Vasomotor symptom therapy reference (2026)

Vasomotor symptom therapy in 2026 organises around three tiers.

Menopausal hormone therapy: estrogen plus progestogen for women with a uterus, estrogen alone for women without a uterus. Multiple delivery routes (oral, transdermal patch, gel, spray, vaginal). Effective for vasomotor symptoms and broader menopausal symptom relief; risk-benefit assessment is individualised based on age, time since menopause, cardiovascular risk, and breast cancer risk.

Non-hormonal pharmacotherapy: SSRI/SNRI medicines (paroxetine, venlafaxine, escitalopram, others) at lower doses than for depression. Gabapentin or pregabalin. Clonidine in selected patients. These provide modest vasomotor symptom benefit and are options for women who cannot or prefer not to use hormone therapy.

Mechanism-targeted non-hormonal therapy: fezolinetant (NK3 receptor antagonist), elinzanetant (combined NK1-NK3 receptor antagonist) provide substantial vasomotor symptom benefit through the brain's thermoregulatory pathway. Follow-on NK-pathway programs are in late-stage trials.

The breast cancer survivor population is a particular use case. Hormone therapy is generally avoided in breast cancer survivors, especially those with hormone receptor-positive disease. Non-hormonal pharmacotherapy and mechanism-targeted NK-pathway therapy are the modern options for this population.

The care-pathway integration matters. Vasomotor symptom assessment, structured discussion of options, and shared decision-making increasingly anchor menopause care in primary care, OB-GYN, and specialised menopause clinics.