Question 195 of 433
What if I cannot or do not want to take hormones?
The short answer
There are now effective non-hormonal medicines for hot flashes, including two new ones that act directly on the brain’s thermostat.
Fezolinetant (Veozah) was approved in 2023. It reduces hot flashes substantially. It carries a boxed warning about rare liver injury, so liver blood tests are required.
Elinzanetant (Lynkuet) was approved in October 2025. It is taken at bedtime and also improves sleep.
Low-dose antidepressants such as paroxetine and venlafaxine reduce hot flashes by about half.
Gabapentin at night helps night sweats and sleep.
Oxybutynin, a bladder medicine, also works. It is anticholinergic, so avoid it in older women and anyone with memory concerns (see Question 396).
Cognitive behavioral therapy and clinical hypnosis have evidence from trials.
Black cohosh, evening primrose oil, and most menopause supplements perform no better than placebo. Soy foods give a small benefit to some women.
“This book is for education. It is not medical advice, and reading it does not make you my patient or create a doctor-patient relationship.” From the book’s medical disclaimer. Full disclaimer
ROBUST HUMAN TRIALS — Symptomatic women: several non-hormonal medicines reduce hot flashes; safety and monitoring differ.Evidence grade (draft mapping)ARobust human trialsPart 14, Q195 · Part sources
From Longevity Unmasked by Afshine Ash Emrani, MD, FACC. Medical disclaimer. This book is for education. It is not medical advice, and reading it does not make you my patient or create a doctor-patient relationship. Nothing here is meant to diagnose, treat, cure, or prevent any disease. Medicine is personal: a test, drug, supplement, or exercise plan that helps one person can harm another. Do not start, stop, or change any medication or treatment because of something you read in these pages. Talk with a licensed clinician who knows your history first. If you think you are having a medical emergency, call 911. The author disclaims responsibility for any loss or harm arising from use of the information in this book.