By: Dr. Shane Kurth, D.C., BCN
Co-Owner, Radiant Results
Updated September 2026

This guide was prepared by the clinical team at Radiant Results. It covers the primary categories of non-hormonal menopause options supported by current clinical evidence — including FDA-approved medications, behavioral approaches endorsed by the North American Menopause Society, and adjunct therapies such as photobiomodulation. It does not replace individualized medical care or prescribe any course of treatment. Women considering any option discussed here are encouraged to review it with their OB-GYN or primary care provider.

Medical Disclaimer: The information on this page is educational and is not a substitute for professional medical advice, diagnosis, or treatment. Individual menopause experiences vary widely. Consult a qualified healthcare provider — preferably one experienced in menopause care — before starting, stopping, or changing any treatment.

Non-Hormonal Menopause Options in Charlotte

Non-hormonal menopause options fall into three evidence-graded categories: FDA-approved pharmacologics (fezolinetant/Veozah, SSRIs/SNRIs, gabapentin); guideline-backed behavioral approaches (cognitive-behavioral therapy and clinical hypnosis, both Level I per the 2023 North American Menopause Society position statement); and adjunct wellness therapies such as photobiomodulation for musculoskeletal symptoms.

Hormone therapy remains the most effective treatment for vasomotor symptoms per NAMS. Non-hormonal options are the medically appropriate primary pathway for women who cannot or choose not to use hormones — not a lesser alternative.

Key Takeaways

• HRT remains the most effective treatment for vasomotor symptoms per the 2023 NAMS position statement, but non-hormonal options provide meaningful, evidence-supported relief for women who cannot or choose not to use hormones.
• The 2023 NAMS position statement gives Level I evidence to cognitive-behavioral therapy, clinical hypnosis, SSRIs/SNRIs, gabapentin, and fezolinetant — and explicitly does NOT recommend supplements, herbal remedies, yoga, acupuncture, or mindfulness-based interventions for vasomotor symptoms.
• Fezolinetant (Veozah) carries a December 2024 FDA Boxed Warning for rare but serious liver injury. Regular liver function monitoring is now required during treatment.
• Musculoskeletal pain affects approximately 71% of perimenopausal women (Lu et al., 2020) — and is the most clinically supported application for photobiomodulation in perimenopausal populations, backed by multiple randomized controlled trials.
• No single non-hormonal option addresses every menopause symptom. The most effective plans are individualized and typically coordinated with an OB-GYN or menopause specialist.

Who Should Consider Non-Hormonal Menopause Options

The symptom cluster that brings women to this search is familiar: hot flashes, night sweats, disrupted sleep, mood changes, joint pain, and vaginal dryness. For many women, these symptoms arrive simultaneously and affect work, relationships, and daily function for years.

Hormone therapy is the standard of care for vasomotor symptoms. The 2023 NAMS position statement is explicit: HRT is the most effective treatment for hot flashes and night sweats and should be considered for menopausal women within 10 years of their final menstrual period who are appropriate candidates. Non-hormonal options are not a second-best substitute. They are the medically appropriate primary pathway for a specific population.

That population includes women with a personal history of hormone-sensitive cancers — such as breast or endometrial cancer — a history of deep vein thrombosis or blood clots, or uncontrolled cardiovascular disease. It also includes women who have made an informed choice to avoid systemic hormones after a full discussion with their provider. These are conditions a provider weighs; they are not a self-assessment checklist. A Harvard Health overview of menopause treatment options provides accessible background on why the decision is individualized.

The menopause symptom picture extends well beyond hot flashes. Research indicates that musculoskeletal symptoms are among the most prevalent complaints during the menopause transition — affecting approximately 71% of perimenopausal women in one systematic review (Lu et al., 2020) — yet they receive less clinical attention than vasomotor symptoms. This burden is real and frequently underaddressed.

What follows is a structured, evidence-graded review. Its purpose is to help women in Charlotte’s Uptown and surrounding neighborhoods have better conversations with their providers — not to replace those conversations.

FDA-Approved Non-Hormonal Medications: Clinical Trial Evidence

Two pharmacologic classes carry FDA approval specifically for menopause-related vasomotor symptoms. Several others have strong clinical guideline endorsement despite off-label status for this indication.

