Non-Hormonal Prescription Treatments for Menopause: What Are the Options?
Menopausal hormone therapy (MHT) is an effective treatment for hot flushes and night sweats, but it might not be the right choice for every woman. Some women cannot take MHT for medical reasons, while others experience side effects or simply prefer a non-hormonal approach.
There are several non-hormonal prescription medications that you may come across which have been prescribed by a healthcare practitioner that can help manage menopause symptoms, particularly hot flushes, night sweats, sleep disturbance and in some cases, mood changes.
Interestingly, many of these medications were originally developed for completely different conditions.
How can a non-hormonal medication reduce hot flushes?
Hot flushes aren't simply caused by being “too hot”.
As oestrogen levels fluctuate and eventually decline through perimenopause and menopause, changes occur in the hypothalamus, the temperature-control centre of the brain.
The temperature range in which your body feels comfortable becomes narrower and even a relatively small change in body temperature can therefore trigger an exaggerated cooling response where blood vessels dilate, the skin becomes warm and sweating occurs.
Several brain chemicals, including serotonin, noradrenaline and neurokinin B, are involved in these temperature-regulating pathways. This helps explain why medications that influence these chemical messengers can reduce hot flushes even though they don't contain hormones.
Which medications are used?
SSRIs and SNRIs are antidepressant medications. Examples include escitalopram, paroxetine, venlafaxine and desvenlafaxine. By changing serotonin and/or noradrenaline signalling in the brain, certain medications in these groups can also influence temperature regulation and reduce hot flushes and night sweats. They may be particularly useful when anxiety or depression are also present.
Gabapentin was developed as an anti-seizure medication and is also commonly used for nerve pain. It affects signalling within the nervous system and can reduce vasomotor symptoms i.e. hot flushes and night sweats. Because sleepiness can occur, it may sometimes be useful for women troubled by night sweats and disrupted sleep.
Oxybutynin is normally prescribed for an overactive bladder and urinary urgency. It blocks the action of acetylcholine and can also reduce sweating and hot flushes. However, because it has anticholinergic effects, side effects such as dry mouth, constipation and potentially cognitive effects need to be considered, particularly with increasing age.
Clonidine was originally used to treat high blood pressure and has previously been prescribed for hot flushes. However, its benefits tend to be modest and side effects can include dizziness, dry mouth and low blood pressure. Current Australasian Menopause Society guidance states that clonidine is no longer recommended for vasomotor symptoms because more effective options are available.
Fezolinetant (Veoza) is different. Rather than being a medicine borrowed from another area of medicine, it was specifically developed to treat moderate-to-severe menopausal vasomotor symptoms. Fezolinetant blocks neurokinin-3 (NK3) receptors in the hypothalamus and this helps regulate the nerve cells involved in temperature control when oestrogen declines. It was TGA-approved in Australia in 2024.
An important consideration here is liver health. Australian prescribing information now requires liver blood tests before treatment, monthly for the first three months, and again at six and nine months because rare cases of serious liver injury have been reported.
Finding the right treatment
There isn't one hormonal or non-hormonal medication that suits every woman of course. The best option really depends on your symptoms, medical history, other medications and personal preferences. It’s also important to remember that these medications generally manage specific symptoms rather than replacing the broader physiological actions of oestrogen.
If menopause symptoms are affecting your sleep, mood, work or quality of life, talk with your GP or menopause healthcare practitioner about the full range of hormonal and non-hormonal options available.
This article is for educational purposes and does not replace individual medical advice.
References:
The Menopause Society. The 2023 Nonhormone Therapy Position Statement. Menopause. 2023.
Australasian Menopause Society. Non-Hormonal Treatments for Menopausal Symptoms.
Huang AJ, et al. Nonhormonal Treatment of Menopausal Vasomotor Symptoms. JAMA. 2025.
Cleveland Clinic Journal of Medicine. Nonhormone therapies for vasomotor symptom management. 2024.
Morga A, et al. Systematic review and network meta-analysis comparing fezolinetant with hormonal and non-hormonal therapies. Climacteric. 2024.