Your options, explained honestly.
There are real, effective options for menopause symptoms — and a lot of noise around them. Here's what the clinical evidence actually says, in plain language, so you can have a better conversation with a provider. We don't recommend specific treatments or tell you what to take. We just make sure you walk in knowing the landscape.
Important: this page is educational. It is not a recommendation to start, stop, or change any treatment. Those decisions belong to you and a qualified prescriber.
Hormone therapy (MHT/HRT) — the basics
Clinical guidelines describe menopausal hormone therapy as the most effective treatment for moderate-to-severe hot flashes, night sweats, and genitourinary symptoms. For healthy women under 60, or within 10 years of their final period, the benefit-to-risk balance is generally favorable — this is called the "window of opportunity." It also protects bone and reduces fracture risk.
It isn't right for everyone: a history of certain cancers, blood clots, stroke, heart disease, or liver disease are reasons it may be off the table. That's exactly the kind of thing to weigh with a prescriber.
What many women are never told about MHT
Modern guidelines (including the 2025 Korean Society of Menopause guidelines) highlight nuances that can make hormone therapy appropriate for women who assumed it wasn't:
- How you take it matters. Estrogen through the skin (a patch or gel) skips the first pass through the liver and is considered safer for clotting and cardiovascular risk than swallowing a pill.
- The progesterone type matters. Micronized progesterone and dydrogesterone have a more favorable breast-cancer and clot profile than older synthetic progestogens.
- For vaginal and urinary symptoms, there's a targeted option. Low-dose vaginal estrogen is recommended as first-line — it's effective, barely absorbed into the bloodstream, helps prevent recurrent UTIs, and usually doesn't require added progesterone.
These are conversations to have with a prescriber — but knowing they exist changes what you can ask for.
If hormones aren't for you — what the evidence supports
The North American Menopause Society's 2023 review found good evidence for several non-hormonal options for hot flashes: cognitive behavioral therapy (CBT), clinical hypnosis, certain antidepressants (SSRIs/SNRIs), gabapentin, and a newer drug called fezolinetant.
What the evidence does not support for hot flashes
This is where we differ from a lot of the internet. For hot flashes specifically, the evidence does not support most supplements and botanicals — black cohosh, soy/isoflavones, maca, dong quai, evening primrose, and others — nor, for symptom relief, paced breathing, yoga, or mindfulness.
Those practices can be wonderful for overall health and stress; they just haven't been shown to reduce hot flashes. Some supplements also carry real safety concerns — for example, black cohosh and liver toxicity. We'd rather tell you that than sell you a myth.
About fezolinetant (Veozah)
A newer non-hormonal pill that targets the brain mechanism behind hot flashes. In trials it produced statistically significant improvement, though independent reviewers (ICER) judged the average benefit modest and flagged that it requires liver-enzyme monitoring, with long-term data still limited. It's something some women choose to raise with their provider — with eyes open.
The throughline: every option here is something to discuss with a qualified prescriber. Our job is to make you the most informed person in the room — not to tell you what to do.
Walk in ready.
Bring the right questions and the right provider to the table. We'll help with both.