Non-hormonal treatments for perimenopause: your options

Non-hormonal treatments for perimenopause symptoms include FDA-approved hot flash medicines, off-label options, CBT, hypnosis and vaginal moisturizers.

By The Change Champions team · Updated 2026-10-01

Part of our guide: Perimenopause treatment: HRT and other options

Maybe hormone therapy isn't an option for you, or you'd simply rather not take it. Either way, the hot flashes, broken nights and short fuse are still there, and you want to know what else might help. There are real non-hormonal treatments for perimenopause symptoms, and the list has grown in the last few years.

This article covers the FDA-approved non-hormonal medicines for hot flashes, the medicines doctors sometimes use off-label, the talking and mind-body therapies with the best evidence, and simple products for vaginal dryness. It also looks at who these options might suit and what to ask your doctor.

The short answer: three non-hormonal medicines are FDA-approved for moderate to severe hot flashes due to menopause: paroxetine mesylate (Brisdelle), fezolinetant (Veozah) and elinzanetant (Lynkuet). Doctors also use some antidepressants, gabapentin and oxybutynin off-label. The Menopause Society recommends cognitive behavioral therapy (CBT) and clinical hypnosis, and vaginal moisturizers and lubricants can ease dryness.

FDA-approved non-hormonal treatments for perimenopause hot flashes

These three medicines are approved specifically for moderate to severe hot flashes (also called vasomotor symptoms) due to menopause. Much of the research behind them was done in women who had already reached menopause, so there's less evidence on how well they work while you're still having periods. For the bigger picture on hot flashes themselves, see what's happening during hot flashes, and what helps.

Paroxetine mesylate (Brisdelle). This low-dose form of an SSRI antidepressant was approved in 2013 for moderate to severe hot flashes associated with menopause. It isn't approved to treat any mental health condition. Its label warns that it may make tamoxifen, a breast cancer medicine, less effective, and that it can raise the risk of bleeding when taken with aspirin, NSAID pain relievers or blood thinners. Like all antidepressants, it carries a boxed warning about suicidal thoughts and behavior in children and young adults.

Fezolinetant (Veozah). Approved in May 2023, this was the first of a new kind of medicine. It blocks a signal in the brain, the neurokinin 3 (NK3) receptor, that's involved in controlling body temperature. In December 2024, the FDA added a boxed warning about rare but serious liver injury. Liver blood tests are now needed before you start, every month for the first three months, and then at months 6 and 9. The FDA advises stopping it and contacting your prescriber if you notice signs of liver trouble, such as feeling more tired than usual, nausea, vomiting, unusual itching, yellowing of the skin or eyes, light-colored stools or dark urine. It isn't suitable for people with cirrhosis or severe kidney disease, or for people taking certain other medicines.

Elinzanetant (Lynkuet). Approved on October 24, 2025, this medicine blocks two related brain signals (NK1 and NK3). Its label warns that it can cause sleepiness, fatigue and dizziness, and advises against driving or other hazardous activities until those effects have worn off. Liver blood tests are needed before starting and again after three months. It must not be used in pregnancy, which matters in perimenopause because you can still get pregnant. Grapefruit juice and some medicines can interact with it.

Off-label medicines doctors may suggest

Off-label means a medicine is FDA-approved for something else, but doctors prescribe it for hot flashes because research supports it. The Menopause Society's 2023 nonhormone therapy position statement recommends these options.

SSRIs and SNRIs. Several antidepressants in these groups, including escitalopram, citalopram, venlafaxine and desvenlafaxine, reduced hot flashes in clinical trials. Your doctor will check your other medicines first.

Gabapentin. This medicine also reduced hot flashes in trials. Drowsiness is a common side effect, which is why The Menopause Society notes that taking it at bedtime may be a good choice.

Oxybutynin. This bladder medicine eased hot flashes in trials too. The Menopause Society notes that long-term use of this type of medicine, called an anticholinergic, may be linked with cognitive decline, especially in older people, so it's one to weigh carefully with your doctor.

Non-drug options with good evidence

Cognitive behavioral therapy (CBT). CBT is a short, structured talking therapy. For hot flashes, The Menopause Society says it reduces how bothersome they are and how much they interfere with daily life, even if they don't disappear. It has been studied in women going through menopause and in breast cancer survivors.

