Menopause Treatment in Canada (2026): HRT, Veozah, Non-Hormonal Options, and the Kisspeptin Science Behind Hot Flashes

Comparison Guide · 23 min read · Updated October 2026

Perimenopause, menopause, postmenopause

Perimenopause is often the hardest phase, because estrogen doesn’t simply fall: it swings, sometimes higher than before, then crashes. That can cause heavy periods, worsening PMS, sleep disruption and mood changes, often in women who don’t realize menopause has started.

Hot flashes last much longer than many people expect. In the large US SWAN study, the median duration of frequent hot flashes and night sweats was about 7.4 years, and longer for women whose symptoms began early in perimenopause (Avis et al., 2015).

The full list of symptoms

• Vasomotor: hot flashes, night sweats, palpitations
• Sleep: trouble falling or staying asleep, often from night sweats
• Mood: irritability, anxiety, low mood; higher risk of depression in perimenopause
• Cognitive: brain fog, word-finding trouble, poor concentration
• Genitourinary: vaginal dryness, painful sex, urinary urgency, recurrent UTIs
• Musculoskeletal: joint aches, muscle loss
• Metabolic: weight shifting to the abdomen, rising cholesterol
• Skin and hair: dryness, thinning skin, hair thinning
• Libido: reduced desire, arousal difficulties

Not every symptom is menopause. Thyroid problems, iron deficiency and depression overlap heavily and are worth ruling out.

Why hot flashes happen: the kisspeptin connection

This is where the science got genuinely exciting in the last decade. Deep in the hypothalamus sits a group of neurons called KNDy neurons, named for the three signals they make: Kisspeptin, Neurokinin B and Dynorphin. These neurons control the pulses of reproductive hormones, and they are normally kept in check by estrogen.

When estrogen falls at menopause, that brake comes off. KNDy neurons grow and become overactive, and they send excess neurokinin B signalling to the nearby brain centre that regulates body temperature. The thermostat effectively narrows: tiny rises in core temperature trigger a full heat-dumping response, which is a hot flash.

The proof came from a striking experiment: when researchers infused neurokinin B into healthy premenopausal women, it triggered hot flashes (Jayasena et al., 2015). Block the neurokinin B receptor (NK3), and hot flashes drop. That is precisely how the new drug Veozah works.

The treatment scorecard

Hormone therapy: what changed since 2002

In 2002, the Women’s Health Initiative (WHI) trial of combined estrogen plus progestin was stopped early after finding increased risks of breast cancer, heart attacks, strokes and blood clots (Rossouw et al., 2002). Prescriptions collapsed almost overnight, and a generation of women and doctors came to see hormones as dangerous.

Over the following two decades, re-analysis changed the picture:

• The WHI participants were older: average age 63, most more than a decade past menopause. That is not who usually seeks treatment for hot flashes.
• Timing matters. Women who start HRT under 60 or within 10 years of menopause have a much more favourable risk profile than those who start later.
• Estrogen alone behaved differently. In the WHI estrogen-only arm (women without a uterus), breast cancer risk did not rise and was slightly lower.
• Formulations have changed: transdermal estrogen and micronized progesterone are now widely used and may carry lower risks than the oral products studied in WHI.

The Menopause Society’s 2022 position statement concludes that for women under 60 or within 10 years of menopause without contraindications, the benefit-risk ratio is favourable for treating bothersome hot flashes and preventing bone loss (Menopause Society, 2022). Canadian guidance from the Society of Obstetricians and Gynaecologists of Canada is broadly aligned.

HRT risks, honestly

HRT is generally not recommended for women with a history of breast cancer, blood clots, stroke, heart attack or active liver disease. Those women have non-hormonal options.

Types of HRT: pills, patches, gels, progesterone

• Estrogen: pills, patches, gels and sprays. Patches and gels avoid first-pass liver metabolism.
• Progestogen (if you have a uterus): micronized progesterone capsules, synthetic progestins, or a hormonal IUD.
• Combined products in one pill or patch.
• Tibolone and other options are available in some countries.
• “Bioidentical” compounded hormones: regulated, approved products already include bioidentical estradiol and progesterone. Custom-compounded creams are not tested for consistent dosing and are not recommended by major societies.

Most HRT products in Canada are inexpensive generics and are covered by many provincial and private plans.

