1. Hormonal therapy
Most symptoms of menopause (hot flashes, insomnia, night sweats, osteoporosis, mood swings, decreased libido) are caused by a drop in levels of estrogen, a hormone primarily produced by the ovaries.
Hormone therapy, or hormone replacement therapy, is exactly what it sounds like: increasing estrogen levels via oral medications, skin patches, or vaginal creams, rings, or gels. It may contain estrogen alone or estrogen and progestin together. There has been controversy around hormone therapy in the past, regarding its link to an increased risk of breast cancer and cardiovascular disease, but more recent research has shown that these risks are minimal for most women.
There is no one-size-fits-all recommendation, so it is important to discuss your medical history with your doctor to assess the potential risks and benefits of different menopause treatments.
2. Antidepressants
Certain classes of antidepressants—including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors—can help stabilize mood and also reduce hot flashes.
Antidepressants are considered non-hormonal medical treatments for symptoms related to perimenopause and menopause. Currently, paroxetine (Brisdelle) is the only SSRI approved by the FDA for the treatment of hot flashes.
3. Gabapentin
Gabapentin is a medication designed to mimic the effects of the neurotransmitter gamma-aminobutyric acid (GABA). GABA sends chemical messages throughout the brain and nervous system and helps regulate communication between brain cells. GABA levels have been shown to be lower in postmenopausal women, leading to symptoms of depression.
Gabapentin was originally a seizure medication, but it is also used effectively off-label to reduce hot flashes and improve sleep. Since it does not contain reproductive hormones, it can be used by women with breast cancer.
It can cause significant side effects, including blurred vision, drowsiness, nausea, dizziness, and tremor.
4. Bioidentical hormones
Bioidentical products are compounds that closely resemble the chemical and molecular structure of human hormones.
Many false and misleading claims have been made about these compounds, such as that they are safer and more effective than hormone therapy, but these claims have not been verified. That said, the FDA has approved a bioidentical combination drug called Bijuva (estradiol and progesterone) for hot flashes.
One caveat: Bioidentical hormones are prescribed and made available through compounding pharmacies.
Compounded medications are not regulated by the FDA and should be approached with caution. The concern mainly concerns bioidentical products that are custom-prepared by pharmacists according to a doctor’s prescriptions. These are not subject to any FDA oversight and there is no evidence that they are superior to regular hormone therapy or FDA-approved bioidentical products.
5. Neurokinin receptor antagonists
Fezolinetant (Veozah) is a newer oral medication approved by the FDA to treat moderate to severe hot flashes. It works by managing the cause of hot flashes in brain signaling.
If you are taking this medication, watch out for symptoms such as new fatigue, jaundice, nausea, and vomiting. If you experience any of these symptoms, stop taking fezolinetant, as it may cause rare but serious liver damage.
Elinzanetant (Lynkuet), another neurokinin receptor antagonist, was approved by the FDA in October 2025 to treat moderate to severe hot flashes.
Like fezolinetant, it works by managing chemical signaling in the brain to prevent hot flashes; however, no serious side effects were observed in clinical trials.
6. Oxybutynin (Ditropan XL, Oxytrol)
This medication is commonly used to treat overactive bladder, but studies have shown that oxybutynin reduces hot flashes by 70 to 86 percent.
Note that it is used off-label for the treatment of menopause. Oxybutynin is not considered a drug of choice for people over 65 years of age, due to the risk of cognitive impairment. So if you’re looking for postmenopausal relief, your doctor may or may not recommend this medication based on your age, medical history, risk factors, and other medications.
Related treatments that middle-aged women may need: medications for osteoporosis
To prevent further bone loss, experts recommend that women receive sufficient doses of calcium and vitamin D.
Your doctor can help you determine whether you need calcium or vitamin D supplements. If there are signs of osteoporosis or you are at higher risk for osteoporosis because of your family history, medical history, or use of certain medications, your doctor may prescribe one of these osteoporosis medications:
- risedronate (Actonel, Atelvia), ibandronate (Boniva), alendronate (Binosto, Fosamax): prevents bone deterioration via an oral pill
- zoledronate (Reclast): given once a year IV, for people who have difficulty taking the above medications orally
- denosumab (Prolia): antibody injection given twice a year
- raloxifene (Evista): mimics estrogen
- teriparatide (Forteo), abaloparatide (Tymlos) and romosozumab (Evenity): injectables containing a bone strengthening agent
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