Last checked September 2026 against 55 sources · Editorial policy
Menopause medications: the full list
Menopause medications fall into four groups. Hormone therapy (estrogen, with a progestogen if you have a uterus) is the most effective for hot flashes. Non-hormonal prescription medicines include fezolinetant, elinzanetant, low-dose paroxetine, other SSRIs and SNRIs, gabapentin and oxybutynin. Vaginal estrogen, prasterone and ospemifene treat vaginal dryness. Over-the-counter products are supplements, not FDA-approved medicines.
Every prescription option for menopause symptoms in one table: estrogen, progestogens, tibolone, fezolinetant, SSRIs, gabapentin, ospemifene.
Menopause medications: expectation vs reality
What people often expect
“There's HRT, and if you can't take it, nothing else works”
What the evidence shows
There are more options than ever. Since 2023 the FDA has approved two non-hormonal medicines that block the brain signal behind hot flashes, fezolinetant and elinzanetant, and low-dose paroxetine has been approved for hot flashes too. Older generics such as gabapentin and oxybutynin also work. For vaginal symptoms, low-dose vaginal estrogen, prasterone and ospemifene are all approved.
How menopause medications are grouped
Hormonal menopause medicine: estrogen and progestogen
Estrogen is the main menopause medicine. It reduces hot flash frequency by about 75%, treats vaginal dryness and prevents bone loss. Women with a uterus take a progestogen with it to protect the uterine lining: micronized progesterone, a synthetic progestogen such as medroxyprogesterone or norethindrone, a 52 mg hormonal IUD, or bazedoxifene in Duavee. After a hysterectomy, estrogen can be taken alone.
Learn more →Non-hormonal menopause medication for hot flashes
Three medicines are FDA-approved for hot flashes without hormones: fezolinetant (Veozah), elinzanetant (Lynkuet) and paroxetine 7.5 mg (Brisdelle). Others are used off-label with good trial evidence: escitalopram, citalopram, venlafaxine and desvenlafaxine, which cut hot flashes by about 40% to 65%, plus gabapentin and oxybutynin. The North American Menopause Society recommends all of these, but no longer recommends clonidine. Fezolinetant and elinzanetant need liver blood tests before and during treatment.
Learn more →Medication for vaginal and urinary symptoms
Low-dose vaginal estrogen, as a cream, insert or ring, is the first-line medicine for vaginal dryness and painful sex and improves symptoms by about 60% to 80%. Prasterone (Intrarosa) is a nightly DHEA insert, and ospemifene (Osphena) is a daily pill, an estrogen agonist/antagonist with tissue-selective effects. Vaginal estrogen also reduces recurrent urinary tract infections, and very little is absorbed into the body.
Learn more →Over-the-counter menopause medicine: what's really available
In the US there's no over-the-counter menopause medicine. Estrogen needs a prescription, and products sold OTC for menopause are dietary supplements, which the FDA doesn't approve for safety or effectiveness before they're sold. Red clover and soy haven't reliably reduced hot flashes in trials. Vaginal lubricants and moisturizers are the useful OTC products. In the UK, low-dose vaginal estradiol tablets can be bought from pharmacies.
Learn more →What is the best prescription medicine for menopause?
For hot flashes and night sweats, estrogen is the most effective, and transdermal estradiol avoids the clot risk of tablets. For women who can't take hormones, the choice depends on other conditions: an SSRI or SNRI if mood is also low, gabapentin for night sweats, a neurokinin blocker for the most targeted effect. For vaginal symptoms alone, low-dose vaginal estrogen is best. For bone protection alone, the label advises estrogen only for women at significant risk when non-estrogen medicines aren't appropriate.
Learn more →Menopause medicines for mood and sleep
HRT helps low mood, anxiety and sleep problems caused by menopause. If low mood, depression or anxiety persist, the NHS says antidepressants may be offered, and SSRIs and SNRIs can also reduce hot flashes. For insomnia, CBT for insomnia improved sleep in a trial of women going through menopause, and the benefit held at 24 weeks. Treating night sweats often improves sleep too.
