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If HRT isnt the safest choice, there are effective non-hormonal alternatives to manage menopausal symptoms, such as: Antidepressants, like SSRIs and SNRIs for hot flashes and mood stability Gabapentin , clonidine , and fezolinetant to reduce hot flashes Oxybutynin to treat an overactive bladder and improve hot flashes Ospemifene to manage painful sex caused by vaginal changes Vaginal lubricants and moisturizers to relieve dryness and discomfort The right combination of treatments depends on your symptoms, health history, and comfort level