For a long time, menopause was something many women were told to just “get through.” If you had hot flashes, trouble sleeping, or mood swings, the advice was often to wait it out. But menopause symptoms can last years, and they can seriously affect daily life.

The good news is that treatment options have expanded. Some treatments use hormones to replace what the body is losing during menopause. This is called menopause hormone therapy. Other treatments work in different ways to manage symptoms like hot flashes or sleep problems.

“Menopause treatment is really individualized,” said Maariya Bassa, a board-certified nurse-midwife and women’s health nurse practitioner at Unity Healthcare in Washington, D.C. “It’s a conversation between the clinician and the patient about which symptoms are affecting quality of life the most.”

This guide covers some of the most common hormonal and nonhormonal treatments for menopause symptoms. Think of it as a starting point before talking with your healthcare provider.

Estrogen therapy is considered the main hormone treatment for menopause symptoms, especially hot flashes and night sweats. During menopause, the ovaries stop producing as much estrogen. That drop in hormone levels causes many common symptoms.

“During natural menopause, there’s a reduction in ovarian estrogen production,” explained Bassa. “That reduction leads to symptoms like hot flashes and vaginal dryness.”

Estrogen therapy replaces some of that lost hormone. It can help reduce:

• Hot flashes
• Night sweats
• Sleep problems
• Vaginal dryness
• Pain during sex

If you still have your uterus, estrogen usually isn’t prescribed by itself. Taking estrogen alone can cause the lining of the uterus to grow too much and raise the risk of endometrial cancer, so doctors usually also prescribe progesterone.

How Is Estrogen Therapy Delivered?

Estrogen can be taken in several forms:

• Pills (oral estrogen)
• Skin patches
• Topical gels or sprays
• Vaginal rings

These treatments are called systemic therapy because the hormone circulates throughout the body. Some forms are absorbed through the skin instead of the digestive system. These transdermal treatments may have less effect on the liver and a lower risk of blood clots than oral medications.

If you still have your uterus, doctors usually prescribe estrogen and progesterone together.

Progesterone protects the uterus from the effects of estrogen. Without it, the uterine lining can grow too thick over time, which increases the risk of endometrial hyperplasia or cancer.

Some research suggests progesterone can help with:

• Sleep quality
• Mental clarity
• Nighttime symptoms

However, some people find progesterone harder to tolerate than estrogen. Side effects can include mood changes or fatigue, so doctors may adjust the type or dose.

Perimenopause is the stage before menopause when hormone levels begin to fluctuate. This phase can last several years. Symptoms may include:

• Irregular periods
• Heavy bleeding
• Mood swings
• Hot flashes
• Sleep problems

Low-dose birth control pills can be a helpful treatment. Certified nurse-midwife Margaret Ladner, founder of Attune Menopause Care in Chicago, says birth control can help smooth out hormone swings. “We can use low-dose birth control pills as a treatment in perimenopause,” Ladner explained. “They can treat hot flashes, mood disruption, and regulate bleeding patterns.”

Birth control pills may help with hormone fluctuations, irregular cycles, heavy bleeding, and hot flashes. They also provide contraception, which is still important during perimenopause. Many people assume pregnancy is unlikely in their late 40s, but that is not always true.

“People in their late 40s and early 50s who are still having periods can absolutely get pregnant,” Ladner noted.

Because of this, birth control can sometimes solve two problems at once.

Some menopause symptoms mainly affect the vaginal and urinary area. Symptoms like vaginal dryness, painful sex, and urinary incontinence or urgency are collectively called genitourinary syndrome of menopause. Local vaginal estrogen can help treat these symptoms. It works mainly in the vaginal and urinary area. Common options include:

• Vaginal creams
• Vaginal tablets
• Vaginal rings

These treatments use very low doses of estrogen. Local estrogen therapy is considered very safe.

“It doesn’t increase breast cancer risk, and it doesn’t cause blood clots,” Ladner explained. “There’s really not a downside to using it.”

Another advantage is that it can often be used long term, even into older age, to help prevent urinary symptoms.

Testosterone has recently become a popular topic in menopause discussions online, but it’s not a treatment for every symptom.

Women naturally produce small amounts of testosterone. Levels can decline with age, which may affect sexual desire. Some providers prescribe testosterone for hypoactive sexual desire disorder, a condition involving persistent low libido that causes distress.

However, Ladner said it is important to look at the bigger picture first. “Libido is really complex,” she explained. “Testosterone isn’t a magic fix. You have to look at relationship factors, pain with sex, health issues, and mood.”

If those issues have been addressed and low libido continues, testosterone therapy may help improve sexual desire. Testosterone therapy for women is considered off-label, which means it is not approved by the U.S. Food and Drug Administration (FDA) to treat menopause symptoms. It’s still being studied.

Hormone therapy is not the right choice for everyone. Some women cannot take hormones due to medical history or personal preference. In these cases, nonhormonal medications may help.

Antidepressants (SSRIs and SNRIs)

Some antidepressants can reduce hot flashes by affecting the brain’s temperature control system. They can also help treat anxiety or depression during perimenopause. Paroxetine (Brisdelle) is FDA approved to treat hot flashes, and other antidepressants are sometimes prescribed off-label for the same purpose.

Some research shows these medications can cut the number of hot flashes by 50 percent or more.

Gabapentin

Gabapentin is another medication sometimes used for menopausal symptoms. Originally developed for seizures and nerve pain, it can help reduce nighttime hot flashes and improve sleep.

Medications Targeting Hot Flashes

Newer medications are being developed specifically for menopause symptoms. These include fezolinetant (Veozah), approved by the FDA in 2023, and elinzanetant (Lynkuet), approved in 2025. These drugs work on brain pathways that control body temperature and can reduce hot flashes without hormones.

Medication can help, but lifestyle changes can also make menopause symptoms easier to manage.

Bassa often talks with women about improving sleep habits and daily routines. Helpful strategies include:

• Going to bed and waking up at the same time each day
• Reducing caffeine and alcohol
• Exercising regularly
• Keeping the bedroom cool and quiet
• Avoiding screens before bed

Good sleep habits are especially important because insomnia is common during menopause. These steps will not eliminate symptoms completely, but they can make them easier to manage.

The Real Takeaway: Menopause Treatment Is Personal

Menopause care is not one-size-fits-all.

Different women have different symptoms, health histories, and priorities. Some want to avoid hormones. Others find hormone therapy life-changing. Many use a combination of treatments.

The most important step is finding a healthcare provider who listens and understands menopause care. As Ladner explained, good treatment starts with understanding the person experiencing the symptoms. “It’s really about identifying which symptoms are bothering you the most and matching treatment options to those symptoms.”

Menopause is a natural transition, but that does not mean you have to struggle through it without help. Today, there are more options than ever to help you feel like yourself again.