Perimenopause Treatment: What Works Best, and What's Changed

Quick answer: There is no single best treatment for perimenopause; the right one depends on which symptom is bothering you and what your own medical history allows. For hot flashes and night sweats specifically, hormone therapy is the most effective option available — "the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause", in the words of The Menopause Society's 2022 position statement (The Menopause Society, 2022) — and UK guidance is equally direct: "Offer HRT to people with vasomotor symptoms associated with menopause" (NICE NG23, 1.5.1). For women who can't take it or don't want it, several non-hormonal options carry the highest grade of evidence, two of them not drugs at all. Some of what was written about all of this before 2026 is now out of date, and the next section sets out exactly how.

Every option below carries an evidence level, because that is the piece almost always missing. The guidance this page draws on grades recommendations on a three-point scale: Level I is good and consistent scientific evidence, Level II is limited or inconsistent, Level III is consensus and expert opinion (The Menopause Society, 2023). For scale: hot flashes and night sweats — vasomotor symptoms — occur in up to 80% of menopausal women, last a mean of 7 to 9 years, and in one in three women last over 10 years. Nothing here is prescriptive; doses and suitability are decisions for a clinician who knows your history.

What works best for perimenopause symptoms

Hormone therapy remains the most effective treatment for vasomotor symptoms and for genitourinary syndrome of menopause, and it has been shown to prevent bone loss and fracture. That is the conclusion of the 2022 hormone therapy position statement of The Menopause Society, and the 2023 nonhormone statement restates it (The Menopause Society, 2022).

The risk-benefit picture depends heavily on when treatment starts. For women under 60 or within 10 years of menopause onset who have no contraindications, the 2022 statement found the benefit-risk ratio favourable for treating bothersome vasomotor symptoms and preventing bone loss. For women beginning hormone therapy more than 10 years from menopause onset, or after age 60, it found the ratio appears less favourable, because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism and dementia.

That timing distinction is why the perimenopausal reader sits differently from the postmenopausal one. If you are still having periods, you are inside the window the statement describes as favourable — which does not mean hormone therapy is right for you, since contraindications and personal history decide that. It does mean the risk framing many women absorbed years ago came from a largely older trial population: the 2022 statement notes that the Women's Health Initiative had limited enrolment of women under 60 or fewer than 10 years from menopause onset — the group it calls the one for whom hormone therapy is currently primarily indicated.

None of which is a blanket endorsement. Risks differ by type, dose, duration, route, timing and whether a progestogen is used, and the statement calls for treatment to be individualised, with periodic reassessment.

What's changed since 2025

Updated 6 October 2026. Three things moved after most menopause pages were written: a US labelling change the FDA requested in November 2025 and first approved in February 2026, NICE's fezolinetant appraisal in March 2026, and two rounds of amendments to the NICE menopause guideline, in 2024 and 2026.

In the US, risk statements came out of the boxed warning. On 10 November 2025 the FDA told the companies marketing menopausal hormone therapy to change their labels. For every product, systemic and local vaginal, it asked them to make three changes "specifically in the label's Boxed Warning, the agency's most prominent safety-related warning": "Remove the language related to cardiovascular diseases, breast cancer, and probable dementia"; "Remove language related to endometrial cancer except in the systemic estrogen-alone drugs"; and "Remove the recommendation to use the lowest effective dose for the shortest amount of time". One warning goes entirely rather than moving: "In the labeling as a whole: Remove the probable dementia warning" (FDA, 10 November 2025, content current 12 February 2026).

What stays is as important as what goes, and the FDA is specific about it. For systemic products, the same request lists these under "In the labeling as a whole": "Retain the Boxed Warning about endometrial cancer in the systemic estrogen-alone products", "Retain information about cardiovascular diseases and breast cancer warnings", "Add consideration of starting hormone therapy for moderate to severe VMS in women < 60 years old or < 10 years since menopause", and "Add WHI data in women 50-59 years old". Read against each other, those lines describe a change in where risk information sits and how prominently it is flagged, plus a new statement about who to consider treating. They are not a finding that hormone therapy carries no cardiovascular or breast-cancer risk.