Veozah (fezolinetant): the new non-hormonal option

Fezolinetant blocks the NK3 receptor that neurokinin B acts on, calming the overactive KNDy signalling behind hot flashes without adding hormones. In the SKYLIGHT 1 trial, it significantly reduced the frequency and severity of moderate-to-severe hot flashes compared with placebo within weeks (Lederman et al., 2023).

• Approval: Health Canada approved Veozah for moderate to severe vasomotor symptoms of menopause, announced in December 2024, the first drug of its class in Canada.
• Who it suits: women who can’t take hormones (for example after breast cancer, with specialist input) or prefer not to.
• Safety: regulators have added warnings about rare but serious liver injury, so liver blood tests before and during treatment are recommended.
• Cost: it is a brand-name drug and public coverage is limited; check your plan.

A second drug in this family, elinzanetant, which blocks both NK1 and NK3 receptors, has been in late-stage development and approval in some markets.

Other non-hormonal medications

• SSRIs and SNRIs (such as paroxetine, escitalopram, venlafaxine) reduce hot flashes moderately and can help mood. Paroxetine and fluoxetine can interfere with tamoxifen, which matters after breast cancer.
• Gabapentin, taken at night, can reduce night sweats and help sleep.
• Oxybutynin reduces hot flashes and bladder urgency, though anticholinergic drugs raise cognitive concerns in older adults.
• Clonidine has modest effect and is less used now.

The Menopause Society’s 2023 non-hormone position statement ranks these options and recommends against most herbal products for lack of evidence (Menopause Society, 2023).

CBT, hypnosis and lifestyle

• Cognitive behavioural therapy adapted for menopause reduces how bothersome hot flashes feel and improves sleep and mood.
• Clinical hypnosis reduced hot flash frequency in trials and is recommended by the Menopause Society.
• Layering, cooling and trigger management (alcohol, spicy food, hot drinks, warm rooms) help at the margins.
• Weight loss reduces hot flashes in some women.
• Exercise helps mood, sleep, bone and muscle, though its effect on hot flashes specifically is modest.
• Stopping smoking: smokers have more hot flashes.

Vaginal dryness and bladder symptoms

Unlike hot flashes, genitourinary symptoms (now called genitourinary syndrome of menopause) usually get worse over time rather than better. They affect a large share of postmenopausal women and are often not raised with doctors.

• Moisturizers and lubricants are first-line for mild symptoms.
• Low-dose vaginal estrogen (cream, tablet or ring) is highly effective, with minimal absorption into the bloodstream. It also reduces recurrent urinary tract infections.
• Vaginal DHEA (prasterone) is another prescription option.
• Pelvic floor physiotherapy helps pain and urinary symptoms.

Low libido

Desire is affected by hormones, sleep, mood, relationship factors, painful sex and medications. Treating vaginal dryness and sleep often helps more than anything else. For postmenopausal women with distressing low desire, an international consensus supports testosterone at female physiological levels as an evidence-based option (Davis et al., 2019). No testosterone product is approved specifically for women in Canada, so it is used off-label under medical supervision.

Bremelanotide (Vyleesi), a melanocortin peptide known in research as PT-141, was approved by the US FDA in 2019 for low sexual desire in premenopausal women. It is not approved in Canada. We compare it with related research compounds in kisspeptin vs hCG vs PT-141.

Sleep and brain fog

Night sweats wake women repeatedly, and fragmented sleep then drives daytime fatigue, irritability and the “menopause brain fog” many describe. Treating the hot flashes (with HRT or Veozah) often improves sleep. CBT for insomnia works well for menopause-related insomnia. See our guides to insomnia treatment and brain fog causes and fixes.

The good news about cognition: studies following women through the transition suggest menopause-related memory changes are usually modest and improve after menopause.

Weight gain and metabolism

Many women notice weight gain around the middle during the transition. Aging and lower activity explain much of the total weight gain, but the drop in estrogen shifts fat toward the abdomen, which affects heart and metabolic risk. What helps:

• Resistance training to protect muscle, which declines faster after menopause.
• Protein at each meal to support muscle.
• Sleep, because poor sleep increases appetite and cravings.
• Medical treatment for obesity when appropriate: see weight loss injections in Canada, and how to protect muscle on GLP-1 drugs.

Bones and heart

Women can lose bone rapidly in the years around menopause. HRT prevents bone loss and reduces fractures, and is a reasonable choice for younger women at risk. Weight-bearing exercise, adequate calcium and vitamin D, and not smoking matter for everyone. Bone density testing is recommended for women 65 and older, or earlier with risk factors.