Paroxetine salt (Brisdelle) is the only SSRI with an FDA-approved indication for menopausal VMS — prescribed at 7.5mg, below the antidepressant dose. Other SSRIs and SNRIs — including venlafaxine, escitalopram, and desvenlafaxine — are frequently prescribed off-label for hot flashes and carry Level I evidence in the 2023 NAMS position statement (Menopause, PMID 37252752).

Effects are meaningful, though generally smaller in magnitude than hormone therapy — particularly for severe VMS. All require a prescription; dosing decisions belong to the prescribing clinician.

Gabapentin is included in the NAMS Level I recommendation set for vasomotor symptoms despite being off-label for this indication. Bedtime administration may be advantageous for women whose VMS primarily disrupts sleep onset, given gabapentin’s tendency to cause drowsiness. A prescribing provider determines the appropriate timing and dose.

Oxybutynin, an anticholinergic agent, appears in NAMS guidance at Levels I–II for VMS. Clinical decisions about its use — including the relevance of anticholinergic burden in older adults — require a qualified prescriber.

For genitourinary syndrome of menopause (GSM) — which includes vaginal dryness, discomfort, and urinary changes — the strongest non-systemic options are topical vaginal estrogen and ospemifene, an oral selective estrogen receptor modulator (SERM). Both require a prescription and gynecologist evaluation.

Fezolinetant (Veozah): Mechanism, Evidence, and the 2024 Safety Update

Fezolinetant represents a mechanistically distinct approach to menopause-related hot flashes — one grounded in hypothalamic thermoregulation rather than hormone replacement.

How it works: Fezolinetant is a non-hormonal neurokinin-3 receptor (NK3R) antagonist. During the menopause transition, declining estrogen alters activity in hypothalamic KNDy neurons that regulate body temperature. Fezolinetant modulates KNDy neuron activity in the thermoregulatory center, interrupting the neurochemical signal that triggers hot flashes. This mechanism differs fundamentally from SSRIs and SNRIs, which act through serotonin and norepinephrine pathways rather than the thermoregulatory center directly.

Approval and trial basis: The FDA approved fezolinetant 45mg once daily on May 12, 2023. Approval was supported by the BRIGHT SKY program — three Phase 3 clinical trials (SKYLIGHT 1, SKYLIGHT 2, and SKYLIGHT 4) conducted across multiple countries and enrolling more than 3,000 individuals. These trials demonstrated statistically significant reductions in both the frequency and severity of hot flashes. The 2023 NAMS position statement places fezolinetant at Level I evidence alongside SSRIs/SNRIs, gabapentin, and behavioral therapies (Menopause, PMID 37252752).

The December 2024 FDA Boxed Warning: In a December 16, 2024 Drug Safety Communication, the FDA added a Boxed Warning — its most serious warning category — to fezolinetant (Veozah) for the known risk of rare but serious liver injury. The FDA’s fezolinetant safety communication followed a postmarketing report of a patient who experienced elevated liver enzyme values after approximately 40 days of treatment.

New liver monitoring requirements specify: monthly testing for the first two months, then at months 3, 6, and 9. Women with pre-existing liver conditions or cirrhosis should not take fezolinetant.

Astellas, the manufacturer, has stated that the overall benefit-risk profile of Veozah remains positive. Women and their providers should be fully informed before starting this medication.

Safety note: Women taking photosensitizing medications, or who are pregnant or may become pregnant, should consult their provider before beginning any light-based therapy. Fezolinetant is contraindicated in women with hepatic impairment or cirrhosis — discuss your full medication list and liver health history with your prescribing clinician.

Red Light Therapy for Menopause Symptoms: Evidence and Honest Limits

Photobiomodulation — commonly called red light therapy — is the area where Radiant Results contributes directly to non-hormonal menopause care. An honest account of the evidence is the appropriate starting point.

Musculoskeletal and Joint Pain: The Strongest Application

The most clinically supported application of photobiomodulation in the menopause context is joint and musculoskeletal pain. Musculoskeletal symptoms are among the most common complaints during and after the menopause transition — affecting approximately 71% of perimenopausal women in one systematic review (Lu et al., 2020) — with evidence indicating that estrogen deficiency plays a role in their development. This prevalence is frequently underaddressed in clinical settings relative to vasomotor symptoms.

