--- title: "Non-hormonal options for menopause symptoms" description: "CBT, fezolinetant, elinzanetant and other options for menopause symptoms, with safety checks for medicines and cautions on herbal remedies." url: "https://myruva.co/learn/non-hormonal-treatments-for-menopause" language: "en-GB" topic: "Menopause" published: "2026-10-18" updated: "2026-10-19" author: "Ruva team" reading_minutes: 5 --- # Non-hormonal options for menopause symptoms CBT, fezolinetant, elinzanetant and other options for menopause symptoms, with safety checks for medicines and cautions on herbal remedies. *Written and reviewed by the Ruva team · Updated 2026-10-19 · Menopause* ## Key points - Non-hormonal treatments are available if HRT isn’t suitable or you’d prefer something else. - CBT designed for menopause is an option for hot flushes and the sleep problems they cause. - Fezolinetant and elinzanetant need a check before prescribing and safety monitoring. - Herbal remedies can interact with medicines, and it’s not clear how well they work. If hormone replacement therapy (HRT) isn’t suitable, hasn’t helped or isn’t what you want, there are other treatments. The right choice depends on the symptom you want help with, such as hot flushes or vaginal dryness. This advice changed recently. NICE now recommends fezolinetant for a specific group of people, and elinzanetant is approved in the UK and US. Before prescribing a newer medicine, your clinician needs to talk it through with you, including the safety checks. ## CBT for flushes and disrupted sleep Cognitive behavioural therapy (CBT) designed for menopause is an option for hot flushes and sweats. CBT is a talking therapy that looks at how thoughts and habits affect how you feel. NICE says it can be used alongside HRT, when HRT can’t be used, or when someone would rather not take it. It also recommends considering CBT for sleep problems linked to these symptoms. The Menopause Society includes CBT and clinical hypnosis among approaches without a prescription for hot flashes. Ask a clinician what’s available and what the sessions aim to help with. Start with how your symptoms affect your day, perhaps at work or when you’re trying to sleep. ## Fezolinetant: the recommendation and the checks Fezolinetant is a non-hormonal prescription medicine for moderate to severe hot flushes. It works on a pathway in the brain that helps control body temperature. NICE only recommends it when HRT isn’t suitable. NICE’s current guideline refers to TA1143, 2026. This appraisal says the NHS in England must fund it for the people it’s recommended for, when it’s the most suitable option. It reports that fezolinetant works better than a placebo (a dummy treatment). It’s less clear how it compares with other non-hormonal medicines. The FDA warns that fezolinetant can cause rare but serious liver damage. A clinician needs to check your liver with blood tests before and during treatment. Ask who arranges the tests and how you’ll hear about follow-up. These checks need to be part of the treatment plan from the start. ## Elinzanetant: another prescription option Elinzanetant, also called Lynkuet, is a non-hormonal medicine that works on the brain’s temperature-control signals. The MHRA has approved it for moderate to severe hot flushes caused by menopause, and the FDA also lists it as approved for this. Ask your prescriber whether you can get it locally. The NHS recommendation for fezolinetant doesn’t automatically apply to elinzanetant. Its US patient information describes liver blood tests before treatment and at follow-up. It also warns about trouble staying awake, tiredness and dizziness. If these happen, the leaflet advises not driving or doing anything risky until they have gone. Tell the prescriber about any liver problems, any history of seizures, and all medicines or supplements you use. Elinzanetant can interact with other medicines. Its US label says it isn’t suitable during pregnancy, so talk about whether you could get pregnant when you’re assessed. Follow the instructions you’re given. Ask your prescriber to explain what pregnancy tests and contraception you need. Contact your prescriber straight away (UK, US and elsewhere), or an urgent medical service if you can’t reach them, if you think you may be pregnant while taking elinzanetant. Follow the urgent safety instructions in the leaflet straight away. Don’t wait for a call back before you follow them. ## Other prescription options differ by country The Menopause Society describes some antidepressants, gabapentin and oxybutynin as off-label options for hot flashes. Off-label means they’re used for this even though they’re approved for other conditions. Antidepressants have been studied for hot flashes in women who don’t have depression. UK NICE advice puts the weight differently. It says not to routinely offer antidepressants called SSRIs or SNRIs, or clonidine, as the first treatment for hot flushes and sweats alone. You can still talk about these medicines with your