Brisdelle, Lynkuet, and More: 5 Non-Estrogen and Nonhormonal Menopause Medications

Menopause is a natural part of life that marks the end of menstrual periods. But it often causes uncomfortable symptoms. Hot flashes and night sweats, which are called vasomotor symptoms, are two of the most common. But you may also experience vaginal symptoms, such as vaginal dryness. There are many ways you can manage these menopause-related effects — from lifestyle changes to prescription medications.

A common option for many is menopausal hormone therapy (previously called hormone replacement therapy, or HRT). That’s because dropping levels of estrogen and other hormones is the primary cause for menopause symptoms. Raising levels of these hormones with medication helps to ease symptoms. But this treatment approach isn’t right for everyone, and some people prefer hormone-free options.

So what’s available for menopause symptoms if you’re looking to avoid menopausal hormone therapy? Below is a summary of five FDA-approved nonhormonal menopause medications — and ways you can save on each — with the brand names in bold.

1. Intrarosa

Intrarosa (prasterone) is a medication that can help manage vaginal symptoms of menopause. It comes as an insert that you place in your vagina once a day at bedtime.

Intrarosa contains a lab-made, plant-based version of dehydroepiandrosterone (DHEA). Experts aren’t fully clear on how it works. But it’s thought that your body converts the DHEA in Intrarosa into natural estrogen and other hormones. This boost in natural hormone levels in the vaginal area helps to relieve local symptoms, such as dryness and pain during sex.

This medication is slightly different from vaginal estrogen products. With vaginal estrogens, you’re placing lab-made or naturally-derived estrogen inside your vagina. With Intrarosa, your body changes the active ingredient into estrogen after it absorbs the medication from the insert.

How to save: There are ways to save on Intrarosa, which is available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $35 per month by using a copay savings card from the manufacturer. If you have Medicare Part D or a Medicare Advantage plan, you may be able to pay as low as $85 per month through the manufacturer’s savings program.

2. Osphena

Osphena (ospemifene) is an oral medication that can also help manage vaginal symptoms. It comes as a tablet that you take once a day with food.

Osphena belongs to a class of medications called selective estrogen receptor modulators (SERMs). It attaches to estrogen receptors (binding sites) in and around your vagina. Once Osphena binds to these receptors, your body acts like it would if estrogen was attached. Notably, your vagina will produce more natural lubrication. And this helps relieve bothersome vaginal symptoms.

EXPERT PICKS: WHAT TO READ NEXT

• Compare treatment options. Nonhormonal medications are just some of the available menopause treatments. Learn about the different options and how to save on them.

• Natural menopause treatments: Learn about supplements and vitamins for menopause, including which ones are worth a try and which you should avoid.

• Advice for handling hot flashes: Read one woman’s firsthand account of experiencing hot flashes — and her top tips for managing them.

How to save: GoodRx can help you save on Osphena, a brand-name-only medication. Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of Osphena at an exclusive cash price of $84.90. If you have commercial insurance, a manufacturer copay savings card may reduce your costs to as little as $35 per month.

3. Brisdelle

Brisdelle (paroxetine) is a nonhormonal option to help relieve vasomotor symptoms. It comes as a capsule that you take by mouth once a day at bedtime.

Brisdelle is a selective serotonin reuptake inhibitor (SSRI). It contains the same active ingredient as the antidepressant Paxil, but at a much lower dose. It’s not clear exactly how Brisdelle works. But experts think it might affect areas of the brain that help regulate body temperature. This action helps reduce the frequency and severity of hot flashes.

How to save: GoodRx could help you save on the average retail price of the generic version. A 30-day supply of generic Brisdelle may cost as low as $52.12 with a free GoodRx discount.

4. Veozah

Veozah (fezolinetant) is another hormone-free option for managing hot flashes and night sweats. It comes as a tablet that you take by mouth once a day, with or without food.

Veozah is a neurokinin 3 (NK3) receptor antagonist. It blocks the activity of a chemical called neurokinin B (NKB) in your brain. This chemical helps regulate body temperature. 

NKB becomes more active during menopause. And more NKB activity raises body temperature, causing vasomotor symptoms. By blocking NKB, Veozah helps rebalance your body temperature.

How to save: There are ways to save on Veozah, which is available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $0 for your first month of Veozah using a manufacturer copay savings card. Subsequent fills may cost as low as $30 with the card. If you’re uninsured or underinsured, you may be eligible for Veozah’s patient assistance program, which offers the medication free of cost.

5. Lynkuet

Lynkuet (elinzanetant) is the newest nonhormonal menopause medication. It’s available as a capsule that you take by mouth once daily at bedtime.

Lynkuet is a neurokinin 1 (NK1) and NK3 receptor antagonist. Similar to Veozah, Lynkuet blocks the activity of NKB in your brain. But it also blocks another brain chemical called substance P.

Experts believe that substance P widens blood vessels and contributes to insomnia (sleep troubles). Wider blood vessels allow blood to travel faster through your body, making you feel warmer. Blocking substance P not only reduces hot flashes, but also helps improve sleep quality.

How to save: There are ways you can save on Lynkuet, a brand-name medication. If you have commercial insurance, you may be able to pay as little as $25 a month for Lynkuet using a copay savings card from the manufacturer. And if you’re uninsured or underinsured, you may qualify for Lynkuet’s patient assistance program, which offers the medication at no cost.

Other nonhormonal treatments for menopause

There are other nonhormonal treatments and supplements for menopause symptoms available over the counter (OTC). Discuss these options with your healthcare team to see if any would be right for you:

• Asian ginseng

• L-theanine

• Maca

• Plant phytoestrogens, either taken as a supplement or consumed in your diet

• Omega-3 fatty acid supplements, such as fish oil or flaxseed oil

• Pollen extract products, such as Relizen

• Certain probiotics

• St. John’s wort

• Vitamin D

Keep in mind that the evidence is weak or unclear as to whether many of these supplements work for menopause symptoms. And they all have their own side effects and interactions to consider. Ask your prescriber or pharmacist before trying any of these options. And be sure to provide them with a current medication list so they can check for potential interactions.

You can also try the following medication-free options to relieve menopause symptoms:

• Use an OTC personal lubricant to help with vaginal dryness.

• Try to exercise regularly or increase your amount of movement.

• Eat more fruits and vegetables that have a high water content, such as cucumbers, watermelon, and celery.

• Ask a healthcare professional about trying the Mediterranean diet. This diet typically focuses on plant-based foods, such as whole grains, nuts, and healthy fats like olive oil.

• Limit spicy and sugary foods, which can contribute to hot flashes.

• Make water your beverage of choice.

• Limit or avoid caffeinated or alcoholic beverages.

• If you smoke, take steps to quit. Your healthcare team can help you do so safely.

• Keep your house cooler, and wear loose-fitting clothes.

• Try stress-reducing activities, such as yoga or meditation.

Frequently asked questions

Why trust our experts?

Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Our editorial standards

Meet our experts