The cellular mechanism is well established. As described in Hamblin’s foundational photobiomodulation review (PMC5523874), photobiomodulation using red (~630–660nm) and near-infrared (~810–850nm) wavelengths is absorbed by cytochrome c oxidase in the mitochondria, stimulating ATP production and modulating inflammatory signaling pathways. Near-infrared light penetrates 2–5cm into tissue, reaching joint capsules, muscle belly, and periarticular structures. Red light penetrates approximately 8–10mm, primarily addressing the dermis and superficial musculature.

A 2021 meta-analysis of photobiomodulation for musculoskeletal pain (Tripodi et al., PMC8364035) evaluated photobiomodulation for tendinopathy and musculoskeletal pain across multiple randomized controlled trials. When photobiomodulation plus exercise was compared to sham treatment plus exercise, PBM demonstrated greater decreases in pain and improved function. Evidence strength for musculoskeletal and joint pain is assessed as moderate to strong across the RCT base.

For red light therapy for joint pain relief, this is the application with the most consistent clinical trial support. The cellular mechanisms — ATP upregulation and modulation of inflammatory mediators — overlap with the musculoskeletal pain pathway and extend across multiple tissue types.

Skin and Collagen: A Secondary Application

Perimenopausal women often experience accelerated skin changes — reduced collagen density, increased laxity, altered texture — as estrogen levels decline. Photobiomodulation has peer-reviewed evidence for collagen stimulation and dermatologic applications, documented in Avci et al.’s review of low-level light therapy in skin (PMC4126803). Evidence strength is moderate, based on multiple studies, with ongoing research. This is a secondary application relative to musculoskeletal pain — but it is clinically relevant for this population.

What Red Light Therapy Does Not Address

Photobiomodulation has not been established as an effective treatment for vasomotor symptoms — hot flashes and night sweats. No current RCT base supports PBM as a primary intervention for VMS. Women seeking relief from hot flashes and night sweats should work with their OB-GYN to evaluate the pharmacologic and behavioral options described in the preceding sections.

Safety note for PBM: Women taking photosensitizing medications, or who are pregnant or may become pregnant, should consult their provider before beginning photobiomodulation sessions. Medical clearance decisions belong to the treating provider.

What a Session at Radiant Results Looks Like

Radiant Results’ Dahlia Full Body Medical Grade Light Therapy Bed delivers red (~630–660nm) and near-infrared (~810–850nm) wavelengths simultaneously across the full body in 15-minute sessions. A facial protection pad maintains comfort during full-body treatment. Styku 3D body scanning is available for objective tracking of physical changes over time.

Photobiomodulation at Radiant Results is used as an adjunct non-pharmacologic tool — not a replacement for physician care or prescription options. Women using PBM for menopause-related musculoskeletal symptoms should do so as part of a care plan that includes their OB-GYN.

Realistic Timeline: Photobiomodulation for Adjunct Musculoskeletal Support

Individual results vary. Photobiomodulation is used as an adjunct wellness tool, not as medical treatment for menopause or any diagnosed condition. Consult your healthcare provider for medical symptom management.

Behavioral Options: What NAMS Evidence Actually Shows

What follows is not a general wellness section. These are options the 2023 NAMS position statement evaluated with explicit evidence-level designations — which matters because most resources present acupuncture, yoga, and supplements alongside CBT as if they carry equivalent clinical standing. They do not.

Cognitive-behavioral therapy (CBT) and clinical hypnosis both receive Level I evidence designations in the 2023 NAMS position statement — the same evidence tier as FDA-approved medications (Menopause, PMID 37252752). CBT for menopause is a structured, typically 4–6 session intervention. It targets the cognitive and behavioral response to hot flashes rather than eliminating the vasomotor event physiologically.

The NAMS statement notes CBT is supported by several RCTs, including the MENOS 1 and MENOS 2 trials. Menopause-specific CBT resources — including self-help workbooks developed from those trials — are available through the British Menopause Society for women with limited access to trained therapists.

Clinical hypnosis also reaches Level I evidence for VMS specifically. A licensed practitioner trained in clinical hypnosis is required — consumer recordings and apps are not equivalent. Access is more limited than CBT in most markets, including Charlotte, but clinical hypnosis is an evidence-based option for women who have not responded to other approaches.

Weight loss is included in the NAMS framework at Levels II–III — meaning real but less robust evidence exists — specifically for overweight and obese women, among whom weight reduction is associated with reduced hot flash frequency. This applies to a defined subpopulation; it is not a general lifestyle recommendation.

