In short
Non-hormonal menopause treatment relieves hot flushes with prescription medicines such as fezolinetant, low-dose SSRIs or SNRIs, and gabapentin, for women who cannot or do not want to take HRT. Fezolinetant 45 mg cut hot flush frequency by 64 percent in a 12-week trial, against 45 percent on placebo. Supplements such as black cohosh and soy work no better than placebo.
Treatment Overview
Who needs non-hormonal menopause treatment?
Non-hormonal treatment is for women with moderate to severe hot flushes who cannot take HRT or choose not to. Clinical guidance names these groups:
- Medical reasons: previous breast cancer, a blood clot or stroke, coronary heart disease, active liver disease or unexplained vaginal bleeding
- Raised risk: a 10-year cardiovascular risk above 10 percent, or a raised 5-year breast cancer risk
- After HRT: hot flushes that return after stopping HRT
- Preference: women who prefer to avoid hormones
HRT remains the most effective treatment for hot flushes. Women with a family history of breast cancer are not automatically excluded: HRT with a family history of breast cancer.
Which non-hormonal medicines treat hot flushes?
The Menopause Society lists fezolinetant, elinzanetant, SSRIs, SNRIs, gabapentin, oxybutynin and cognitive behavioural therapy as effective non-hormonal options. The table compares the main medicines.
| Medicine | Key points |
|---|---|
| Fezolinetant (NK3 blocker) | Targets the brain’s temperature centre; liver tests at set intervals |
| Elinzanetant (NK1 and NK3 blocker) | Also helps sleep; also studied in women on breast cancer treatment |
| Citalopram, escitalopram, paroxetine, venlafaxine | Work within days; helpful with low mood; paroxetine avoided with tamoxifen |
| Gabapentin | A bedtime dose suits hot flushes at night; causes drowsiness |
| Oxybutynin | Dry mouth common; avoided in older women because of a possible dementia link |
How well does fezolinetant work?
Fezolinetant 45 mg daily reduced hot flush frequency by 64 percent after 12 weeks in the SKYLIGHT 1 trial of 527 women, against 45 percent on placebo. For a woman with 10 hot flushes a day, that average means about 6 fewer. Fezolinetant blocks the neurokinin 3 receptor on the brain cells that trigger hot flushes when oestrogen falls.
Rare serious liver injury has been reported, so the FDA requires liver blood tests before starting, monthly for the first 3 months, then at 6 and 9 months. Fezolinetant is not started if liver values are twice the upper limit or more.
How do SSRIs and SNRIs help hot flushes?
Low-dose citalopram, escitalopram, paroxetine, venlafaxine and desvenlafaxine reduce hot flushes modestly and work within days, faster than for depression. Clinical guidance starts with citalopram or escitalopram because they cause fewer side effects. Sertraline and fluoxetine are not used, because they have no relevant effect on hot flushes.
Women on tamoxifen avoid paroxetine, because it blocks the conversion of tamoxifen to its active form. SSRIs are tapered, not stopped suddenly.
When is gabapentin used for hot flushes?
Gabapentin suits women woken by hot flushes at night. A single bedtime dose starts at 100 mg and rises every 3 nights up to 900 mg until the flushes settle, according to clinical guidance. Drowsiness and dizziness are the main side effects, and the bedtime dose uses the drowsiness to help sleep. Sleep problems in general: hormonal sleep disturbance.
Do supplements help with hot flushes?
Black cohosh, soy isoflavones, red clover, evening primrose oil, flaxseed and other herbal remedies work no better than placebo in systematic reviews, and the Menopause Society does not recommend them. Acupuncture was no better than sham acupuncture. Placebo alone reduces hot flushes by 20 to 50 percent in trials, which explains many positive personal reports.
Weight loss in women with overweight improved hot flushes in a trial. Cognitive behavioural therapy reduces how bothersome hot flushes feel and improves menopause-related insomnia.
Non-hormonal menopause treatment in Dubai and the UAE
Are fezolinetant and elinzanetant available in Dubai?
Fezolinetant and elinzanetant are approved in the US and Europe. A UAE approval notice from the Emirates Drug Establishment was not found at the time of writing, so Dr Felix checks current pharmacy stock at the consultation and uses an SSRI, SNRI or gabapentin when an NK blocker is not available.
Why are herbal remedies popular in the UAE?
