Clinical recommendation	Evidence rating	Comments
Systemic estrogen-containing hormone therapy is effective for treating menopausal hot flashes.7,8,12	A	Clinical practice guidelines supported by a Cochrane review and other RCTs and meta-analyses
Because of potential risks with long-term use of hormone therapy, physicians should prescribe the lowest effective dose for the shortest duration necessary to improve symptoms.7,8	C	Consensus and expert opinion
Nonhormonal medications including SSRIs, SNRIs, gabapentin, clonidine, and oxybutynin may reduce hot flashes and are reasonable alternatives for patients who cannot or choose not to use hormone therapy.25–30	B	Inconsistent or limited-quality patient-oriented evidence from RCTs and systematic reviews
Cognitive behavior therapy and clinical hypnosis are effective for reducing vasomotor symptoms in the short-term. Other nonpharmacologic therapies, including black cohosh and isoflavones, may be considered for select patients, although there is low-quality evidence to support their effectiveness.9,32–41	B	Inconsistent results or limited-quality data (small or heterogeneous studies) from RCTs
Effective nonhormonal therapies for genitourinary syndrome of menopause include vaginal lubricants and moisturizers, oral ospemifene (Osphena), and intravaginal dehydroepiandrosterone.7,11,42–46	B	Limited-quality patient-oriented data from small, short-term RCTs