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Reproductive Endocrinology

ORF38-04 - Recommendations for the Use of Non-Hormone Treatment of Vasomotor Symptoms of Menopause: Insights from a Modified Delphi Panel

Monday, June 15, 2026
9:45 AM - 10:00 AM CT
Location: Room W187
Disclosure(s):
Gina Woods, MD: Bayer Inc.: Advisory Board (); Roon: Consultant (); Solarea, Bio: Consultant ()

Background
Vasomotor symptoms (VMS; also known as hot flashes or night sweats, if occurring at night), are among the most common and disruptive menopausal symptoms. While hormone therapy (HT) has been the gold standard, it is often unsuitable for many women with contraindications or preferences for other options. Non-hormone therapies (NHT) provide alternatives, but US guidance on their use, particularly in women with comorbidities, remains limited.

Methods
We conducted a modified Delphi (mDelphi) panel of 15 multidisciplinary experts to establish US-focused consensus recommendations for NHT use in managing moderate-to-severe VMS, as well as the appropriate use of HT in various comorbid conditions. A systematic literature review of US guidelines (2014–2024) informed survey development. An online survey assessed agreement with proposed recommendations using a 9-point Likert scale, with ≥70% agreement defining consensus. Items lacking consensus were discussed in a structured in-person meeting (Boston, MA; March 14, 2025), leading to refined recommendations.

Results
Eleven of 15 experts completed the survey; all 15 attended the meeting. Panelists affirmed HT as first-line for eligible women historically and NHT for those with contraindications or who decline HT. Recommended first-line NHT options were SSRIs/SNRIs, gabapentin, and oxybutynin, after accounting for contraindications. Newly approved neurokinin targeted therapies (NKT), Fezolinetant, a neurokinin-3 receptor (NK-3R) antagonist and elinzanetant (dual NK-1R/NK-3R antagonist) were supported as first-line with high level evidence but limited by access and cost. Clonidine and most herbal/over-the-counter products were not recommended due to potential adverse effects, drug-drug interactions, or lack of evidence of benefit or harm. Specific recommendations regarding the appropriateness of HT versus NHT addressed women with cardiovascular disease, metabolic syndrome, thrombosis, liver disease, smoking, and hormone-sensitive cancers. Barriers to appropriate prescribing that were identified included insurance step-therapy requirements and limited formulary access to newer agents. All panelists agreed that there was an urgent need to provide structured guidance to the primary care community regarding selection and use of HT and NHT.

Conclusions
This mDelphi panel provides structured, symptom- and comorbidity-based recommendations for NHT in VMS management. Findings extend existing guidelines by addressing real-world challenges and will support development of a Menopause Medical Eligibility Criteria (MenoMEC) tool to guide individualized, evidence-informed care.