Nonhormonal Treatment of Vasomotor Symptoms of Menopause

Vasomotor symptoms (VMS), such as hot flashes and night sweats, are experienced by over 80% of women during menopause and can significantly impair quality of life. While hormone replacement therapy (HRT) is the gold standard for managing VMS, concerns over its association with breast cancer, cardiovascular disease (CVD), and thromboembolic events have led to increasing interest in nonhormonal alternatives. This review explores the efficacy and cardiovascular safety of nonhormonal treatments for VMS. Given the heightened risk of CVD in postmenopausal women due to estrogen deficiency, the ideal nonhormonal therapy should not only alleviate VMS but also mitigate cardiovascular risks. Various nonhormonal options, including lifestyle modifications, acupuncture, cognitive behavioral therapy, and pharmacological agents such as SSRIs/SNRIs, gabapentin, clonidine, and the emerging class of neurokinin-3 receptor antagonists, are examined. Clinical trials demonstrate that SSRIs (eg, paroxetine) and SNRIs (eg, venlafaxine) provide significant VMS relief, particularly for women who are unable to use HRT. Neurokinin-3 receptor antagonists, such as fezolinetant, show promising results in reducing hot flashes without affecting cardiovascular health. While more research is needed to further assess long-term outcomes, nonhormonal therapies present a viable and safer alternative for managing VMS, especially for women at risk for cardiovascular complications.