Six products so far, out of 29 companies. On 12 February 2026 the FDA announced it had "approved drug labeling changes to six menopausal hormone therapy products", said that "At the FDA's request, 29 drug companies have submitted proposed labeling changes", and described the six as spanning all four categories of HRT (FDA, 12 February 2026). That press release is still the agency's most recent published count as of 6 October 2026, so the label on any particular product may or may not have been revised yet; we could not confirm how many beyond the first six have been relabelled since, and the only reliable check is the label itself. The FDA's and HHS's announcements also carried benefit claims that are not part of the labelling request and that neither The Menopause Society nor NICE endorses. This page quotes the labelling instructions and leaves that framing alone.

In England, fezolinetant now has an appraisal. NICE published technology appraisal TA1143 on 31 March 2026: "Fezolinetant can be used as an option to treat moderate to severe vasomotor symptoms associated with menopause when hormone replacement therapy is unsuitable", and it "must be funded in England within 90 days of final publication of this guidance" (NICE TA1143). NICE also states the limit of the evidence without softening it: "Fezolinetant has not been directly compared with non-hormonal treatments. Indirect comparisons suggest that it may have similar effectiveness to non-hormonal treatments, but this is uncertain." The drug is sold as Veoza in the UK and Veozah in the US.

Elinzanetant has no NICE appraisal yet. When we checked on 6 October 2026, NICE's appraisal of elinzanetant for menopausal vasomotor symptoms (GID-TA11428) was listed as "In development" with "Expected publication date: TBC", and a separate appraisal, for vasomotor symptoms caused by breast-cancer endocrine treatment, as "Awaiting development" (NICE). A US approval does not by itself make a drug routinely funded on the NHS; that is what a NICE appraisal decides, which is why TA1143 carries a funding requirement and elinzanetant does not yet have one (NICE TA1143).

The NICE guideline itself moved twice. NG23 was last updated on 15 April 2026. Its 2024 additions brought menopause-specific cognitive behavioural therapy into the recommendations proper, and its 2026 amendment sharpened the advice about bleeding on HRT, which matters particularly in perimenopause and is covered below.

Hormone therapy during perimenopause specifically

Most writing about hormone therapy is really about postmenopause, and it skips what makes perimenopause different: your cycles are still happening, and pregnancy is still possible. The Office on Women's Health states you can still get pregnant during perimenopause even if you miss your period for a month or a few months (OWH), and the National Institute on Aging advises continuing birth control for at least a full 12 months after the last period (NIA). Symptom control and contraception are one conversation here, not two.

That is also why the options raised at a perimenopause appointment are broader. Cleveland Clinic lists antidepressants, birth control pills, hormone therapy, gabapentin, oxybutynin, a hormonal IUD for abnormal or irregular bleeding, and vaginal preparations (Cleveland Clinic). Hormonal contraception appears there because it can address cycle-related bleeding, symptoms and pregnancy prevention at once. We found no verified head-to-head comparison of contraceptive versus menopausal hormone regimens, so this page makes no claim that either is more effective — a question for a clinician rather than a website.

Which regimen, and why the perimenopausal answer is different. If your periods are still happening, the daily-oestrogen-plus-daily-progestogen option is normally off the table. The UK's Faculty of Sexual and Reproductive Healthcare says so plainly: "Continuous combined regimens (which administer both daily estrogen and progestogen) are not appropriate in perimenopause due to a high chance of irregular bleeding" (FSRH, August 2017, amended May 2025). What is used instead is a sequential regimen, with progestogen for part of each cycle; FSRH notes that perimenopausal women on sequential HRT "will usually continue to have regular withdrawal bleeds". Which side of that line you fall on depends on where your cycles have got to, and how the early and late stages are defined is the clearest way to work that out.

The progestogen half does not have to be a tablet. FSRH supports "use of any 52 mg LNG-IUD for up to 5 years for endometrial protection in individuals using estrogen as part of hormone replacement therapy" — one device doing contraception and the progestogen job at the same time. There is a gap between licence and guidance worth knowing about before the appointment: FSRH records that all 52 mg LNG-IUDs are "licensed for 8 years for contraception and licenced for 4 years for endometrial protection as part of HRT", while the Faculty itself supports five years for the second purpose. The same guideline is firm about what cannot stand in: the progestogen-only pill, the implant and the injection "are not licensed for and cannot be recommended as endometrial protection with estrogen-only HRT".

