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As you approach menopause, hormone levels can rise and fall, leading to symptoms like irregular periods, hot flashes, and sleep problems. Although menopause hormone therapy is a common treatment, it's not the only option. Nonhormonal treatment options can also help manage symptoms.
"We have to tease out what symptoms we're needing to treat to figure out what treatment options there are," said Margaret Ladner, a certified nurse-midwife and founder of Attune Menopause Care in Chicago. This process often starts with a detailed conversation with your healthcare provider about your symptoms, medical history, and personal preferences. If you're considering nonhormonal menopause treatments, here's what you need to know.
According to Ladner, nonhormonal treatments may help relieve some bothersome symptoms, but not all.
Several nonhormonal treatment options may help manage menopause symptoms. Here are some of the medications and approaches that might be recommended.
When someone cannot or prefers not to take estrogen, healthcare providers often use antidepressants as a first-line treatment for hot flashes. Some selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, may be prescribed. Brisdelle, a specific low-dose form of paroxetine, is approved by the U.S. Food and Drug Administration (FDA) to treat hot flashes and isn't used for depression.
Other SSRIs, including citalopram and escitalopram, may reduce hot flashes but aren't approved for this use. The antidepressants venlafaxine and desvenlafaxine may also be used, but may have more side effects. Overall, studies show antidepressants can reduce hot flashes by 24 percent to 69 percent compared with a placebo.
Gabapentin, a medication used to treat seizures, may also help relieve hot flashes, Ladner said. It's often taken at night but may also be used during the day. Studies show it can reduce the frequency of hot flashes by 54 percent.
"[Gabapentin is] used for all sorts of other neurological pains and pain syndromes," Ladner said. "It can be really effective for hot flashes at night, so that's another option if somebody can't use hormone therapy."
The drug fezolinetant (Veozah) works on brain pathways involved in hot flashes. "It can be super effective for hot flash management," she said, adding that "it doesn't really work on any of the other symptoms."
Fezolinetant is approved to treat hot flashes, but it may affect the liver. Doctors often check liver function before prescribing it. Studies show that after 12 weeks, fezolinetant can reduce hot flash frequency by 50 percent to 60 percent and may improve sleep.
Elinzanetant (Lynkuet) is another medication approved to treat hot flashes and manage sleep problems. Some research suggests it may be less likely to affect the liver than fezolinetant.
Oxybutynin is often used to treat overactive bladder and urinary incontinence. It may also help reduce hot flashes, but it can cause side effects such as dry mouth. Studies show it may reduce hot flashes by 70 percent to 86 percent.
Typically used to treat high blood pressure, clonidine works by relaxing blood vessels and may help reduce hot flashes. Studies have shown reductions of about 26 percent to 38 percent.
Phytoestrogens are plant-based compounds found in foods such as soybeans, chickpeas, lentils, red clover, and flaxseed. Supplements containing isoflavones are also available. However, their effectiveness is unclear, and some health experts are concerned they may act like estrogen in the body. Because of this, they may not be a safe choice for people with certain cancers.
Lifestyle changes like limiting alcohol, avoiding spicy foods, and reducing caffeine may help reduce hot flashes. Maintaining a healthy weight and practicing mind-body exercises may also help. Some research suggests hypnotherapy and mindfulness meditation may reduce symptoms. Other studies show that cognitive behavioral therapy (CBT) may help manage menopause symptoms.
It's important to note that herbal supplements are generally not recommended as nonhormonal treatments. There is little to no evidence that cannabis, black cohosh, ammonium succinate, rhubarb, or probiotics help relieve symptoms like hot flashes and night sweats.
For some women, menopause hormone therapy isn't an option. They may prefer not to use it, or they have medical conditions or risk factors that make hormone therapy unsafe.
For example, certain cancers — such as estrogen-sensitive breast cancer, some ovarian cancers, and endometrial cancer — may make hormone therapy inappropriate. A history of blood clots, heart disease, or liver disease may also make nonhormonal options a better choice.
Some women may also choose nonhormonal options if their symptoms are mild or can be managed without hormone therapy.
No one experiences menopause in exactly the same way. The pros and cons of nonhormonal options can vary based on personal preferences, symptoms, and medical history. Some women find that nonhormonal options work well for them, while others choose hormone therapy.
When deciding if nonhormonal options are right for you, it's important to discuss your questions and concerns with a healthcare provider and review the possible benefits and downsides.
Weighing the pros and cons can help you and your doctor decide which approach best fits your needs and goals.
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