Does it work? Menopause treatment evidence checker
This is not medical advice — it is general information based on what you searched for that may help.
General information based on published sources and the symptoms you searched for. This isn't medical or legal advice, a diagnosis or a treatment plan. Please consult a doctor about your own symptoms. If your symptoms are severe or sudden, seek urgent care.
Pick a symptom or search for a treatment to see what current clinical guidelines say about it: an evidence grade, a short verdict and the guideline behind it. The checker covers hormone therapy, the newer non-hormonal prescriptions fezolinetant (Veozah) and elinzanetant (Lynkuet), CBT, pelvic floor training, vaginal moisturisers and popular supplements. Save the options you want to ask about and print a shortlist for your appointment. Every entry summarizes published evidence, never a personal recommendation or dose.
Evidence verdicts (12)
Summaries reflect guideline consensus; never a personal recommendation or dose.
- HormonalStrong evidence
Systemic hormone therapy (estrogen + progestogen, or estrogen alone after hysterectomy)
The Menopause Society (2022) states systemic hormone therapy is the most effective treatment for vasomotor symptoms and prevents bone loss. Benefit-risk ratio is most favorable under age 60 or within 10 years of menopause onset without contraindications.
Guideline source: The Menopause Society 2022 Position Statement; FDA 2025–2026 labeling updates
- HormonalStrong evidence
Low-dose vaginal estrogen (creams, tablets, or rings)
Highly effective for moderate-to-severe genitourinary syndrome of menopause (vaginal dryness and painful sex) when non-hormonal moisturisers are not enough, with minimal systemic absorption.
Guideline source: NAMS 2020 GSM Position Statement; Cochrane 2021
- Non-hormonal RxStrong evidence
Fezolinetant (Veozah) — NK3 receptor antagonist
with liver monitoring warning
FDA-approved non-hormonal prescription option with Level I evidence for moderate-to-severe hot flashes. Carries an FDA boxed warning for liver injury (hepatotoxicity), requiring baseline and scheduled blood liver tests.
Guideline source: NAMS 2023 Nonhormone Statement; FDA Veozah Prescribing Information (2026)
- Non-hormonal RxStrong evidence
Elinzanetant (Lynkuet) — dual NK1/NK3 receptor antagonist
FDA-approved in October 2025 for moderate-to-severe vasomotor symptoms. Efficacy came from two 12-week phase 3 trials (OASIS 1 and 2) in 796 women; safety data covered 1,420 women across OASIS 1–3, including 627 followed for up to a year.
Guideline source: Manufacturer (Bayer) approval announcement, 2025, reporting the OASIS 1–3 trials; brand-funded source
- Non-hormonal RxStrong evidence
Certain SSRIs, SNRIs, gabapentin, and oxybutynin
strong to moderate depending on option, Level I–II
Recommended by The Menopause Society (2023) as non-hormonal prescription options that reduce hot flash frequency and severity when hormone therapy is contraindicated or not chosen.
Guideline source: The Menopause Society 2023 Nonhormone Therapy Position Statement
- Behavioral & PhysicalStrong evidence
Cognitive behavioral therapy (CBT) and clinical hypnosis
Level I
The Menopause Society (2023) recommends CBT and clinical hypnosis (Level I) for reducing how much hot flashes bother daily life and sleep.
Guideline source: The Menopause Society 2023 Nonhormone Therapy Position Statement
- Behavioral & PhysicalStrong evidence
Supervised pelvic floor muscle training (PFMT)
First-line treatment in NICE NG123 and Cochrane systematic reviews (at least 3 months of structured contractions); participants in PFMT trials were 8 times more likely to report complete resolution of urinary leakage than inactive controls.
Guideline source: NICE NG123 (2019); Cochrane Review CD005654 (2018)
- Behavioral & PhysicalStrong evidence
High-intensity resistance and impact training (HiRIT)
for bone density & strength
In the LIFTMOR randomized trial, twice-weekly supervised high-intensity resistance and impact training improved lumbar spine and femoral neck bone mineral density and functional strength in postmenopausal women with low bone mass. (Not recommended by NAMS 2023 as a treatment for hot flashes.)