Expect some bleeding early; report it late. NICE asks clinicians to explain that vaginal bleeding is a common side effect "during the first 6 months of taking systemic HRT" or "within any 3 months of changing the dose or preparation of systemic HRT", and to "advise them to seek medical help promptly if they experience unscheduled vaginal bleeding beyond these timeframes" (NICE NG23, 1.8.4, amended 2026). The 2026 amendments added that the evidence on unscheduled bleeding during sequential or continuous HRT is limited, and pointed clinicians to British Menopause Society guidance (1.8.5). That is a side effect with a deadline attached, which is a useful thing to know in advance; bleeding on HRT, and when to get it checked sits alongside the wider normal-versus-check picture.

And hormone therapy is still not contraception. FSRH states it in six words — "HRT is not a contraceptive method" — and supplies the reason: in a small study of sequential HRT users aged 42 to 52, HRT "inhibited ovulation in only 40% of women with regular cycles", and some women who had been anovulatory or had irregular cycles beforehand "did subsequently ovulate on HRT". One sentence in the same guideline is easy to quote out of context, so here is its scope intact: "Postmenopausal women do not need to start contraception when they commence HRT as it does not restore fertility even if they experience cyclical bleeding." That applies to women already past menopause, not to anyone still in the transition.

One perimenopause-specific finding is easy to miss. The 2022 statement reports that estrogen therapy's effect on depression varies by stage: there is Level II evidence of antidepressant effects similar in magnitude to antidepressant medications in depressed perimenopausal women, with or without hot flashes, while it is ineffective for depressive disorders in postmenopausal women — which the panel calls a possible window of opportunity during the perimenopause. The same section states the evidence is not sufficient to recommend estrogen-based therapies for preventing depression in women without symptoms. Level II means limited or inconsistent evidence, and it is reported here as that.

For vaginal dryness, discomfort and urinary symptoms — genitourinary syndrome of menopause — the 2022 statement recommends low-dose vaginal estrogen or other local therapies when over-the-counter products haven't worked, in women who don't otherwise need systemic hormone therapy. That is a separate decision from whole-body treatment, and it gets lost in the broader hormone debate.

Non-hormonal prescription options

If hormone therapy is contraindicated — the 2023 statement names estrogen-dependent cancers and cardiovascular disease as examples — or you prefer not to take it, the alternatives are better evidenced than their reputation suggests. Here is that statement's full verdict for treating vasomotor symptoms, grades intact.

Source: The Menopause Society 2023 nonhormone therapy position statement, Menopause 30(6):573-590. Every verdict here refers to treating vasomotor symptoms — see the lifestyle section below, which matters more than the table does.

The line most readers will not expect is at the top. Cognitive behavioural therapy and clinical hypnosis sit at Level I — the same grade as the prescription drugs, and higher than several of them. These are not a soft option; on this scale they are among the best-evidenced non-hormonal approaches that exist. In the trials underpinning the CBT recommendation, 65% to 78% of women across studies reached a clinically significant threshold for improvement in how much their symptoms bothered them, maintained at 26 weeks.

One number explains a lot: trials of non-hormonal treatments for hot flashes carry a placebo improvement rate of 20% to 66%. That range is why individual testimonials, however sincere, are weak evidence here.

UK and US guidance don't fully agree

If a page you have read recommends an antidepressant for hot flushes and your GP does not start there, neither source is simply wrong. The table above comes from a US position statement. UK practice is set by a NICE guideline, and on several points the two land in different places.

Sources, row by row: The Menopause Society 2022 and 2023 position statements; NICE NG23 (last updated 15 April 2026); NICE TA1143; NHS (page last reviewed 19 May 2026); FDA.

Two things explain most of the gap. The first is vintage: NICE's SSRI, SNRI and clonidine recommendation carries the tag [2015], so it predates the 2023 evidence review that graded SSRIs and SNRIs Level I and put clonidine on the not-recommended list. The second is that the two documents answer different questions. The Menopause Society grades how well each option performs in trials. NICE decides what the NHS should offer, in what order, and at what cost — TA1143 is in part a cost-effectiveness judgement, and it says so.