Heart disease risk rises after menopause as LDL cholesterol and blood pressure tend to climb. Midlife is a good time to check blood pressure, cholesterol and blood sugar.

Supplements: what the evidence says

In Canada, these are sold as natural health products. Tell your pharmacist what you take, because some interact with prescription drugs.

Peptide research: kisspeptin and beyond

The discovery that KNDy neurons drive hot flashes has made kisspeptin one of the most studied peptides in reproductive endocrinology. In humans, kisspeptin is a powerful trigger of the reproductive hormone cascade: infused kisspeptin raises luteinizing hormone (LH) and testosterone in men (Dhillo et al., 2005), and it has been studied as a gentler way to trigger egg maturation in IVF.

It is important to be clear about what this does and does not mean:

• The approved menopause drug (fezolinetant) works by blocking neurokinin B signalling, not by giving kisspeptin.
• Kisspeptin itself is not a menopause treatment. It acts upstream on the pituitary, and after menopause the ovaries can no longer respond to that signal by making estrogen.
• Research interest is in understanding the KNDy network: how kisspeptin, neurokinin B and dynorphin interact, and why the system becomes overactive.

TrueLabs supplies kisspeptin (from $34) as a research compound for laboratory use, along with related reproductive-axis research peptides hCG and PT-141. These are not treatments for menopause, are not approved for human use, and are sold with independent lab reports in our COA library. More context in kisspeptin side effects.

Getting care in Canada

• Start with your family doctor or nurse practitioner. Bring a symptom list and how much each one affects your life.
• Ask about a certified menopause practitioner if your needs are complex. The Menopause Society lists certified clinicians, including in Canada.
• Menopause clinics exist in several cities, often hospital-based with referral waits.
• Virtual care services now offer menopause consultations and prescriptions in many provinces.
• Coverage: generic HRT is inexpensive and widely covered; newer brand drugs like Veozah may not be.

Perimenopause: periods, mood and the “am I in it?” question

Perimenopause is the phase most often missed, partly because there is no single test for it. Hormone levels swing so much from day to day that a single blood test can look normal or misleading, which is why guidelines generally diagnose perimenopause in women over 45 based on symptoms and cycle changes rather than blood work.

Common signs

• Cycles that become shorter, then longer and irregular
• Heavier or more painful periods, sometimes with flooding
• New or worsening PMS, anxiety, irritability or low mood
• Sleep disruption, often before hot flashes start
• Night sweats around periods
• Breast tenderness, headaches and migraines

Treatment in perimenopause

Options differ slightly from postmenopause because women can still ovulate and need contraception if avoiding pregnancy:

• A hormonal IUD controls heavy bleeding, provides contraception, and can serve as the progestogen part of HRT.
• Low-dose combined hormonal contraception can smooth hormonal swings for suitable non-smoking women.
• Estrogen therapy for vasomotor symptoms, paired with endometrial protection.
• Mood symptoms may respond to hormone therapy, SSRIs, or both; a history of severe PMS or postpartum depression is a risk factor for perimenopausal depression.

Heavy or irregular bleeding should still be assessed, because fibroids, polyps and, less commonly, endometrial problems can cause similar symptoms.

Early and premature menopause

Early loss of estrogen raises the long-term risks of osteoporosis, cardiovascular disease and possibly cognitive decline. That changes the HRT calculation: for women with POI or early menopause, guidelines recommend hormone therapy at least until the average age of natural menopause (around 51) unless there is a specific reason not to. In this group, HRT replaces hormones the body would normally still be making, so the risk data from studies in older women don’t apply in the same way.

POI also has implications for fertility, and women affected should have access to fertility counselling. Causes include genetic conditions, autoimmune disease, and cancer treatment, though often no cause is found.

HRT in special situations

• After breast cancer: systemic HRT is generally avoided. Non-hormonal options, including fezolinetant, SSRIs/SNRIs (avoiding paroxetine and fluoxetine with tamoxifen), gabapentin and CBT, are preferred. Low-dose vaginal estrogen may be considered for severe genitourinary symptoms in consultation with the oncology team.
• BRCA carriers after preventive ovary removal: HRT is often recommended until around 51 in women without a personal history of breast cancer, guided by specialists.
• History of blood clots: oral estrogen is generally avoided; transdermal estrogen may be considered with specialist input in some cases.
• Migraine: transdermal estrogen at steady levels is generally preferred.
• Starting after 60 or more than 10 years after menopause: risks are higher, and decisions are more individualized, often favouring non-hormonal or vaginal options.
• How long to stay on HRT: there is no mandatory stop date. Major societies support continuing as long as benefits outweigh risks, with a yearly review.

