Hormonal and Non-Hormonal Treatment Options in VMS

This episode, titled "Hormonal and Non-Hormonal Treatment Options in VMS," features panelists walking through the full spectrum of evidence-based treatment options for vasomotor symptoms, grounded in The Menopause Society position statement and decades of clinical and research experience.

Menopausal hormone therapy (MHT) is presented as the most effective treatment for VMS, reducing hot flashes and night sweats by 50–70%. The menopause specialist details the components of MHT, including estradiol-based options available in oral, transdermal, and vaginal ring formulations, paired with progestogen therapy for women with a uterus. Both synthetic progestogens and bioidentical micronized progesterone are discussed as options, with the overall approach described as individualized and combinatory based on each patient's profile.

The Women's Health Initiative (WHI) study is reviewed as a cornerstone of hormone therapy evidence, noting that the majority of participants were over age 60 and many years past menopause — a population distinct from those typically treated for active VMS. The "timing hypothesis" is highlighted, confirming that women under 60 or within 10 years of menopause onset have a more favorable benefit-to-risk profile for MHT.

For women who cannot or choose not to use hormone therapy, the panelist distinguishes between ineffective options — such as supplements including black cohosh and valerian root, which demonstrate only placebo-level effects — and evidence-supported non-hormonal alternatives. These include cognitive behavioral therapy for insomnia, weight loss, stellate ganglion block, low-dose paroxetine, and oxybutynin. Notably, newer pharmacologic classes are introduced, including NK1 and NK3 receptor antagonists targeting the hypothalamic KNDy neurons, with one agent approved in 2023 and another dual-receptor antagonist approved in 2025, representing a meaningful expansion of treatment options for women with elevated cardiovascular risk or other contraindications to hormone therapy.

In the next episode, "Navigating Menopausal Hormone Therapy Safety in VMS," panelists will revisit common misconceptions surrounding menopausal hormone therapy, examine how formulation, timing, and cardiovascular risk profile shape treatment decisions, and emphasize the need for ongoing, individualized risk reassessment in patients using menopausal hormone therapy for VMS.