The wording also rewards close reading. NICE's instruction is not to offer SSRIs or SNRIs first-line "for vasomotor symptoms alone" — which leaves room for them when low mood or anxiety is part of the picture, and the NHS says as much when it mentions antidepressants for "low mood, depression or anxiety caused by perimenopause or menopause". And on the last row, the FDA's November 2025 request is an instruction about what a drug label must say, not a clinical recommendation about how to prescribe; NICE's 1.8.3 is the opposite kind of statement. They are not strictly contradictory, but anyone comparing a US label with a UK guideline will notice they now read differently, and that is worth knowing before an appointment.

The two newest drugs

Two drugs here were approved recently enough that most guidance hasn't caught up, and one carries a safety update post-dating the guideline that recommends it.

Fezolinetant (Veozah) was FDA-approved in May 2023 as a neurokinin 3 receptor antagonist for moderate to severe vasomotor symptoms due to menopause, and the 2023 position statement gives it a Level I recommendation. On 16 December 2024, the FDA added a boxed warning — its most prominent warning — for the known risk of rare but serious liver injury (FDA Drug Safety Communication). That sequence matters: the Level I recommendation was published before the warning existed, so any page citing one without the other is out of date.

The specifics are checkable. The FDA acted after a post-marketing case in which a patient developed fatigue, nausea, itching, yellowing of the eyes and skin, light-coloured stools and dark urine within 40 days of starting the drug; symptoms and blood values gradually returned to normal after it was stopped. In the three trials behind approval, ALT and/or AST elevations above three times the upper limit of normal occurred in 2.3% of women taking fezolinetant against 0.9% on placebo (prescribing information via DailyMed). The label requires liver blood tests before starting, monthly for three months, then at six and nine months. None of this makes fezolinetant unreasonable — it remains recommended at Level I — but it is a drug with a monitoring schedule attached, and that belongs in the decision.

Elinzanetant (Lynkuet) was FDA-approved on 24 October 2025 for moderate to severe vasomotor symptoms due to menopause (FDA Drug Trials Snapshot); its label describes it as a neurokinin 1 and neurokinin 3 receptor antagonist (prescribing information via DailyMed). It post-dates every position statement in circulation, including both cited here, so no guideline covers it yet and it carries no evidence level — an absence of grading, not a poor grade.

What was measured is worth stating precisely. Approval rested on three trials — OASIS-1, OASIS-2 and OASIS-3 — involving 1,423 participants. OASIS-1 and OASIS-2 assessed efficacy, with co-primary endpoints of mean change from baseline in the frequency and severity of moderate to severe vasomotor symptoms at weeks 4 and 12; the FDA records that each showed statistically significant reductions against placebo on both, at both timepoints. We are not quoting a percentage reduction, because we could not verify effect magnitudes from a primary source. The efficacy trials enrolled postmenopausal women with a mean age of 55, not perimenopausal women, and women aged 65 and over were excluded. Safety was assessed in OASIS-3 over 52 weeks — real, but a year and no more; beyond that there is no long-term outcome data.

One point lands harder for perimenopausal readers than postmenopausal ones, because pregnancy is still possible: the label contraindicates elinzanetant in pregnancy, carries a warning for risk of pregnancy loss, and directs prescribers to exclude pregnancy before starting it. Its other warnings cover CNS depressant effects and daytime impairment, hepatic transaminase elevations, and — added in August 2026 — risk of seizure.

What lifestyle changes actually do

The honest version of this is easy to garble. The 2023 statement does not recommend exercise, yoga, mindfulness-based interventions, relaxation, cooling techniques, avoiding triggers or dietary modification as treatments for hot flashes and night sweats — and that qualification is not a footnote, it is the entire meaning of the verdict. The statement makes the distinction itself: "Although there are other health benefits associated with exercise or yoga, the evidence of those interventions for the treatment of VMS is sparse," and, in its key points, "A healthy diet is important for health promotion and chronic disease prevention; however, there is limited evidence to support dietary modifications as a tool for improving VMS."

