Menopause treatment with and without hormones

Relieve hot flashes, night sweats and mood shifts with options that are right for you

Hot flashes that hit out of nowhere. Night sweats that disrupt your sleep. Mood shifts you can't quite explain. Sound familiar? You may be transitioning into menopause — and you have more menopause treatment options today than ever before.

Katie Shvartsman, MD, a gynecologist specializing in menopause care and vulvar conditions at Geisinger, believes every woman deserves evidence-based care to help her thrive in midlife and beyond.

Whether you're looking for hormonal support or prefer to explore menopause treatment without hormones, the right approach depends on your health history, your symptoms and what matters most to you. Many menopause treatment paths are available, from hormone replacement therapy for menopause to non-hormonal choices and lifestyle interventions.

When do women go through menopause?

Every woman goes through menopause at their unique time. Menopause officially begins when a woman has gone 12 consecutive months without a period. By the time your periods stop, you’ve already gone through a huge hormonal shift. Studies find most women reach menopause between age 45 and 55. A person’s health, family history, smoking history and other factors play a role.

Before that, perimenopause — the transitional phase leading up to menopause — can begin years earlier, sometimes in a woman's early-to-mid 40s. During perimenopause, hormone levels fluctuate and gradually decline. This is when many women first notice irregular periods, sleep problems and mood changes — and when hot flashes often begin.

Hormone replacement therapy for menopause symptoms

Hormone replacement therapy — commonly called HRT or menopause hormone therapy (MHT) — is the most effective treatment for menopause symptoms like hot flashes and night sweats. It works by replenishing the estrogen your body stops producing.

HRT is available in several forms, including pills, patches, gels and vaginal rings. Beyond hot flashes, HRT can also help with vaginal dryness, bone loss and sleep disruption. If you and your doctor decide it's the right fit, the formulation and the dose will be individualized to best support your needs.

HRT isn't the right choice for everyone. Your doctor will carefully review your personal health history before recommending it — particularly if you have a history of certain cancers, blood clots or stroke. For women who can't use or prefer to avoid hormones, non-hormonal options can still provide meaningful relief and remain important treatment for menopause symptoms.

Menopause treatment without hormones

If hormone therapy isn't right for you, or if you'd simply prefer a hormone-free path, there are several proven approaches to menopause treatment without hormones. These options include non-hormonal medications, lifestyle changes and supplements that may support symptom relief.

Non-hormonal medications, lifestyle changes and supplements for menopause treatment

A growing number of non-hormonal medications have been shown to reduce the frequency and severity of hot flashes and night sweats.

“There are options that can offer real help,” says Dr. Shvartsman, “including a very new class of medication that’s shown great promise.”

Neurokinin receptor antagonists: A new type of medicine, including fezolinetant (Veozah) and elinzanetant (Lynkuet), blocks nerve messages in the brain from triggering hot flashes. They’re nearly as effective as HRT and improve hot flashes and night sweats by 20% to 60%.
Low-dose antidepressants: Certain SSRIs and SNRIs — such as paroxetine and venlafaxine — reduce of the number and severity hot flashes.
Other medications: Gabapentin (a nerve pain medication) and clonidine (a blood pressure drug) are sometimes prescribed to help with night sweats and hot flashes.
Supplements: Magnesium glycinate supplements have been found to help women with sleep and mood symptoms. They’re generally easier on the stomach than magnesium citrate, which can work like a laxative. “It’s hard to know the best supplements for menopause. They aren’t regulated well,” cautions Dr. Shvartsman. “Always tell your medical team what supplements you’re taking to avoid interactions.”

Lifestyle changes that can help treat menopause

Small, consistent changes to your daily routine can also support menopause treatment without hormones and complement any medical approach.

Stay moving: Regular physical activity supports mood, sleep and healthy weight management. Aim for 20 to 30 minutes of moderate exercise — like a brisk walk — most days of the week. Include strength training, which keeps your muscles strong, helps burn fat and strengthens bones.
Identify your triggers: Caffeine, alcohol, spicy foods and stress can all intensify hot flashes. Keeping a simple log can help you spot patterns and reduce them.
Cool your environment: Sleep in a cooler room, keep a fan nearby and wear lightweight, breathable fabrics during the day.
Practice relaxation: Deep breathing exercises, yoga and meditation can lower stress levels and may reduce the frequency of hot flashes.

When to find a trained menopause provider

“Lifestyle changes can improve symptoms for some women, but aren’t enough for all women,” says Dr. Shvartsman. “There are times you need to seek medical help. Menopause is a change just as dramatic as puberty, with long-term implications for decades of your life. This hormonal shift affects your entire body from bones to brain. Many doctors haven’t received the training to help or understand. Just as you would seek a well-trained heart surgeon, seek a gynecologist or primary care manager with training or specialization in menopause.”

Don’t push through symptoms affecting your quality of life. And don’t blame every new symptom on this change of life. You know it’s time to seek extra help when you have:

Hot flashes or night sweats that disrupt your sleep or daily routine
Vaginal dryness, recurring urinary tract infections or discomfort during sex (possibly genitourinary syndrome of menopause)
Mood changes, such as anxiety or depression, that feel hard to manage
Any symptoms that feel new, severe or out of the ordinary

A specialist in menopause care can walk you through all your menopause treatment options and help you build a plan tailored to your health history, your goals and your life.