Are you wondering how best to find relief from menopause-related vasomotor symptoms such as hot flashes and night sweats, and genitourinary symptoms like painful urination? Understanding the types and roles of both hormonal and non-hormonal treatment options can help you have more productive discussions with your care team. You do have choices. Learn more about them here.* 

Non-Hormonal Treatments

Non-hormonal treatments are a method many women may use solely or in combination with menopausal hormone therapy (MHT). Non-hormonal treatments are divided into pharmacologic and non-pharmacologic therapies. 

Many of the non-pharmacoligic therapies have less clinical data to support their use as treatments for menopause symptom relief, but some women have found them to be beneficial. Examples of non-pharmacologic therapies are: 

• Cognitive behavioral therapy 
• Clinical hypnosis
• Mindfulness-based stress reduction 
• Weight loss
• Exercise
• Yoga
• Acupuncture
• Herbal therapies

There are a variety of pharmacological treatments with supporting evidence for treating menopause symptoms. These include:

• Serotonin reuptake inhibitors (SSRI) including paroxetine, which is FDA-approved to treat moderate to severe symptoms, are commonly used. 
• Gabapentin with low starting doses has been shown effective, but higher doses may cause dizziness, confusion, fatigue, and mood changes.
• Clonidine has shown some benefit, but can result in low blood pressure, which can be followed by ‘rebound’ high blood pressure when discontinued.
• Anticholinergic medications (such as oxybutynin) can offer relief, but some data associate it with cognitive decline.

A neurokinin B antagonist drug designed to treat hot flashes and night sweats is currently under FDA review. 

Menopausal hormone therapy

Considered more effective than non-hormonal treatments by many experts, MHT can treat symptoms of low estrogen levels such as bone loss, hot flashes, night sweats, and moderate to severe vaginal symptoms. MHT is available in several different formulas.

• Estrogen MHT is available in different routes that include transdermal (through the skin), oral, and vaginal. It can be prescribed as estradiol, which is the form of estrogen made by the ovaries, or a synthetic (chemically manufactured) estrogen. 
• Systemic vaginal estrogens are delivered by a vaginal ring that is replaced in the vagina every 90 days. 
• Local low-dose vaginal estrogens are available in the form of a cream, tablet, insert, or ring. They are designed to treat genitourinary symptoms such as vaginal dryness, irration, burning, and/or itching. 
• Progestogens come in three formulations and must be prescribed to women with a uterus who are taking systemic estrogen, to prevent endometrial cancer. 
• Estrogen-progestogen combinations come in oral and transdermal formulas. They can be prescribed daily or cyclically, where the estrogen is taken daily while the progesterone is taken for only 12-14 days each month. 

While all the above-mentioned MHT formulas are approved by the FDA, some data suggest that transdermal formulations carry a lower risk of blood clots. Experts recommend that you not use MHT if you have a history of breast cancer, stroke, blood clots in the veins, or heart disease. 

There are risks to taking any MHT, but research shows that the benefits can exceed the risks, particularly in women who are less than 10 years past menopause or under 60 years old. If you are outside that range, consult with your doctor to determine the safest and most effective option for you. Understanding the benefits versus risks is key to making the best decisions for your body. 

*Madsen, T. E., Sobel, T., Negash, S., Allen, T. S., Stefanick, M. L., Manson, J. E., & Allison, M. (2023). A Review of Hormone and Non-Hormonal Therapy Options for the Treatment of Menopause. International Journal of Women’s Health, Volume 15, 825–836. https://doi.org/10.2147/ijwh.s379808

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