Hormone replacement therapy (HRT) is a safe and effective treatment for managing menopause symptoms, which is why around 15% of women aged 45 to 64 in England are currently prescribed it1.
However, it isn’t an option for everyone, either because of their medical history or personal preferences. If you're seeking alternatives to hormone therapy for menopause symptoms, this guide will give you insights into non-hormonal approaches to support your well-being during this transitional phase.
Non-hormonal medication for menopause symptoms
For individuals where HRT isn’t appropriate, non-hormonal medications can offer effective relief from menopause symptoms. These treatments work in various ways to provide an alternative solution to HRT for patients.
While they may not be suitable for everyone, non-hormonal options can be an important part of a tailored approach to menopause care, especially for those with specific health concerns or preferences, such as those navigating menopause and a history of breast cancer.
Veozah
Veozah (Fezolinetant) is a new non-hormonal treatment that targets the vasomotor symptoms of menopause. It works on the brain’s temperature control centre to reduce the frequency and severity of hot flushes and night sweats2. It doesn’t address other menopause symptoms such as brain fog or vaginal dryness.
It isn’t currently available on the NHS but can be prescribed privately3.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
SSRIs are selective serotonin reuptake inhibitors. They are thought to work by increasing levels of serotonin in the brain. SNRIs are serotonin-noradrenaline reuptake inhibitors, meaning they impact both serotonin and noradrenaline rather than only serotonin. These chemicals in the brain are thought to have a beneficial influence on mood, emotion and sleep.
These medications are commonly used to treat mood disorders. In menopause these medications can help manage hot flushes, low mood, and anxiety. Some examples include Venlafaxine (Effexor), Paroxetine (Paxil), and Fluoxetine (Prozac)3.
Bear in mind that some antidepressant medications must not be used if you are taking the breast cancer drug Tamoxifen. These include Fluoxetine (Prozac), Paroxetine (Paxil) and Buproprion (Wellbutrin). This is because these specific medications interact with an enzyme making Tamoxifen less effective. There are alternative antidepressants that can be used with Tamoxifen e.g. Venlafaxine.
It's true that some women do not like the idea of using an antidepressant, but these medicines can be very useful additions or alternatives to HRT. Whilst these medications are classed as antidepressants, they're also used to treat menopausal symptoms as well as mood, depression and anxiety. It's worth noting that side effects include nausea and anxiety.
Clonidine
Originally a blood pressure medication, clonidine can alleviate hot flushes. It's typically prescribed as a tablet and needs to be used with caution in women who already take blood pressure medication. Side effects include fatigue, dizziness, dry mouth and mood disturbance.
Oxybutynin
Usually used to treat an overactive bladder, oxybutynin has been shown to reduce hot flushes which is why it is used off licence to treat this menopause symptom.
Its side effects may include stomach pain, diarrhoea, nausea, headaches, dry mouth and dry eyes3.
Gabapentin and Pregabalin
Originally developed to treat seizures, these medications can help reduce hot flushes, night sweats and restless legs by affecting nerve signals. Examples include Gabapentin (Neurontin) and Pregabalin (Lyrica).
They're typically prescribed as a tablet. It is important to start at a low dose and increase gradually as there can be unwanted side effects. These can include dizziness, fatigue, nausea and mood changes. It is also classified as a controlled drug. At Menopause Care, we rarely prescribe Gabapentin and Pregabalin because of this.
Alternatives to medication for menopause symptoms
If HRT isn’t for you, and you don’t wish to take any prescribable medication, you might wonder what options are left for managing menopause symptoms. Fortunately, there are holistic tools that can be used alone or in conjunction with one another.
Yoga
Yoga is a versatile tool for managing menopause symptoms, offering benefits for both the body and mind. Certain yoga practices, like mindfulness and meditation, can help alleviate hot flushes, improve sleep quality, and support cognitive function. Regular sessions also promote relaxation, reduce stress, and build physical strength and flexibility, which are vital during menopause.
Read more about yoga for menopause.
Cold water swimming
Cold water swimming is increasingly recognised for its ability to support physical and mental well-being during menopause. Immersion in cold water may help manage hot flushes by regulating body temperature and promoting circulation. It also boosts endorphin levels, which can enhance mood and reduce stress.
Read more about cold water swimming during menopause.
Reflexology
A practice targeting specific points on the feet, hands, and ears, reflexology can provide relief from a range of menopause symptoms. By stimulating these points, reflexology may help balance hormones and reduce stress levels, potentially easing hot flushes and improving sleep quality. This calming therapy also encourages mindfulness, helping women feel more centred and in control during this transitional phase.
Read more about reflexology for menopause.
Herbal remedies
Herbal remedies such as black cohosh, red clover, and evening primrose oil are popular for managing menopause symptoms without medication. These natural options are believed to help with hot flushes, night sweats, and mood swings although evidence of their efficacy is often limited. It is important that medical conditions and medication interactions must be checked when taking herbal remedies.
Read more about herbal remedies for menopause.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is a structured, evidence-based approach that addresses emotional and physical challenges associated with menopause. It can be particularly effective for managing mood swings, helping to manage hot flushes, anxiety, and sleep disturbances. By combining cognitive training with mindfulness techniques, CBT helps women develop coping strategies to handle stress and improve their quality of life.
Read more about CBT for menopause.
Non-hormonal medications for menopause symptoms may not be right for everyone
Every person’s experience with menopause is unique and what works for one individual may not be optimal for another.
Before starting any medication, it's important to discuss your symptoms, medical history, and preferences with your doctor. They can help determine the most suitable non-hormonal options for you. Our doctors at Menopause Care are all highly trained in discussing your options and formulating a plan that is right for you.
It’s also crucial to be aware of potential side effects associated with each medication. At Menopause Care, our doctors will provide information on what to expect and how to manage any side effects.
We will also tailor a treatment plan that aligns with your specific symptoms and health concerns. To get started, book a consultation with a menopause doctor.
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