What NAMS does not recommend for vasomotor symptoms: The 2023 position statement explicitly does not recommend paced respiration, supplements and herbal remedies, cooling techniques, trigger avoidance, exercise, yoga, mindfulness-based intervention, soy foods, cannabinoids, or acupuncture for VMS. These approaches may carry other general health benefits. Current evidence does not support their use as primary or adjunct interventions for hot flashes and night sweats specifically.

Behavioral approaches require time, skilled practitioners, and patient engagement. They are generally most appropriate for mild-to-moderate VMS or as complements to pharmacologic treatment.

Comparing Non-Hormonal Options: A Symptom-by-Symptom Guide

The table below maps each major non-hormonal option to the symptom it targets, its evidence level per the 2023 NAMS position statement (where applicable), the population it best suits, and its primary limitation. No single option is appropriate for every woman — individualized provider consultation is essential.

A single non-hormonal option rarely addresses the full menopause symptom picture. In clinical practice, a multi-modal approach is common — for example, an SSRI for non-hormonal hot flash treatment, photobiomodulation for joint pain, and CBT for sleep and mood management. Coordination with an OB-GYN or menopause specialist ensures the combination fits the individual’s full health picture.

How Non-Hormonal Options Fit Into a Complete Menopause Care Plan

Radiant Results operates as a complementary, non-prescribing partner in Charlotte’s menopause care landscape — not a primary care or prescribing provider. Every pharmacologic option in this guide — Veozah, SSRIs/SNRIs, gabapentin, topical vaginal therapies — requires a licensed prescriber. OB-GYN involvement is not optional for women pursuing any of these options.

A well-structured non-hormonal menopause care plan typically involves multiple providers with distinct roles. An OB-GYN or menopause specialist evaluates candidacy for prescription options and monitors for safety outcomes — particularly important now that fezolinetant carries a Boxed Warning requiring regular liver function testing. A behavioral health provider delivers CBT or clinical hypnosis if those Level I options are selected. Adjunct full-body photobiomodulation can run in parallel with any of the above without interfering with prescription care.

A question that surfaces frequently: can non-hormonal options be used alongside hormone therapy? For most options, the answer is yes — these approaches are not competing. Some women use HRT for vasomotor symptoms while also using photobiomodulation for musculoskeletal discomfort or CBT for mood and sleep. The prescribing provider determines the overall plan, but multi-modal care is clinically common.

Women in Charlotte’s Uptown and surrounding neighborhoods who do not yet have a menopause-focused provider can use the NAMS practitioner locator at menopause.org to find board-certified menopause specialists. Radiant Results does not diagnose menopause, prescribe treatment, or position red light therapy as a treatment for any diagnosed medical condition. Women considering fezolinetant in particular — given its Boxed Warning — should not self-manage this decision.

Non-Hormonal Menopause Support at Radiant Results Uptown Charlotte

Radiant Results Uptown provides adjunct photobiomodulation therapy using the Dahlia Full Body Medical Grade Light Therapy Bed. The bed delivers red (~630–660nm) and near-infrared (~810–850nm) wavelengths simultaneously across the full body in 15-minute sessions. Styku 3D body scanning is available for objective, data-driven tracking of physical changes over time.

In the menopause context, Radiant Results is appropriate for women seeking adjunct support for musculoskeletal discomfort and skin changes as part of a care plan that includes provider oversight. The clinical evidence for photobiomodulation is strongest for joint and musculoskeletal pain — a symptom category that affects a large proportion of menopausal women and is frequently underdiscussed in clinical settings.

What Radiant Results does not offer, and does not claim: Radiant Results does not prescribe medications, does not diagnose menopause, and does not represent that photobiomodulation eliminates hot flashes or night sweats. The evidence does not support that claim.

For women in Charlotte’s Uptown, Midtown, South End, and the Fourth Ward corridor — and for those exploring non-pharmacologic menopause support alongside prescription care — the $79 New Patient Special includes a full-body session and a Styku 3D body scan.

Radiant Results — Uptown Charlotte

201 S Tryon St, Suite 150, Charlotte, NC 28202 · [phone — confirm before publish]

Claim the $79 New Patient Special → · All locations

Frequently Asked Questions

What are the most effective non-hormonal treatments for hot flashes?

