Treatment Options
Here's what the clinical trials actually found — effect sizes, not marketing. Your clinician uses this same evidence to build your treatment plan.
Hormonal (Rx)
Systemic Estrogen Therapy
Oral or transdermal estrogen for vasomotor symptoms. Most effective treatment for hot flashes and night sweats.
Evidence
~75% reduction in hot flash frequency (multiple RCTs)
Considerations
Requires progesterone if uterus is intact. Contraindicated in active breast cancer, unexplained vaginal bleeding, history of VTE.
Local (Vaginal) Estrogen
Low-dose vaginal estrogen for GSM symptoms. Minimal systemic absorption.
Evidence
Significant improvement in vaginal atrophy within 4-12 weeks (RCTs)
Considerations
Generally considered safe even in some populations where systemic estrogen is contraindicated. Discuss with clinician.
Progesterone / Progestins
Required with systemic estrogen if uterus is intact. Micronized progesterone preferred by many clinicians.
Evidence
Uterine protection established. Micronized progesterone may have fewer side effects than synthetic progestins.
Considerations
Formulation and route matter for risk profile.
Non-Hormonal (Rx)
Fezolinetant (Veozah)
NK3 receptor antagonist. First non-hormonal Rx specifically approved for vasomotor symptoms.
Evidence
40-60% reduction in hot flash frequency (Phase 3 trials)
Considerations
FDA-approved 2023. Option for women who cannot or prefer not to use hormones.
SSRIs / SNRIs
Certain antidepressants (paroxetine, venlafaxine) reduce hot flash frequency.
Evidence
Moderate efficacy (30-60% reduction). Paroxetine is FDA-approved for VMS.
Considerations
May help with concurrent mood symptoms. Side effect profile varies.
Lifestyle & Non-Rx
Cognitive Behavioral Therapy (CBT)
Structured therapy targeting the cognitive and behavioral response to symptoms.
Evidence
RCTs show CBT reduces the perceived impact of hot flashes and improves sleep quality.
Considerations
Does not reduce frequency of hot flashes but significantly improves coping and quality of life.
Exercise & Weight Management
Regular physical activity may reduce symptom severity and improve overall wellbeing.
Evidence
Moderate evidence for improvement in sleep, mood, and cardiovascular health. Limited evidence for direct hot flash reduction.
Considerations
Benefits extend well beyond menopause symptoms. No contraindications.
Reading the evidence is step one. Step two is a clinician who's read it too — and has time to explain what it means for you specifically.
Start your assessmentIf your clinician determines treatment isn't appropriate, you get a full refund — not a prescription you don't need. Individual results vary. Treatment decisions are based on your medical history.