Menopause treatments: the options and who they suit
Menopause treatments include hormone therapy (HRT, also called MHT), vaginal estrogen (oestrogen in the UK) and non-hormonal medicines, and The Menopause Society's 2022 position statement names HRT as the most effective for hot flashes (hot flushes in the UK) and night sweats. That statement, and NICE NG23 (2024) in the UK, place the best balance at under 60 or within 10 years of the last period, when benefits usually outweigh risks for most healthy women.
Menopause symptoms are common, and there is more than one good way to ease them. The four guides below cover hormone therapy, contraception through the transition, fezolinetant and vaginal estrogen, while CBT, antidepressants and herbal remedies are answered in the questions further down. The Atlas covers every life stage, so if you are reading for a daughter or a younger relative there is what changes in childhood, signs of puberty in girls and menstrual cycle phases, and for your own stage perimenopause symptoms, menopause symptoms and postmenopause symptoms set out what these treatments are easing.
- HRT: What hormone therapy does, the forms it comes in and how its benefits and risks are weighed for you.
- Hormonal contraception: How long contraception is needed through the transition, and which methods many women find suit this stage.
- Fezolinetant and non-hormonal options: A daily non-hormonal tablet that blocks the brain's hot-flash signal, FDA-approved in the US and, in the UK, recommended by NICE (TA1143, 2026) when HRT isn't suitable or wanted.
- Vaginal estrogen: The low-dose local treatment for vaginal and urinary symptoms, and how it differs from HRT.
Facts
Common questions
What helps hot flashes if I can't or don't want to take HRT?
Several non-hormonal options have evidence behind them. Some antidepressants (SSRIs and SNRIs) and gabapentin reduce hot flashes, and cognitive behavioral therapy (CBT) helps with flashes, sleep and mood. In the UK, the NHS lists CBT, clonidine or an antidepressant for hot flushes and night sweats. A primary care provider (GP in the UK) can talk through which one fits your health history.
Can I stay on HRT after 60?
Many women do. In the US, The Menopause Society (2022) weighs benefit against risk by age and years since the last period, and the FDA removed most of the boxed warning from HRT labels in November 2025. In the UK, NICE NG23 (2024) sets no fixed age to stop and supports continuing beyond 60 while the benefits still outweigh the risks for you, ideally with a patch, gel or spray.
What helps vaginal dryness and painful sex?
These symptoms are common and treatable. Low-dose vaginal estrogen, as a cream, pessary or ring, eases dryness, painful sex and urinary symptoms. Very little reaches the bloodstream, and NICE NG23 (2024) describes it as safe long term at any age, often alongside HRT. Non-hormonal moisturizers and lubricants also help, and many women start with those.
Do herbal remedies like black cohosh work?
Wanting to try something plant-based first is common, and it's a reasonable question to ask. So far the evidence for remedies such as black cohosh, red clover and St John's wort is weak or inconsistent, a view the NHS shares in the UK. Some can interact with other medicines, including tamoxifen and the pill, so many women find it reassuring to have a pharmacist check a remedy against everything else they take.
How often is menopause treatment reviewed?
Yearly is the usual rhythm if you take HRT or another treatment, with an OB-GYN or primary care provider in the US or a GP in the UK, where NICE NG23 (2024) writes a yearly review into continuing HRT. It covers symptom control, side effects and bleeding pattern, and is a good time to revisit dose and type. If something changes sooner, there's no need to wait.
Next steps
A good place to start is the guide that matches your most bothersome symptom, then a conversation with your primary care provider (GP in the UK) about what you would like to try. Many women find it helps to write down their symptoms and questions beforehand. It's worth a prompt visit for any bleeding 12 months or more after your last period, a new breast lump or any breast change, or symptoms that are getting worse. Menopause treatment is not one size fits all: a patch may suit one woman, a vaginal cream alone another and a non-hormonal tablet a third, so the choice that fits your symptoms, health history and preferences is yours to make.
Sources
The guidelines and studies this page draws on.
- Menopause: Treatment, NHS (UK) (n.d.)
- FDA to remove boxed warnings from hormone therapies, RAPS (Regulatory Affairs Professionals Society) (2025)
- NICE NG23, updated 2024: Menopause: identification and management, NICE (2024)
- NICE TA1143, 2026: Fezolinetant for vasomotor symptoms of menopause, NICE (2026)
- The Menopause Society, 2022: hormone therapy position statement, The Menopause Society (2022)
- Collaborative Group on Hormonal Factors in Breast Cancer, 2019: HRT and breast cancer risk, The Lancet (2019)