Are non-hormonal treatments as effective as HRT?
For hot flashes, HRT remains the most effective treatment overall. Non-hormonal options like Veozah come closest but do not fully match HRT across all symptom domains. That said, non-hormonal treatments are effective and can meaningfully improve quality of life. For people who cannot or do not want to take HRT, they are the right choice. And for mood-predominant symptoms, SSRIs may actually be more effective than HRT.
Does FOLX prescribe Veozah and GLP-1 medications?
Yes. FOLX clinicians can prescribe Veozah, GLP-1 medications, SSRIs, gabapentin, and other non-hormonal treatments for menopause. Your clinician will help you evaluate which options make sense based on your symptoms, medical history, and goals.
Can I combine non-hormonal treatments?
Yes, and many people do. For example, Veozah for hot flashes and an SSRI for mood. Or gabapentin for sleep and a GLP-1 for weight. Your clinician can help you build a combination that addresses your most pressing symptoms without unnecessary overlap.
FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), menopause care, mental health care, sexual and reproductive health care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more.