Guideline source: LIFTMOR Trial (JBMR 2018); NAMS 2023 Nonhormone Statement
- Topical & DevicesModerate evidence
Non-hormonal vaginal moisturisers and personal lubricants
first-line non-hormonal option
Recommended by NAMS (2020) and ACOG (2021) as first-line non-hormonal care: vaginal moisturisers used several times a week hydrate tissue continuously, while lubricants reduce friction during sex.
Guideline source: NAMS 2020 GSM Statement; ACOG Clinical Consensus No. 2 (2021); Cochrane 2021
- Supplements & CoolingLimited evidence
Cooling pillows, breathable bedding, and moisture-wicking sleepwear
comfort aid only, not a treatment
The Menopause Society (2023) notes that cooling techniques are not recommended as a clinical treatment that stops vasomotor flashes (Level II), though many women use breathable layers and cooling pillows for practical comfort when night sweats wake them.
Guideline source: The Menopause Society 2023 Nonhormone Therapy Position Statement
- Supplements & CoolingNot supported
Over-the-counter herbal supplements (black cohosh, evening primrose, soy extracts, cannabinoids)
Level I–II trials
The Menopause Society (2023) does not recommend over-the-counter supplements, herbal remedies, soy extracts, or cannabinoids for vasomotor symptoms because randomized trial results are inconsistent or no better than placebo.
Guideline source: The Menopause Society 2023 Nonhormone Therapy Position Statement
- Behavioral & PhysicalNot supported
Paced respiration, acupuncture, and relaxation alone for hot flashes
Level I–II trials
Controlled trials found paced respiration (Level I) and acupuncture or relaxation (Level II) did not consistently outperform sham or control groups for reducing hot flashes.
Guideline source: The Menopause Society 2023 Nonhormone Therapy Position Statement
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How to use the evidence checker
- Do the safety check first. If anything there applies, the advice to get help appears before the results.
- Filter by symptom or goal, such as hot flashes, vaginal dryness, bladder leaks, bone loss or sleep and mood, or by evidence grade.
- Search by name, including brand names such as Veozah, or a supplement such as black cohosh.
- Tap "Save to ask my doctor" on anything you want to discuss, then print your shortlist or save it with today's date. Saved shortlists stay in this browser on this device.
Example. Choose Hot flashes & night sweats and the grade Not recommended by guidelines. You'll see over-the-counter herbal supplements and paced breathing, both of which The Menopause Society does not recommend for hot flashes. Switch the grade to Strong evidence to see the options it does recommend, then save two or three to discuss.
What the evidence grades mean
- Strong evidence: Supported by medical society position statements (such as The Menopause Society 2022 hormone therapy statement and 2023 nonhormone therapy statement), NICE guidelines, or Cochrane systematic reviews.
- Moderate evidence: Recommended as first-line non-hormonal care or supported by smaller randomized trials (for example, non-hormonal vaginal moisturisers for genitourinary symptoms).
- Limited / comfort aid: Practical comfort measures (such as cooling pillows and breathable sleepwear) that are not recommended by clinical guidelines as a medical treatment that stops hot flashes, but are used for everyday comfort.
- Not recommended by guidelines: Over-the-counter supplements, herbs and techniques where controlled trials did not show consistent benefit over placebo for vasomotor symptoms.
A grade describes the evidence for one use, such as black cohosh for hot flashes, not the product in general. Our page on how we grade evidence explains the full method.
Why a lot of hot flash advice online is out of date
Many articles about "what works" for hot flashes predate the current guidance. The Menopause Society's 2023 nonhormone statement includes fezolinetant among its Level I recommendations, and the FDA approved elinzanetant in October 2025. Older advice may not mention either. The checker is updated when guidelines or approvals change, and each verdict names its source so you can check how current it is.
