Menopause tablets: what actually exists and what needs a prescription

You type "menopause tablets" into a search engine and up come two worlds that have nothing to do with each other: on one side, medicines that only a doctor can prescribe; on the other, food supplements you can buy without asking anyone. They look alike in format (a tablet, a capsule) and in the implicit promise (that the hot flushes will settle), but not in the level of evidence behind them or the controls they are subject to. This article sorts out the confusion: which groups genuinely exist, what the reference guideline says about each one and why some things need a prescription and others do not.

First things first: "tablet" is not a medical category

The pharmaceutical form (tablet, capsule, patch, gel, pessary) tells you very little about what a product does. There are hormonal treatments taken by mouth and others absorbed through the skin; there are non-hormonal options that are prescription tablets and there are jars of capsules that are legally foods. Searching for "tablets" is searching by the packaging, not by the mechanism. That is why it helps to redraw the map into four groups: hormonal treatment, non-hormonal prescription treatment, local treatment for the genital area and food supplements.

Group 1: hormone therapy (HRT), the first-line option

For vasomotor symptoms — hot flushes and night sweats — the NICE NG23 guideline recommends offering hormone replacement therapy (recommendation 1.5.1). It does not say "if nothing else works": it says offer. It is the benchmark against which all the other options are compared.

Within HRT there is no single product. NG23 asks that the conversation explicitly cover the benefits and risks of combined HRT versus oestrogen-only HRT, and also the dose and the duration (recommendation 1.4.2). That distinction is not a technicality: it depends on each person's situation, and it is one of the reasons why these medicines are not sold without a prescription. If you want to understand how it is approached today, we have an explanation of how hormone therapy with estradiol and micronised progesterone works and another on who HRT is indicated for and what its real risks are.

There is a nuance in the guideline itself that is almost never mentioned and that matters: the benefits and risks described in NG23 only cover use within the authorised doses. When doses or combinations are prescribed outside what is approved in the summary of product characteristics — including specially prepared, made-to-measure formulations — the guideline's figures stop being applicable, quite simply because they have not been studied that way. It is not a moral judgement: it is that there are no data.

NG23 also covers one specific off-label situation: as of November 2024, using combined or oestrogen-only HRT in people with active or recent arterial thromboembolic disease was off-label, that is, outside the authorised indication. And it adds that anyone with a personal history of, or high risk of, breast cancer should be offered information on all the options and referral to a professional with expertise in menopause; not a flat "no", but an assessment with someone who knows the field.

The duration is also decided at the outset

If HRT is chosen, NG23 asks that the expected duration be discussed from the start, that benefits and risks be reviewed again at every review and that it be explained that symptoms may return when it is stopped, with the option of restarting (recommendation 1.4.3). Put another way: this is not a treatment you start and forget, but one that gets reviewed. And in April 2026 the guideline adjusted its recommendations on unscheduled vaginal bleeding on systemic HRT (it amended 1.8.4 and added 1.8.5) to bring them into line with the suspected cancer guideline: unexpected bleeding while taking HRT is a reason to seek advice, not something to wait out and see whether it settles on its own.

Group 2: the non-hormonal prescription options

There are non-hormonal medicines aimed specifically at hot flushes. NG23 includes fezolinetant as an option for moderate to severe vasomotor symptoms when HRT is unsuitable (recommendation 1.5.3). In Spain, the AEMPS register (CIMA) lists it as authorised since December 2023, marketed and prescription-only. Whether it is also funded by the Spanish National Health System is a separate question that has to be checked on its own: authorised, marketed and funded are three different things. Here we explain what it is and what is known about fezolinetant, the non-hormonal tablet for hot flushes.

The other option NG23 places in this territory is not a medicine: the guideline recommends considering menopause-specific cognitive behavioural therapy for vasomotor symptoms, and it sets it out in three different scenarios — added to HRT, when HRT is contraindicated and when the person prefers not to take it (recommendation 1.5.2). It usually comes as a surprise that a clinical guideline puts a psychological intervention in the same section as hot flushes, but there it is.

NG23 also considers HRT for depressive symptoms that do not meet the criteria for depression and that appear at the same time as the rest of the menopausal symptoms (recommendation 1.5.21, from 2015 and amended in 2024). It is a fine distinction: we are talking about low mood that begins at the same time as the hot flushes and the insomnia, not an established depressive illness, which is managed along its own pathway.

Group 3: local treatment is not the same as systemic treatment

Vaginal dryness, vaginal stinging and pain during sexual intercourse have their own chapter, with treatments that act locally rather than throughout the body. Here NG23 is explicit about one heavily advertised technology: it recommends NOT offering vaginal laser for genitourinary symptoms of the menopause except within a randomised trial (recommendation 1.5.20). It is a useful example of the fact that "new" and "high-tech" do not mean "proven". We go into the subject in the article on vaginal dryness and pain during sexual intercourse.

Group 4: the food supplements from the health food shop

Soya isoflavones, black cohosh, evening primrose oil, vitamin blends with evocative names. Legally they are food supplements, not medicines: that means they have not gone through the same evaluation of efficacy and safety as a medicine before reaching the shelf. It does not mean they are inert or that it makes no difference whether you take them — some plants interact with medication — but that the evidence requirement is different.

What NG23 says about these products is cautious: it acknowledges some evidence that isoflavones or black cohosh relieve hot flushes, but warns that there are many different preparations, that their safety is uncertain and that interactions with other medicines have been reported (recommendation 1.4.7). If you are interested in the detail of what has been studied for each plant, we review it in phytoestrogens, isoflavones and supplements for the menopause.

Why some things require a prescription and others do not

A prescription is not an inherited piece of red tape: it is the mechanism that forces someone to assess your particular case before you take the product. The whole architecture of NG23 points that way. Recommendation 1.4.1 asks that the benefits and risks of each menopause management option be discussed with the person. Recommendation 1.4.2, that dose, duration and type of HRT be covered explicitly. Recommendation 1.4.3, that all of that be reviewed at every review. None of that happens over a shop counter, and it cannot happen in writing in an article like this one: what is explained here is the map, not the choice.

That is also why in Spain you do not see advertising for prescription medicines aimed at the public. It is a logical consequence of the same principle: the decision to take a prescription medicine is not made on the basis of advertising, it is made after a clinical assessment.

In summary, and what you can do today

What to take away: "menopause tablets" is not a category, it is four different worlds. The reference guideline recommends offering hormone therapy for hot flushes, rules out vaginal laser outside a trial and reminds us that the safety and quality of unregulated preparations may be unknown. The real difference between one option and another is not the packaging: it is whether someone has assessed your case. What does exist in Spain today is menopause treatment by telemedicine with a prior assessment, a prescription where appropriate from a registered doctor and ongoing follow-up, including the periodic review the guideline calls for. If you would rather start with something concrete, you can check whether you are eligible in a few minutes.