Hormonal therapies are still first-line for menopausal vasomotor symptoms, but novel non-hormonal drugs are promising

Menopausal vasomotor symptoms (VMS) are common and can substantially impair health-related quality of life through negative effects on sleep, mood, cognition, daily activities and long-term health outcomes. Menopausal hormonal therapy (MHT) is the first-line treatment for VMS in patients aged < 60 years and within 10 years of menopause onset. Decisions regarding MHT use and formulation should be individualised to each patient according to age, symptoms, time since menopause onset and individual risk factors and medical history. For patients in whom MHT is contraindicated or not preferred, non-hormonal drugs, such as paroxetine, fezolinetant and elinzanetant, offer effective alternative treatment options. Although several non-hormonal drugs are used off label to treat VMS, novel non-hormonal drugs are under investigation and may further expand treatment options.