Joints, skin, hair and heart palpitations

• Joint and muscle aches are one of the most common menopause symptoms and are often missed. Estrogen influences inflammation and connective tissue; strength training and HRT help some women. New swollen joints still need assessment for arthritis.
• Skin: collagen declines rapidly in the first years after menopause, leading to thinner, drier skin. Sunscreen, retinoids and moisturizers help; HRT may slow collagen loss. See our guide to anti-aging skincare ingredients.
• Hair: thinning at the crown and part is common as the balance of hormones shifts. Topical minoxidil is first-line; iron and thyroid should be checked. See hair loss treatment in Canada.
• Palpitations: a racing or pounding heart can accompany hot flashes and is usually harmless, but new or sustained palpitations deserve an ECG to rule out rhythm problems.
• Dry eyes and mouth also become more common.

Menopause at work

Many women experience menopause during peak career years, and symptoms like poor sleep, brain fog and hot flashes can affect work. Surveys in Canada have found that a significant share of women considered reducing hours or leaving work because of symptoms. Helpful measures:

• Temperature control: desk fans, access to cooler areas, breathable uniforms.
• Flexible hours or remote work on bad-sleep days.
• Treating symptoms effectively, which is often the biggest single improvement.
• Workplace policies and manager awareness; a growing number of Canadian employers now include menopause in health benefits and policies.

Menopause myths

• “HRT causes breast cancer in everyone.” Combined HRT carries a small increase in risk with longer use; estrogen alone shows little or none. Absolute risks are small for most younger women.
• “You have to stop HRT after five years.” There is no fixed limit; it’s reviewed individually.
• “Bioidentical compounded hormones are safer.” Approved products already include bioidentical estradiol and progesterone; custom compounds are less tested.
• “Blood tests diagnose perimenopause.” Hormones fluctuate too much; diagnosis over 45 is usually based on symptoms.
• “Hot flashes only last a year or two.” The median is about seven years.
• “Weight gain is inevitable.” Fat shifts toward the abdomen, but strength training, protein, sleep and medical options can counter it.

Hot flash quick-relief kit

While longer-term treatment takes effect, these practical steps reduce how disruptive hot flashes and night sweats are:

• Layer clothing with breathable fabrics so you can shed a layer quickly.
• Keep the bedroom cool, use a fan, and try moisture-wicking sleepwear and bedding.
• Carry a small fan or cooling spray for work and travel.
• Paced breathing: slow breathing at the start of a flash may reduce its intensity for some women.
• Track triggers for two weeks: common ones are alcohol, caffeine, spicy food, hot drinks, stress and warm rooms.
• Cold water at the bedside for night sweats.

FAQ

Related reading

• Insomnia treatment in Canada
• Brain fog: causes and fixes
• Kisspeptin vs hCG vs PT-141
• Best anti-aging skincare ingredients

References

1. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition (SWAN). JAMA Intern Med. 2015;175(4):531–539. PubMed
2. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women (WHI). JAMA. 2002;288(3):321–333. PubMed
3. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. PubMed
4. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573–590. PubMed
5. Jayasena CN, Comninos AN, Stefanopoulou E, et al. Neurokinin B administration induces hot flushes in women. Sci Rep. 2015;5:8466. PubMed
6. Lederman S, Ottery FD, Cano A, et al. Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1). Lancet. 2023;401(10382):1091–1102. PubMed
7. Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019;104(10):4660–4666. PubMed
8. Dhillo WS, Chaudhri OB, Patterson M, et al. Kisspeptin-54 stimulates the hypothalamic-pituitary gonadal axis in human males. J Clin Endocrinol Metab. 2005;90(12):6609–6615. PubMed
9. Health Canada approves non-hormonal treatment for hot flashes and night sweats (Veozah). December 2024. Sleep Review

This article is general information, not medical advice. Talk to a doctor, nurse practitioner or pharmacist about menopause treatment. TrueLabs research compounds are sold for in vitro and laboratory research use only and are not intended for human or veterinary use.