The 2023 NAMS position statement designates cognitive-behavioral therapy, clinical hypnosis, SSRIs/SNRIs, gabapentin, and fezolinetant as Level I evidence options for vasomotor symptoms. Fezolinetant is the only non-hormonal medication with an FDA approval specifically for menopause-related hot flashes. Hormone therapy remains the most effective treatment for VMS; discuss all options with your OB-GYN or a menopause specialist. (Menopause, PMID 37252752)

Who should consider non-hormonal menopause options instead of HRT?

Non-hormonal options are the primary evidence-supported pathway for women with a personal history of hormone-sensitive cancers, blood clots or DVT, or certain cardiovascular conditions — and for women who prefer to avoid systemic hormones after an informed discussion with their provider. The decision is always individualized and should be made with a licensed prescriber who knows your complete medical history.

What is fezolinetant (Veozah) and is it safe?

Fezolinetant is a non-hormonal NK3 receptor antagonist FDA-approved in May 2023 for menopause-related hot flashes. It modulates KNDy neuron activity in the hypothalamic thermoregulatory center. In December 2024, the FDA added a Boxed Warning for rare but serious liver injury, with requirements for monthly liver testing for the first two months, then at months 3, 6, and 9. Women with pre-existing liver conditions or cirrhosis should not take fezolinetant. Discuss the full benefit-risk profile with your prescribing provider before starting treatment.

Can red light therapy help with menopause-related joint pain?

Red light therapy (photobiomodulation) has moderate-to-strong clinical trial evidence for joint and musculoskeletal pain — a symptom that affects approximately 71% of perimenopausal women in one systematic review (Lu et al., 2020). Near-infrared light (810–850nm) penetrates 2–5cm into tissue, supporting ATP production and modulating inflammation via cytochrome c oxidase (Hamblin, PMC5523874). A 2021 meta-analysis (Tripodi et al., PMC8364035) found PBM superior to sham for pain reduction and function in musculoskeletal applications. PBM is not supported as a treatment for hot flashes or night sweats.

What does the North American Menopause Society recommend for non-hormonal options?

The 2023 NAMS position statement (Menopause, PMID 37252752) recommends CBT, clinical hypnosis, SSRIs/SNRIs, gabapentin, and fezolinetant at Level I evidence for VMS. It explicitly does not recommend supplements, herbal remedies, yoga, acupuncture, mindfulness-based interventions, paced respiration, or soy foods for VMS — a distinction most consumer resources do not reflect. Weight loss is noted at Levels II–III for overweight and obese women specifically.

Where can I access non-hormonal menopause support in Charlotte?

Radiant Results Uptown Charlotte provides medical-grade full-body photobiomodulation as an adjunct non-pharmacologic option for menopause-related musculoskeletal discomfort and skin changes. The $79 New Patient Special includes a full-body session and a Styku 3D body scan. For prescription options — fezolinetant, SSRIs/SNRIs, or gabapentin — work with a licensed OB-GYN or menopause specialist. The NAMS practitioner locator at menopause.org is a useful starting point in Charlotte.

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. PMID: 37252752.
2. U.S. 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.” Drug Safety Communication, September 12, 2024; updated December 16, 2024.
3. Lu C, et al. “Musculoskeletal Pain During the Menopausal Transition: A Systematic Review and Meta-Analysis.” Neural Plasticity. 2020. PMC7710408.
4. Tripodi N, et al. “The effect of low-level red and near-infrared photobiomodulation on pain and function in tendinopathy: a systematic review and meta-analysis of randomized controlled trials.” BMC Sports Science, Medicine and Rehabilitation. 2021. PMC8364035. [Confirm before publish.]
5. Hamblin MR. “Mechanisms and Applications of the Anti-Inflammatory Effects of Photobiomodulation.” AIMS Biophysics. 2017;4(3):337–361. PMID: 28748217. PMC5523874. (Cited for cytochrome c oxidase / ATP mechanism only.)
6. Avci P, et al. “Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring.” Seminars in Cutaneous Medicine and Surgery. 2013;32(1):41–52. PMC4126803.
7. SKYLIGHT phase 3 trial program (SKYLIGHT 1, 2, 4) supporting fezolinetant approval — confirm primary publication citation before publish (fallback: NAMS PMID 37252752 covers the evidence-level designation).