So: exercise is not pointless in perimenopause. It is not a reliable way to reduce hot flash frequency. Those are different sentences, and only the second one is what the guideline says. Movement and nutrition still matter during this transition for bone, cardiovascular health, mood, sleep and muscle — and the muscle point is measurable. SWAN's body-composition analysis of 1,246 women found that lean mass rises by 0.2% per year before the transition and falls by 0.2% per year during it, while fat mass gain roughly doubles from 1.0% to 1.7% per year, even though total body weight continues on an unaltered trajectory (Greendale et al., 2019). A body recomposing while the scale stays flat is an argument for resistance training and adequate protein, not against them — though the training evidence for this particular window is thinner than you would expect, and that page says so rather than inventing a prescription.

And one lifestyle intervention is affirmatively recommended for hot flashes in the very same document: weight loss, at Levels II-III. The statement's reasoning is specific to this stage — adiposity acts as a risk factor for vasomotor symptoms earlier in the transition, during perimenopause and early postmenopause, but not later, and weight loss may have greater effects on symptoms when women are earlier in the transition. If you are reading this while still having periods, that is the window the evidence describes.

Two related pages will go deeper: eating during perimenopause, and vitamins and supplements.

What the evidence doesn't support

For treating hot flashes and night sweats, supplements and herbal remedies are not recommended at Levels I-II — and the underlying trial data is more specific than a verdict.

Black cohosh, the most-purchased menopause botanical, was assessed in a 2012 Cochrane review of 16 randomised trials in 2,027 peri- or postmenopausal women over a mean of 23 weeks. There was no significant difference from placebo in vasomotor symptom frequency, and safety data were inconclusive. If you want the trials rather than the verdict, we have gone through what the black cohosh trials actually found in detail, including where the German and US positions diverge. Separately, the US Pharmacopeial Convention's Dietary Supplements-Botanicals Expert Committee reviewed 30 reports possibly related to black cohosh and directed products to carry a warning to discontinue use and consult a practitioner in case of a liver disorder or symptoms of liver trouble.

Evening primrose oil produced the result that should be quoted more often. In the single trial, 56 women took either the oil or placebo for six months; vasomotor symptoms fell by 1.0 per day on the oil and by 2.6 per day on placebo. The placebo did better.

Again — a verdict about hot flashes and night sweats, not about nutrients generally. Calcium and vitamin D for bone, or correcting a genuine dietary shortfall, are a different question with a different evidence base. For a herb with menopause-specific trial data of its own, see ashwagandha for menopause. And for period pain — a different symptom with its own, similarly thin, herbal literature — see herbal teas for period cramps.

"Ovarian rejuvenation" belongs in the same section, for a different reason. Some clinics sell injections of platelet-rich plasma into the ovaries as a way of restarting ovarian function. The nearest authoritative assessment comes from ESHRE's 2023 review of add-ons in reproductive medicine, which examined intraovarian PRP for poor ovarian response and premature ovarian insufficiency, found "a lack of RCTs or controlled studies that demonstrate the efficacy of intraovarian PRP" along with limited safety data, and concluded: "Intraovarian administration of platelet-rich plasma is not recommended" (ESHRE Add-ons working group, 2023). That judgement was reached in a fertility-treatment setting rather than a menopause-symptom one — it is the closest evidence that exists, and we have found nothing stronger — but it is a "not recommended", not a "promising".

How to decide, and what to ask

There is no flowchart here; any page offering one is overstepping. The decision turns on symptom severity, your personal and family medical history, how far into the transition you are, and what you actually want — which is why it belongs in an appointment rather than a search result. This page can at least make that appointment more productive.

Five questions worth writing down:

• Given my history, am I a candidate for hormone therapy — and if not, why not? Contraindications are individual, and "why not" is more useful than "no".
• Do I still need contraception, and does that change which option makes sense? Pregnancy remains possible throughout the transition, and this is the question most likely to go unasked.
• Which non-hormonal options would you consider for me, and at what evidence level? The grades above are public; a clinician can say which apply to you.
• When do we reassess, and what would tell us it isn't working? The 2022 statement calls for periodic reassessment, not an open-ended prescription.
• Does any option I'm considering require monitoring? Fezolinetant's liver blood testing schedule is the clearest example.

