Less well for hot flashes, which is the honest answer. Estrogen remains the most effective treatment available. Non-hormonal options typically reduce flash frequency by a smaller margin, though for many women that is enough to make the difference between coping and not coping.
What has evidence
Los Angeles treatment options: four approaches that stand up
Not everyone can take estrogen, and for those Los Angeles patients the honest question is which non-hormonal options carry real trial evidence behind them. Fezolinetant is a prescription medicine that blocks the brain signalling pathway responsible for hot flashes. It is the first non-hormonal drug designed specifically for this rather than borrowed from another indication, and trial evidence supports it.
Cognitive behavioral therapy has good evidence, not for stopping flashes but for substantially reducing how much they bother you and how badly they disrupt sleep. The Menopause Society recommends it. Clinical hypnosis has trial support for reducing flash frequency itself.
Certain antidepressants at low dose, and some blood pressure and anti-seizure medicines, reduce hot flashes measurably. They work less well than estrogen but they are useful, particularly for women who cannot take hormones after breast cancer. More on that in bioidentical hormones, stopping hrt and treatment options. Side effects tend to show up before the benefit does, so plan on a few weeks before judging any of them, and tell a Los Angeles clinician either way.