clinician. Your GP or doctor can explain what suits your symptoms and history. ## Vaginal moisturisers and lubricants For vaginal dryness or discomfort, NICE recommends considering non-hormonal vaginal moisturisers or lubricants if vaginal oestrogen isn’t suitable or wanted. You can also use them alongside vaginal oestrogen. Ask a pharmacist or clinician which products suit you. ## Herbal products and other medicines There is very little evidence about how well products such as black cohosh and red clover work, or how safe they are. Herbal products aren’t always easier to use or safer than other treatments. Some can cause serious side effects when taken with other medicines. Tell your pharmacist or doctor about any you use. ## When to contact the prescriber Get medical help straight away from your local emergency medical service (UK, US and elsewhere) if you have a seizure or lose consciousness while taking elinzanetant. Contact your prescriber straight away (UK, US and elsewhere), or an urgent medical service if you can’t reach them, for new unusual tiredness, nausea or vomiting, yellow skin or eyes, dark urine, pale stools, unusual itching or tummy pain while taking fezolinetant or elinzanetant. This also applies to losing your appetite while taking elinzanetant, or swelling of your tummy while taking fezolinetant. Follow the urgent safety instructions in the leaflet straight away. Don’t wait for a routine blood test or a call back before you follow them. Book a GP review in the UK, or see your doctor in the US and elsewhere, if treatment isn’t helping or side effects carry on. Bring the medicine names and the symptoms you most want to improve. Ask whether specialist menopause advice would help. ## When to get help - **Emergency:** Get medical help straight away from your local emergency medical service (UK, US and elsewhere) if you have a seizure or lose consciousness while taking elinzanetant. - **Same day:** Contact your prescriber straight away (UK, US and elsewhere), or an urgent medical service if you can’t reach them, for new unusual tiredness, nausea or vomiting, yellow skin or eyes, dark urine, pale stools, unusual itching or tummy pain while taking fezolinetant or elinzanetant. This also applies to losing your appetite while taking elinzanetant, or swelling of your tummy while taking fezolinetant. Follow the urgent safety instructions in the leaflet straight away. Don’t wait for a routine blood test or a call back before you follow them. - **Same day:** Contact your prescriber straight away (UK, US and elsewhere), or an urgent medical service if you can’t reach them, if you think you may be pregnant while taking elinzanetant. Follow the urgent safety instructions in the leaflet straight away. Don’t wait for a call back before you follow them. - **Book an appointment:** Book a GP appointment (UK) or see your doctor (US and elsewhere) if symptoms affect you or treatment isn’t helping, and ask which non-hormonal options suit you. ## Where you live Services and advice differ between countries. - **UK:** NICE recommends fezolinetant when HRT isn’t suitable, and says the NHS in England must fund it for the people it is recommended for. The MHRA has approved elinzanetant. - **US:** The FDA has approved elinzanetant for moderate to severe hot flashes. Fezolinetant carries a warning about rare but serious liver damage. - **Elsewhere:** The NHS funding statement applies to England. Elsewhere, ask your doctor how to get treatment locally and what safety checks the medicine needs. ## Sources 1. [Menopause: identification and management](https://www.nice.org.uk/guidance/ng23/chapter/Recommendations), NICE 2. [Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause](https://www.nice.org.uk/guidance/ta1143/chapter/1-Recommendation), NICE 3. [MHRA approves elinzanetant to treat moderate to severe vasomotor symptoms (hot flushes) caused by menopause](https://www.gov.uk/government/news/mhra-approves-elinzanetant-to-treat-moderate-to-severe-vasomotor-symptoms-hot-flushes-caused-by-menopause), MHRA 4. [FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant) for hot flashes due to menopause](https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-warning-about-rare-occurrence-serious-liver-injury-use-veozah-fezolinetant-hot-flashes-due), FDA 5. [Treatment for menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/), NHS 6. [DailyMed - LYNKUET- elinzanetant capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f42884ff-7dff-419c-8a0c-affe2ed73818), National Library of Medicine / FDA-approved prescribing information 7. [Drug Trials Snapshots: LYNKUET](https://www.fda.gov/drugs/drug-trials-snapshots/drug-trials-snapshots-lynkuet), FDA 8. [Hot Flashes](https://menopause.org/patient-education/menopause-topics/hot-flashes), The Menopause Society --- This guide is general information to help you keep and use your own records. It isn’t medical advice. If you’re worried about a symptom, or something changes suddenly, talk to a doctor, nurse or pharmacist.