Clinical hypnosis. This isn't stage hypnosis. In the research behind the recommendation, women had weekly sessions with a trained clinician and practiced self-hypnosis at home, and their hot flashes became less frequent.

Weight loss, where relevant. The Menopause Society lists weight loss as an option for people with overweight or obesity, with some evidence that it helps most earlier in the menopause transition. It's only relevant for some, and it's never a condition for getting help with your symptoms.

Non-hormonal doesn't have to mean making do. There are several routes to relief, with real evidence behind them.

Vaginal moisturizers and lubricants. Vaginal dryness and discomfort during sex are common as estrogen falls. The Menopause Society says nonhormone, over-the-counter products are first-line for less severe symptoms. Moisturizers are used regularly, often several times a week, to keep tissues moist. Lubricants are used during sex to reduce friction and discomfort. If symptoms don't improve, see your doctor, as yeast infections, allergic reactions and some skin conditions can cause similar symptoms.

What lacks good evidence. The Menopause Society doesn't recommend paced breathing, cooling techniques, avoiding triggers, exercise, yoga, soy or herbal supplements as treatments for hot flashes, mainly because the research isn't strong enough. That doesn't mean they're harmful. Our guide to supplements for perimenopause looks at the herbal options in detail.

Who these options might suit

Non-hormonal treatments may be worth discussing if any of these apply to you.

You can't take hormone therapy. Some people are advised not to, for example after breast cancer or certain types of blood clots.

You'd rather not take hormones. That's a valid choice, and there are effective alternatives.

Hormone therapy hasn't suited you. Side effects or other reasons may have made it a poor fit.

Hot flashes are your main problem. The approved medicines are approved for hot flashes, not for other perimenopause symptoms.

Every option has its own side effects and interactions. If you're still having periods, ask how the research applies to you. To compare with hormone therapy, including low-dose vaginal estrogen, see HRT for perimenopause: a calm look at the evidence.

When to talk to a doctor

Talk to your doctor if hot flashes, night sweats or poor sleep are affecting your work, relationships or quality of life.

See your doctor promptly if you have very heavy bleeding, bleeding after sex, or any bleeding after 12 months without a period. If you're taking fezolinetant or elinzanetant and notice yellowing of your skin or eyes, dark urine or unusual tiredness, contact your prescriber right away.

If low mood is building, our guide to perimenopause rage, tears and low mood may help. If you have thoughts of harming yourself, call or text 988 (the Suicide & Crisis Lifeline). Call 911 in an emergency, such as chest pain, trouble breathing or signs of a severe allergic reaction.

Frequently asked questions

What is the best non-hormonal treatment for hot flashes?

There isn't one best option for everyone. Fezolinetant and elinzanetant work in a newer way that targets the brain's temperature control, while paroxetine mesylate, other SSRIs and SNRIs, and gabapentin have been studied for longer. The right choice depends on your health, your other medicines and the side effects you're willing to accept.

Is Veozah safe?

Fezolinetant is FDA-approved, but in December 2024 the FDA added a boxed warning about rare but serious liver injury. Liver blood tests are needed before you start and at set points during the first nine months. If you notice signs such as yellowing skin or eyes, dark urine or unusual tiredness, stop taking it and contact your prescriber.

Can you take non-hormonal treatments during perimenopause?

The FDA-approved medicines are approved for hot flashes due to menopause, and most trials involved women who were already postmenopausal. Your doctor can advise whether a treatment suits you while you're still having periods. Remember that you may still need contraception, and elinzanetant must not be used in pregnancy.

Your next step

Before your appointment, write down how often your hot flashes happen, how much they bother you, and every medicine and supplement you take. That list helps your doctor rule options in or out quickly. Our guide on how to talk to your doctor about perimenopause has a script you can use.

To pull your symptoms together in one place, try our symptom check-in. You may also like our weekly email: calm, practical information, once a week.

This article is general information, not personal medical advice. If you have symptoms that worry you, please speak to your doctor.

If you take tamoxifen or any other regular medicine, ask your doctor or pharmacist about interactions before starting a hot flash treatment.

Sources

Written by The Change Champions team, an independent educational site. Not reviewed by a clinician. How we write and fact-check.