A 2026 review of 15 studies from Arab countries names a preference for herbal or natural remedies as a main barrier to effective menopause treatment, together with fear of risks (Frontiers in Global Women’s Health). Herbal products bought online also carry quality risks; prescription medicines from licensed pharmacies have passed regulatory review.
Dr Felix treats within the scope of his Dubai Health Authority licence. When a case needs a specialist view, for example after breast cancer or with a clotting disorder, the treatment decision is made together with an endocrinologist, gynaecologist or oncologist.
Hormones possible after all? HRT patches and oestrogen gel. Only vaginal dryness? vaginal oestrogen. Not sure your symptoms are menopause? take the 2-minute menopause self-check.
Who Is a Good Candidate?
- Women with moderate to severe hot flushes after breast cancer, a blood clot, a stroke or with coronary heart disease.
- Women with a high cardiovascular risk or a raised breast cancer risk.
- Women whose hot flushes returned after stopping HRT and who prefer not to restart it.
- Women who prefer to avoid hormones for personal reasons.
- Liver disease or raised liver values: fezolinetant and elinzanetant are not started.
- Tamoxifen treatment: paroxetine and fluoxetine are avoided.
- Flushing with diarrhoea, palpitations or weight loss: other causes such as thyroid or hormone-producing tumours are ruled out first.
- Other medicines that affect serotonin: the combination is checked before an SSRI or SNRI is started.
What Happens During the Consultation
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1
Symptoms and reasons
Dr Felix reviews the pattern of hot flushes, night sweats, sleep and mood, and why HRT is not an option.
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2
Medicine check
Current medicines, especially tamoxifen, antidepressants and sleep medicines, and liver tests where needed.
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3
Choice of medicine
The option that fits day or night symptoms, mood, other medicines and local availability.
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4
Review
A check after 4 to 12 weeks, depending on the medicine, and a switch if the first choice does not help.
Program Structure & Follow-Up
How is non-hormonal treatment followed up?
Reviews follow the medicine: liver tests on the fixed schedule for fezolinetant, and a check of effect and side effects after about 4 weeks for SSRIs, SNRIs and gabapentin. If one medicine does not help, a second one from the same group or another group is tried. After about 2 years, the medicine is tapered to see whether hot flushes have settled. Continuous care: Women’s Hormone Membership.
Benefits, Limits & Safety
What are the benefits of non-hormonal treatment?
Non-hormonal medicines reduce hot flushes without oestrogen, so they are used after breast cancer and with clot or stroke history. SSRIs and SNRIs also treat low mood, and gabapentin improves sleep broken by night sweats.
What are the limits of non-hormonal treatment?
Non-hormonal medicines work less strongly than HRT and do not protect bone or treat vaginal dryness. Each group has its own side effects: liver effects with NK blockers, nausea and withdrawal symptoms with SSRIs and SNRIs, drowsiness with gabapentin.
What the evidence shows
Fezolinetant 45 mg: 64 percent fewer hot flushes at 12 weeks against 45 percent on placebo. Supplements: no better than placebo.
How you are followed
Liver tests at baseline, monthly for 3 months, then at 6 and 9 months on fezolinetant; effect check after about 4 weeks on other medicines.
When a medicine is not used
Liver disease for NK blockers; paroxetine and fluoxetine with tamoxifen; interactions checked before SSRIs and SNRIs.
Cost & Program Investment
What non-hormonal menopause treatment costs depends on the medicine and the tests it needs. Dr Felix explains the figure before any prescription.
Frequently Asked Questions
Fezolinetant and elinzanetant are the strongest non-hormonal medicines in trials; low-dose SSRIs, SNRIs and gabapentin are alternatives. The best choice depends on day or night symptoms, mood, other medicines and availability.
A UAE approval notice for fezolinetant from the Emirates Drug Establishment was not found at the time of writing. Dr Felix checks current pharmacy stock at the consultation.
Black cohosh works no better than placebo for hot flushes in systematic reviews and meta-analyses. The Menopause Society does not recommend it.
Yes, non-hormonal medicines are the usual choice after breast cancer. Women on tamoxifen avoid paroxetine and fluoxetine, and the plan is agreed with the oncologist.
The cost of non-hormonal menopause treatment in Dubai depends on the medicine and the blood tests it needs. Dr Felix explains the full cost in the consultation before anything is prescribed.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- The 2023 nonhormone therapy position statement of The North American Menopause Society
- Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1)
- FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant)
- Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline
- Utilisation of hormone replacement therapy in Arab countries: a systematic review
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.