Increasing numbers of women are requesting non-hormonal treatments for menopausal symptoms. Estrogen-containing HRT is the most effective treatment for menopausal symptoms in healthy women but is contraindicated for some women and avoided by many others. This review will assess the evidence regarding the safety and efficacy of non-hormonal treatments for menopausal symptoms. Relatively few high quality studies have addressed this issue, almost all have only addressed the treatment of hot flushes and there are few long-term data. (c) 2007 Elsevier Ireland Ltd. All rights reserved.