Treatment timing comparison

Hot flashes

Fastest initial relief: Fezolinetant (1 wk)

• HRT (transdermal estradiol)2–12 wk

  Fastest path to full relief.

• Fezolinetant1–8 wk

  Fast onset but plateaus lower than HRT.

• SSRI (paroxetine low-dose)4–12 wk

  Mid-tier reduction.

• CBT-for-menopause4–12 wk

  Reduces bother more than frequency.

• Acupuncture4–12 wk

  Modest effect requires sustained sessions.

Sleep disruption

Fastest initial relief: HRT (2 wk)

• HRT2–8 wk

  Strong impact when vasomotor symptoms drive insomnia.

• CBT-I4–8 wk

  Targeted insomnia therapy. Durable.

• SSRI4–12 wk

  Indirect benefit via hot flash reduction.

Vaginal dryness

Fastest initial relief: Vaginal estrogen (cream/ring) (2 wk)

• Vaginal estrogen (cream/ring)2–12 wk

  Most targeted treatment.

• Vaginal DHEA (Intrarosa)4–12 wk

  Alternative for estrogen-sensitive.

• Systemic HRT4–16 wk

  Less targeted than vaginal.

Weight loss (GLP-1)

Fastest initial relief: Tirzepatide (Zepbound) (4 wk)

• Tirzepatide (Zepbound)4–72 wk

  Highest peak weight loss.

• Semaglutide (Wegovy)4–68 wk

  Established. Predictable trajectory.

• Compounded semaglutide4–52 wk

  Less predictable, cash-pay path.

PCOS — hirsutism

Fastest initial relief: Spironolactone (12 wk)

• Spironolactone12–36 wk

  Slow onset. Hair regrows slowly.

• Combined OCP12–36 wk

  Different mechanism, similar timeline.

Mood swings (peri-related)

Fastest initial relief: HRT (4 wk)

• HRT4–12 wk

  When hormone-driven.

• SSRI4–8 wk

  Targeted for depression.

• CBT4–12 wk

  Behavioral approach.

How to read

Solid bar (accent color) = time to initial measurable relief. Light bar (mint) = time to maximum effect. Individual response varies. Faster initial relief doesn't mean better long-term outcomes — durability and magnitude matter.