Learn more →Testosterone and tibolone
Testosterone has evidence for low sexual desire after menopause, but there's no FDA-approved testosterone product for women, so doctors prescribe reduced doses of male products or compounded creams off-label, within the normal premenopausal range. Tibolone (Livial) is an HRT medicine used in the UK to treat menopause symptoms and help prevent osteoporosis. Pellets and injections of testosterone aren't recommended.
Learn more →Menopause medicine by the numbers
From the studies on this page
reduction in hot flash frequency with estrogen, the most effective menopause medicine
75%
reduction with SSRIs, SNRIs and gabapentin
40% to 65%
improvement in vaginal symptoms with low-dose vaginal estrogen
60% to 80%
3
Effect sizes come from placebo-controlled trials and vary between studies. Most non-hormonal medicines treat hot flashes only; estrogen also treats vaginal symptoms and protects bone.
Menopause medications list: hormonal and non-hormonal
Estradiol (oral)
Generic estradiol tablets
Daily tablet in 0.5, 1 and 2 mg strengths for hot flashes, vaginal atrophy and bone. Raises clot and gallbladder risk more than transdermal estradiol.
Estradiol patches
Climara, Vivelle-Dot, Minivelle, Dotti, generics; Menostar for bone only
Changed once or twice a week, 25 to 100 mcg a day. No extra clot risk.
Estradiol gel and spray
EstroGel, Divigel, Elestrin, Evamist
Applied daily to the skin; doses adjusted by pumps or sprays. No extra clot risk.
Conjugated estrogens
Premarin tablets; Prempro and Premphase with medroxyprogesterone
Mixed estrogens from pregnant mares' urine, used in the WHI trial. Higher clot risk than oral estradiol in observational studies.
Combined estrogen and progestogen products
Activella, Angeliq, Bijuva, CombiPatch, Climara Pro, Prempro
Both hormones in one tablet, capsule or patch for women with a uterus.
Conjugated estrogens with bazedoxifene
Duavee
Estrogen paired with bazedoxifene instead of a progestogen, for hot flashes and bone in women with a uterus. Not recommended over 75.
Progestogens
Micronized progesterone (Prometrium), medroxyprogesterone, norethindrone, 52 mg levonorgestrel IUD
Protect the uterine lining when estrogen is used. Prometrium contains peanut oil.
Vaginal estrogen
Estrace cream, Premarin vaginal cream, Vagifem and Yuvafem inserts, Imvexxy, Estring ring
Low-dose local treatment for dryness, painful sex and recurrent UTIs; very little is absorbed.
Prasterone and ospemifene
Intrarosa vaginal inserts; Osphena tablets
Non-estrogen prescription options for painful sex and dryness after menopause. Prasterone is used nightly; ospemifene is a daily pill.
Fezolinetant (Veozah); elinzanetant (Lynkuet)
Non-hormonal pills that block the brain signal behind hot flashes. Liver blood tests are required.
SSRIs and SNRIs
Paroxetine 7.5 mg (Brisdelle), escitalopram, citalopram, venlafaxine, desvenlafaxine
Reduce hot flashes by about 40% to 65% and can help mood. Paroxetine interacts with tamoxifen.
Gabapentin
Generic gabapentin
Reduced hot flash severity by 46% at 900 mg a day in a trial. Drowsiness and dizziness are common.
Oxybutynin
Generic extended-release oxybutynin
A bladder medicine that roughly halved hot flashes in a 12-week trial. Dry mouth affected 52.1% of women.
Clonidine
Generic clonidine
A blood pressure medicine with a small effect on hot flashes; no longer recommended by The North American Menopause Society.
When to talk to a doctor about menopause medication
Menopause symptoms affecting your daily life
See a doctor to go through the options. Over 45, you usually don't need blood tests to start treatment.
More →Taking tamoxifen or an aromatase inhibitor
Check with your oncologist before starting any menopause medicine; paroxetine, for example, can reduce tamoxifen's effect.
Urgent: Yellow skin or eyes, dark urine or unusual tiredness on Veozah or Lynkuet
Stop the medicine and contact your doctor. These can be signs of liver injury.
Urgent: Thoughts of self-harm on an antidepressant
Get help now: call or text 988, or call 911 in an emergency.
