Cooling the flames: Navigating menopausal vasomotor symptoms with nonhormone medications.

This article focuses on prescription nonhormone treatment options for menopausal vasomotor symptoms (VMS), which are commonly experienced during menopause and include hot flashes. While hormone therapy remains the gold standard for managing VMS, it is underutilized due to contraindications or patient preference, making nonhormone therapies important alternatives. FDA-approved nonhormone options include low-dose paroxetine, a selective serotonin reuptake inhibitor (SSRI), and fezolinetant, a novel neurokinin-3 receptor (NK3R) antagonist shown to significantly reduce VMS frequency comparable to hormone therapy. Other off-label nonhormone treatments such as serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, and oxybutynin offer mild to moderate symptom relief but have varying side effect profiles and limitations. The article emphasizes the role of pharmacists in bridging treatment gaps by being knowledgeable about both hormone and nonhormone therapies, while noting the need for further research on fezolinetant’s long-term safety, affordability, and direct comparisons with other agents.