Pros, Cons of Hormonal and Nonhormonal Therapies for Vasomotor Symptoms: Lee Shulman, MD

Neurokinin-targeted therapy should be considered a first-line, mainstream nonhormonal option for vasomotor symptoms, explained Lee Shulman, MD, professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine.

He stressed the importance of assessing all available nonhormonal and hormonal therapies to empower women to make informed decisions, especially for those with hormone contraindications. Shulman presented the findings of a study comparing nonhormonal approaches for vasomotor symptoms and the effects on sleep disturbances during The Menopause Society’s annual meeting, held October 21-25, 2025, in Orlando, Florida.

This transcript has been edited lightly for clarity; captions were auto-generated.

Transcript

Are there certain patients with vasomotor symptoms for whom nonhormonal options of therapy are preferred or should be prioritized?

I think for women who are symptomatic and cannot use hormones, specifically estrogen, for whatever reason—previous history of blood clot, etc—then consideration of that is warranted. But for me, I believe that providing the assessment of the therapies—nonhormonal and hormonal—in women who can use any of these therapies—they don't have a contraindication to them—for me, that is what is important for when to empower women to make that decision for themselves.

Are there downsides to the nonhormonal therapies? There are, whether it's the antidepressants that may lead to certain side effects [or] the neurokinin-targeted therapies. The downside, in a sense, is that they don't provide the other estrogen-/hormone-related benefits. They don't maintain bone mineral density. They don't positively impact the vaginal mucosa. Things that women who use hormones can gain benefit from.

There is no right answer. I think, however, it's important in that nonhormonal methods are not just methods that one would go to if a woman can’t or won't use hormone therapy. For me, neurokinin therapy is a first-line, mainstream option, and it's one of the effective methods of treatment for vasomotor symptoms that is available. I discussed this with women who can use hormones, as well as with women who can't use hormones.