Menopause Medication: What Works, What Doesn't, and What to Ask Your Doctor

When your body shifts into menopause, it’s not just about missed periods—it’s about hot flashes that strike at dinner, sleepless nights, mood swings that surprise even you, and a brain that feels like it’s running on low battery. Menopause medication, a range of treatments designed to ease symptoms caused by dropping estrogen levels. Also known as hormone replacement therapy, it’s not one-size-fits-all, and not everyone needs it—but knowing what’s out there can save you months of discomfort. The most common approach is hormone therapy, prescription estrogen or a mix of estrogen and progesterone. Also known as HT, it’s the most effective treatment for hot flashes and night sweats, especially when started early in menopause. But it’s not for everyone. If you’ve had breast cancer, blood clots, or liver disease, your doctor will likely steer you away from it.

That’s where alternatives come in. SSRIs, a class of antidepressants like paroxetine and escitalopram. Also known as selective serotonin reuptake inhibitors, they’re FDA-approved for hot flashes in women who can’t take hormones. Yes, you read that right—antidepressants can cool you down without treating depression. Then there’s black cohosh, a herbal supplement some women swear by for hot flashes. Also known as Actaea racemosa, it’s widely used but still lacks strong proof it works better than a placebo. And don’t forget gabapentin, a nerve pain drug that’s surprisingly good for night sweats, or clonidine, a blood pressure pill that helps some women stay cool.

What you don’t hear much about? The real cost of each option—not just in dollars, but in side effects. Hormone therapy might help your sleep and skin, but it raises your risk of stroke and breast cancer if used long-term. SSRIs can cause nausea, weight gain, or low libido. Herbal supplements? They’re not regulated, so what’s in the bottle might not match the label. The key isn’t finding the "best" treatment—it’s finding the right fit for your body, your history, and your goals. Some women need nothing but lifestyle tweaks. Others need a mix of low-dose meds and natural support. And if you’re unsure? Talk to your doctor about your symptoms, your risks, and what you’re willing to tolerate. The right plan isn’t the one everyone else uses—it’s the one that lets you feel like yourself again.

Below, you’ll find real comparisons of menopause treatments—what works, what doesn’t, and what doctors are actually prescribing now. No fluff. Just facts you can use.