Detailed verdicts you can read next
- Non-hormonal treatments for hot flashes, including fezolinetant (Veozah) and elinzanetant (Lynkuet)
- Does black cohosh work? and soy and isoflavones for hot flashes
- Hot flashes: hormonal and non-hormonal evidence
- Vaginal moisturisers vs lubricants for dryness
- Is hormone therapy right for me?
- Every supplement and remedy we've rated, in the Does it work? directory of verdicts
When to get help now
Your shortlist stays on this device
Your shortlist and any dated copies you save are kept in this browser on this device, with no account, and you can reopen or delete them. Nothing is sent to us, to analytics or to advertisers. Turn your shortlist into questions for your clinician with the HRT and treatment question builder.
Where are you right now?
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Evaluating your response or wondering what to adjust next?
Explore evidence-graded treatment and lifestyle options →Questions people ask
Which non-hormonal treatments have the best evidence for hot flashes?
In its 2023 position statement, The Menopause Society recommends cognitive behavioral therapy, clinical hypnosis, certain SSRIs and SNRIs, gabapentin and fezolinetant (Level I), and oxybutynin (Levels I to II). Elinzanetant was approved by the FDA in October 2025, after that statement.
Do menopause supplements like black cohosh work for hot flashes?
The Menopause Society's 2023 statement does not recommend over-the-counter supplements and herbal remedies, including black cohosh, for hot flashes (Levels I to II), because trials haven't shown consistent benefit over placebo. Our black cohosh and soy pages explain the trials in more detail.
Why are most menopause supplements graded not recommended by guidelines?
When The Menopause Society reviewed randomized trials of supplements, herbal remedies and soy extracts for its 2023 nonhormone statement, it found the results inconsistent or no better than placebo for hot flashes, so it doesn't recommend them.
Does Strong evidence mean a treatment is right for me?
No. Evidence grades describe how well a treatment worked across clinical trial populations. Only a clinician who knows your health history, medications and contraindications can advise what is safe for you.
Does anyone pay to be listed or graded higher?
No. Grades come from published guidelines and trials and are set before we check whether any affiliate programme exists. We never place buy links on items graded not recommended.
Related pages
References
- Shufelt CL, Brown V, Carpenter JS et al.. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause (The North American Menopause Society, now The Menopause Society), 2023.
- The 2022 Hormone Therapy Position Statement Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause (The North American Menopause Society, now The Menopause Society), 2022. Funding: Funded by donations to the NAMS Education & Research Fund; the statement reports no commercial support. Individual panel disclosures not yet reviewed..
- Urinary incontinence and pelvic organ prolapse in women: management (NG123). National Institute for Health and Care Excellence, 2019.
- Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2018.
- The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause: The Journal of The Menopause Society, 2020.
- Bayer's Lynkuet (elinzanetant) approved in the U.S. for treatment of moderate to severe vasomotor symptoms due to menopause. Bayer, 2025. [Brand-funded] Funding: Manufacturer press release. Replace with the FDA label for efficacy and safety figures..
- Postmenopausal bleeding. NHS (nhs.uk), 2026.
- Heart palpitations. NHS (nhs.uk), 2026.
- 988 Suicide & Crisis Lifeline. 988 Lifeline, 2026.
- VEOZAH (fezolinetant) tablets, prescribing information. Astellas Pharma US, 2026. Funding: Manufacturer-issued label (FDA-approved text).
- Treatment of Symptoms of the Genitourinary Syndrome of Menopause: Clinical Consensus No. 2. American College of Obstetricians and Gynecologists, 2021.
- Non-hormonal interventions for genitourinary syndrome of menopause. Cochrane Database of Systematic Reviews, 2021.
- High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis. Journal of Bone and Mineral Research, 2018.
Change log
- : Published interactive treatment and supplement evidence checker
- : Added how to use the checker, why older advice is out of date, more detailed verdicts to read next, a saved shortlist and new FAQs