Can’t Take Hormones? The Guide to Non-Hormonal Menopause Treatments (Veozah & Beyond)

For the last few years, the menopause conversation has been dominated by one acronym: HRT.

Influencers, doctors, and friends are all talking about the benefits of the patch. But for millions of women, Hormone Replacement Therapy isn't an option.

Maybe you are a Breast Cancer Survivor. Maybe you have a history of blood clots. Or maybe you simply prefer not to take hormones.

If this is you, you often feel sidelined. You might think your only option is to buy a portable fan and "tough it out."

This is false.

We are currently in a golden age of non-hormonal innovation. From a groundbreaking new FDA-approved drug that targets the brain’s thermostat to repurposed medications that stop the sweats, you have powerful tools available. Here is your non-hormonal toolkit.

To understand Veozah, you have to understand the KNDy Neurons in your brain. Think of these neurons as the "thermostat control center."

• Estrogen acts like the cooling fluid that keeps these neurons calm.

• Neurokinin B (NKB) is a chemical that excites them (turns up the heat).

When you hit menopause, you lose the cooling fluid (estrogen), but you still have the heat (NKB). The thermostat goes haywire, triggering a hot flash.

Veozah is a "Neurokinin 3 (NK3) Receptor Antagonist."

• Translation: It blocks the NKB chemical from binding to the neuron. It essentially puts a cap on the "heat" button so the thermostat stays cool, even without estrogen.

• Effectiveness: Clinical trials showed it reduced moderate-to-severe hot flashes by over 60%.

• Who it's for: It is FDA-approved for treating vasomotor symptoms (hot flashes/night sweats). It is a top choice for women who cannot take estrogen.

Before Veozah, this was the first line of defense. You might be confused if your doctor prescribes an antidepressant when you aren't depressed.

• The Drugs: SSRIs (like Paroxetine/Paxil) and SNRIs (like Venlafaxine/Effexor).

• Why they work: These drugs regulate neurotransmitters like serotonin and norepinephrine. It turns out these chemicals also play a role in the brain's temperature regulation system.

• The Dose: Typically, the dose used for hot flashes is lower than the dose used for depression.

• Effectiveness: They can reduce hot flashes by 30–60% and are particularly helpful if you are also dealing with menopause-related mood swings or anxiety.

Originally designed to treat seizures and nerve pain (shingles), doctors discovered a happy side effect: it stops night sweats.

• How it works: It calms the excitability of nerve cells.

• Best for: Sleep Issues. Because Gabapentin can cause drowsiness, it is often prescribed to be taken right before bed. It tackles the night sweats and helps you sleep through the night.

This is an older medication typically used for overactive bladder.

• How it works: It is an "anticholinergic," meaning it blocks the chemical messenger that triggers sweating.

• The Catch: It dries everything up. While it stops the sweating, it can also cause dry mouth and dry eyes. It is usually a second-line option for women with severe sweating who haven't responded to other treatments.

What About "Natural" Options?

If you want to avoid prescription drugs entirely, the evidence is mixed, but there are standouts.

• Cognitive Behavioral Therapy (CBT): Surprisingly, this is one of the most proven non-drug treatments. It doesn't stop the flash, but it retrains how your brain reacts to it, significantly lowering the distress and "heat" perception.

• Clinical Hypnosis: Studies show specifically designed hypnosis programs can reduce hot flashes by up to 74%.

• Supplements: Black Cohosh and Relizen (Swedish Flower Pollen) have anecdotal success, though clinical data varies. Always check with your oncologist before taking supplements if you have a history of cancer.

Being unable to take HRT does not mean you are sentenced to 10 years of suffering.

Whether it is blocking the brain's heat signal with Veozah, calming the nerves with Gabapentin, or managing the sweat with low-dose SSRIs, modern medicine has a solution for you.

Talk to your doctor specifically about "Non-Hormonal Vasomotor Treatments."

• Looking for lifestyle hacks? Read Mastering Hot Flashes: Triggers & Cooling Breaths.

Need help with anxiety? Read Menopause Rage & Anxiety.