Two things help before you go. Where you are in the transition shapes the treat-or-wait calculation — see how long perimenopause and its symptoms last — and a hormone test usually isn't how the diagnosis is made, so a record of your cycle lengths and worst symptoms beats a blood result. If the terms are unclear, start with what perimenopause actually is and the full symptom picture.

Frequently asked questions about perimenopause treatment (FAQ)

What is the best treatment for perimenopause symptoms? There is no single best treatment, because the answer depends on the symptom. For hot flashes and night sweats, hormone therapy is the most effective option available: The Menopause Society's 2022 position statement calls it "the most effective treatment" for those symptoms, and NICE's UK guideline says "Offer HRT to people with vasomotor symptoms associated with menopause" (NICE NG23, 1.5.1). The same 2022 statement found the benefit-risk ratio favourable for women under 60 or within 10 years of menopause onset without contraindications, and less favourable when therapy starts more than 10 years out or after age 60, because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism and dementia. Whether it suits you is a clinical decision based on your history.

What can I take for hot flashes if I can't take hormones? The Menopause Society's 2023 nonhormone position statement gives Level I evidence — its highest grade — to SSRIs and SNRIs, gabapentin, fezolinetant, cognitive behavioural therapy and clinical hypnosis, and recommends oxybutynin at Levels I-II. Fezolinetant carries an FDA boxed warning for rare but serious liver injury, added on 16 December 2024, and requires liver blood testing before and during treatment. These are clinical decisions to make with a healthcare provider.

Is hormone therapy safe during perimenopause? Safety depends on your individual history, so no article can answer this for you. The Menopause Society's 2022 position statement concluded that for women under 60 or within 10 years of menopause onset without contraindications, the benefit-risk ratio is favourable for treating bothersome hot flashes and night sweats and for preventing bone loss. It adds that risks vary by type, dose, duration, route and timing, and that treatment should be individualised with periodic reassessment.

Do I still need contraception during perimenopause? Yes, and hormone therapy does not cover it — the NHS puts it in four words, "HRT is not contraception" (NHS). The Office on Women's Health states you can still get pregnant during perimenopause even if you miss your period for a month or a few months. How long to carry on differs by country, and which method you use changes the answer again; we set out contraception and HRT during perimenopause in full, including the coil that can do both jobs.

Can perimenopause be reversed? No. Perimenopause is the transition to menopause rather than a condition that gets cured, and no treatment turns it back; what treatment does is address the symptoms. NICE makes that difference visible in what it tells clinicians to say when someone starts HRT: explain that "symptoms may return when HRT is stopped" (NICE NG23, 1.4.3) — which is what treating a symptom looks like, rather than curing its cause. On the fertility side, FSRH states that hormone therapy "does not restore fertility", a point it makes about women who are already past menopause (FSRH). Injections of platelet-rich plasma into the ovaries, sold as "ovarian rejuvenation", are not supported either: ESHRE's 2023 review of add-ons in reproductive medicine concluded that "Intraovarian administration of platelet-rich plasma is not recommended" (ESHRE Add-ons working group, 2023). What can change is how much the symptoms affect you while they last.

Do supplements help perimenopause symptoms? For hot flashes and night sweats specifically, the Menopause Society's 2023 statement does not recommend supplements or herbal remedies (Levels I-II). A 2012 Cochrane review of 16 randomised trials in 2,027 women found no significant difference between black cohosh and placebo, and in the single evening primrose oil trial, placebo outperformed the supplement. That verdict covers vasomotor symptoms only — it does not address nutrients taken for bone health or to correct a genuine dietary shortfall.

Medical disclaimer: This article is for informational purposes only. Always consult a qualified healthcare provider before making changes to your health routine.