Menopause medications: questions women ask
What medications are used for menopause symptoms?
Estrogen, with a progestogen if you have a uterus, is the main one. Non-hormonal options are fezolinetant, elinzanetant, low-dose paroxetine and other SSRIs or SNRIs, gabapentin and oxybutynin. Vaginal estrogen, prasterone and ospemifene treat vaginal dryness.
What is the best medicine for menopause?
For hot flashes, estrogen is the most effective, cutting them by about 75%. If you can't take it, non-hormonal medicines reduce hot flashes by about 40% to 65%. For vaginal dryness alone, low-dose vaginal estrogen works best. The best choice depends on your symptoms and medical history.
Is there an over-the-counter menopause medicine?
Not in the US. OTC menopause products are supplements, which aren't FDA-approved for safety or effectiveness, and the main ones haven't beaten placebo for hot flashes. Lubricants and vaginal moisturizers are useful OTC. In the UK, low-dose vaginal estradiol tablets are sold in pharmacies.
Related →What are hormone replacement pills?
Tablets containing estrogen, such as estradiol or conjugated estrogens, sometimes combined with a progestogen in one pill, such as Activella, Angeliq or Prempro. They're taken daily. Tablets are effective but carry a higher clot risk than patches or gels.
When should you take hormone replacement?
When menopause symptoms bother you, including in perimenopause while you still have periods. The balance of benefits and risks is most favorable if you start before 60 or within 10 years of menopause. You don't need to wait until your periods stop, and HRT can be continued as long as benefits outweigh risks.
What is a natural menopause medication?
No natural product has been shown to work like a medicine for menopause. Herbal remedies and supplements aren't recommended for hot flashes. If you prefer hormones identical to your own, FDA-approved estradiol and micronized progesterone are bioidentical.
Related →Which menopause medications don't contain hormones?
Fezolinetant, elinzanetant, SSRIs such as paroxetine and escitalopram, SNRIs such as venlafaxine, gabapentin, oxybutynin and ospemifene are hormone-free. Lubricants and moisturizers are too. Prasterone is a hormone precursor (DHEA), not estrogen. None of the non-hormonal options protect bone the way estrogen does.
Related →Do I need a prescription for menopause medication?
Yes, for every medicine on this list in the US. A doctor, gynecologist, nurse practitioner or telehealth menopause service can prescribe them. You usually won't need blood tests if you're over 45. Vaginal lubricants and moisturizers are the main products you can buy without one.
Related →Sources
- Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420.
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
- Prescribing information: Veozah (fezolinetant tablets). Astellas Pharma, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Lynkuet (elinzanetant capsules). Bayer HealthCare, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Brisdelle (paroxetine 7.5 mg capsules). Legacy Pharma, 2025. DailyMed, US National Library of Medicine.
- US Food and Drug Administration. Dietary supplements.
- Prescribing information: Intrarosa (prasterone vaginal inserts). Millicent, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Osphena (ospemifene tablets). Duchesnay, 2025. DailyMed, US National Library of Medicine.
- The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
- Women's Health Concern / British Menopause Society. Fact sheet: HRT types, doses and regimens.
- Prescribing information: Duavee (conjugated estrogens/bazedoxifene). Wyeth/Pfizer, 2026. DailyMed, US National Library of Medicine.
- Chen YY, Su TH, Lau HH. Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: a meta-analysis of randomized controlled trials. Int Urogynecol J. 2021;32(1):17-25.
- NHS. Benefits and risks of hormone replacement therapy (HRT).
- Nelson HD, Vesco KK, Haney E, et al. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA. 2006;295(17):2057-71.
- The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992.
- Medicines and Healthcare products Regulatory Agency (UK). Easier access to locally-applied HRT to treat postmenopausal vaginal symptoms in landmark MHRA reclassification. 2022.
- Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810.
- Prescribing information: Estradiol tablets USP. Teva Pharmaceuticals, 2024. DailyMed, US National Library of Medicine.
- NHS. Treatment for menopause and perimenopause.
