Menopause and Vasomotor Symptoms: Narrative Review of Evidence and Therapeutic Perspectives

Menopause is a physiological process characterized by ovarian failure and consequent hypoestrogenism, often accompanied by vasomotor symptoms (VMSs), such as hot flashes and night sweats. These manifestations affect up to 80% of women, may persist for more than a decade, and significantly impact quality of life, occupational performance, and psychosocial well-being. Hormone therapy (HT) remains the gold standard for managing VMS; however, it is not risk-free and is contraindicated in specific subgroups, such as women with a history of breast cancer or thromboembolic events. In this context, non-hormonal alternatives have been increasingly studied, including antidepressants, gabapentin, neurokinin-3 receptor (NK3R) antagonists such as fezolinetant, as well as complementary therapies and behavioral interventions. This article aims to provide a narrative review of the most relevant evidence published between 2014 and 2024 regarding the pathophysiology, clinical impact, and hormonal and non-hormonal therapies for menopausal vasomotor symptoms, highlighting recent advances and future perspectives.