Sources

1. The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause 2023;30(6):573-590 — Clinical position statement (PDF). https://menopause.org/wp-content/uploads/professional/2023-nonhormone-therapy-position-statement.pdf
2. The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 2022;29(7):767-794 — Clinical position statement (PDF). https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf
3. US Food and Drug Administration. FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant) for hot flashes due to menopause. Boxed Warning update 16 December 2024 — Federal regulator drug safety communication. https://www.fda.gov/drugs/drug-safety-communications/fda-adds-warning-about-rare-occurrence-serious-liver-injury-use-veozah-fezolinetant-hot-flashes-due
4. DailyMed, US National Library of Medicine. VEOZAH (fezolinetant) tablet, film coated — full prescribing information, Boxed Warning and Warnings and Precautions 5.1 — Official drug label. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cae9f798-24f9-4580-a4fc-e6c710cbda3c
5. US Food and Drug Administration. Drug Trials Snapshots: LYNKUET (elinzanetant), approval date 24 October 2025 — Federal regulator trial summary. https://www.fda.gov/drugs/drug-trials-snapshots/drug-trials-snapshots-lynkuet
6. DailyMed, US National Library of Medicine. LYNKUET (elinzanetant) capsules — full prescribing information, including Contraindications and Warnings and Precautions — Official drug label. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f42884ff-7dff-419c-8a0c-affe2ed73818
7. Cleveland Clinic. Perimenopause — Hospital patient information. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
8. Office on Women's Health, US Department of Health and Human Services. Menopause basics — Government health information. https://womenshealth.gov/menopause/menopause-basics
9. National Institute on Aging (NIH). What Is Menopause? — Government health information. https://www.nia.nih.gov/health/menopause/what-menopause
10. Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight 2019;4(5):e124865 — Peer-reviewed longitudinal cohort analysis (SWAN). https://insight.jci.org/articles/view/124865
11. National Institute for Health and Care Excellence. Menopause: identification and management. NICE guideline NG23 — National clinical guideline. Published 12 November 2015, last updated 15 April 2026. Recommendations 1.4.3, 1.5.1-1.5.4, 1.8.3-1.8.5 are quoted. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
12. National Institute for Health and Care Excellence. Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause. Technology appraisal guidance TA1143 — National technology appraisal, published 31 March 2026. https://www.nice.org.uk/guidance/ta1143/chapter/1-Recommendation
13. National Institute for Health and Care Excellence. Elinzanetant for treating moderate to severe vasomotor symptoms associated with menopause ID6359, GID-TA11428 — Appraisal in development; recorded as "In development", expected publication date "TBC", checked 6 October 2026. https://www.nice.org.uk/guidance/indevelopment/gid-ta11428
14. US Food and Drug Administration. FDA Requests Labeling Changes Related to Safety Information to Clarify the Benefit/Risk Considerations for Menopausal Hormone Therapies — Federal regulator drug alert, dated 10 November 2025, content current as of 12 February 2026. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requests-labeling-changes-related-safety-information-clarify-benefitrisk-considerations
15. US Food and Drug Administration. FDA Approves Labeling Changes to Menopausal Hormone Therapy Products — Federal regulator press announcement, 12 February 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-labeling-changes-menopausal-hormone-therapy-products
16. NHS. Treatment for menopause and perimenopause — Government health information, page last reviewed 19 May 2026. https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/
17. Faculty of Sexual & Reproductive Healthcare. FSRH Guideline: Contraception for Women Aged Over 40 Years — Clinical guideline. The cover page is dated "August 2017 (Amended May 2025)"; the metadata table on the same page reads "August 2017, Amended July 2023" and gives a publication date of October 2017, and the document's own review date has passed. The cover date is quoted here. https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-contraception-for-women-aged-over-40-years.pdf
18. ESHRE Add-ons working group; Lundin K, Bentzen JG, Bozdag G, et al. Good practice recommendations on add-ons in reproductive medicine. Human Reproduction 2023;38(11):2062-2104 (PMID 37747409) — Professional society good-practice recommendations. https://pmc.ncbi.nlm.nih.gov/articles/PMC10628516/

All sources accessed 6 October 2026, except items 1-10, first accessed 5 August 2026 and re-verified against the live source on 6 October 2026.

Claire Whitfield

Women's Health Specialist

A women's health specialist who reads the position statement itself, then checks what the regulator published after it.

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