- McCurry SM, Guthrie KA, Morin CM, et al. Telephone-Based Cognitive Behavioral Therapy for Insomnia in Perimenopausal and Postmenopausal Women With Vasomotor Symptoms: A MsFLASH Randomized Clinical Trial. JAMA Intern Med. 2016;176(7):913-20.
- Pinkerton JV, Blackman I, Conner EA, et al. Risks of Testosterone for Postmenopausal Women. Endocrinol Metab Clin North Am. 2021;50(1):139-150.
- Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666.
- NHS. Tibolone.
- NHS. About hormone replacement therapy (HRT).
- NICE. Menopause: identification and management (NG23). Updated 2024.
- US Food and Drug Administration. Drug safety communication: FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant). December 2024.
- Federal Communications Commission. 988 Suicide & Crisis Lifeline.
- National 911 Program. 911.gov.
- Liu B, Beral V, Balkwill A, et al. Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study. BMJ. 2008;337:a386.
- Prescribing information: Climara (estradiol transdermal system). Bayer HealthCare, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Vivelle-Dot (estradiol transdermal system). Sandoz, 2023. DailyMed, US National Library of Medicine.
- Prescribing information: EstroGel (estradiol gel 0.06%). Ascend Therapeutics, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Divigel (estradiol gel 0.1%). Vertical Pharmaceuticals, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Elestrin (estradiol gel 0.06%). Viatris, 2023. DailyMed, US National Library of Medicine.
- Prescribing information: Evamist (estradiol transdermal spray). Padagis, 2024. DailyMed, US National Library of Medicine.
- Prescribing information: Premarin (conjugated estrogens tablets). Wyeth/Pfizer, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Prempro/Premphase (conjugated estrogens and medroxyprogesterone acetate). Wyeth/Pfizer, 2026. DailyMed, US National Library of Medicine.
- Smith NL, Blondon M, Wiggins KL, et al. Lower risk of cardiovascular events in postmenopausal women taking oral estradiol compared with oral conjugated equine estrogens. JAMA Intern Med. 2014;174(1):25-31.
- Prescribing information: Activella (estradiol/norethindrone acetate tablets). Amneal, 2023. DailyMed, US National Library of Medicine.
- Prescribing information: Angeliq (drospirenone and estradiol tablets). Bayer HealthCare, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Bijuva (estradiol and progesterone capsules). Mayne Pharma, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: CombiPatch (estradiol/norethindrone acetate transdermal system). Noven, 2024. DailyMed, US National Library of Medicine.
- Prescribing information: Climara Pro (estradiol and levonorgestrel transdermal system). Bayer HealthCare, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Prometrium (progesterone capsules). Acertis Pharmaceuticals, 2026. DailyMed, US National Library of Medicine.
- British Menopause Society. Tool for clinicians: HRT preparations and equivalent alternatives. 2024.
- Prescribing information: Estrace cream (estradiol vaginal cream 0.01%). Allergan, 2024. DailyMed, US National Library of Medicine.
- Prescribing information: Vagifem (estradiol vaginal inserts). Novo Nordisk, 2025. DailyMed, US National Library of Medicine.
- Prescribing information: Imvexxy (estradiol vaginal inserts). Mayne Pharma, 2025. DailyMed, US National Library of Medicine.
- Prescribing information: Estring (estradiol vaginal ring). Pfizer, 2026. DailyMed, US National Library of Medicine.
- Pandya KJ, Morrow GR, Roscoe JA, et al. Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9488):818-24.
- Aguirre W, Chedraui P, Mendoza J, et al. Gabapentin vs. low-dose transdermal estradiol for treating post-menopausal women with moderate to very severe hot flushes. Gynecol Endocrinol. 2010;26(5):333-7.
- Simon JA, Gaines T, LaGuardia KD; Extended-Release Oxybutynin Therapy for VMS Study Group. Extended-release oxybutynin therapy for vasomotor symptoms in women: a randomized clinical trial. Menopause. 2016;23(11):1214-1221.
- NHS. Types of hormone replacement therapy (HRT).
- NHS. When to take hormone replacement therapy (HRT).
- Stuenkel CA. Compounded bioidentical hormone therapy: new recommendations from the 2020 National Academies of Sciences, Engineering, and Medicine. Menopause. 2021;28(5):576-578.
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