“Alternative therapies, including cognitive behavioural
therapy, may also improve hot flushes, nights sweats
and other menopausal symptoms and…”.1

Umbrella

What may the Hormone Therapy Alternatives Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Antidepressants
  • Bioidentical Hormone Therapy
  • Clonidine
  • Complementary Medicine (CM)
  • Complementary and Alternative Medicine (CAM)
  • Complementary and Integrative Health (CIH)
  • Gabapentin (Neurontin)
  • Herbal Medicines
  • Holistic Care
  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Hormone Therapy Alternatives
  • Menopausal Hormone Therapy (MHT)
  • Menopause Lifestyle Changes/Management
  • Natural Approaches/Medicines/Practices/Products/Remedies/Supplements/Therapies/Treatments
  • Nonhormonal/Non-Hormonal Approaches/Medicines/Practices/Products/Remedies/Supplements/Therapies/Treatments
  • Over the Counter Products
  • Phytoestrogens
  • Pregabalin
  • Tibolone or Livial

Effective or Not

What does The 2023 Practitioner’s Toolkit for Managing Menopause explain about the evidence to prove how effective non-hormonal options are?

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Non-Hormonal Options With Evidence To Support Efficacy, published online 30 October 2023, the authors explain:

“While women are commonly told to avoid VMS triggers and dress in layers, there is no evidence that such advice is of value with respect to the severity or frequency of VMS. Activities such as yoga, mindfulness, relaxation and exercise have health benefits but have not been shown to be meaningful treatments for VMS. Similarly, nutritional supplements and botanicals have not been found to be more effective than placebo for moderately to severely bothersome VMS in robust clinical trials”.2

What are VMS?

VMS can be an abbreviation for Vasomotor Symptoms which include hot flushes and night sweats.

What do the European Menopause Society note about alternative and complementary therapies for menopause symptoms?

In Menopause Wellbeing and Health: A Care Pathway From the European Menopause and Andropause Society: 11. Complementary and Alternative Therapies, published 12 May 2022, the authors note:

“Alternative and complementary therapies are less effective than MHT for the control of climacteric symptoms. They include phytoestrogens, yoga, acupuncture, homoeopathic medicine, mindfulness-based stress reduction, clinical hypnosis and paced respiration. These therapies have modest effects on menopausal symptoms; the evidence is limited by the quality and heterogeneity of studies. Health care providers should take into consideration possible interactions with standard medicines such as anticancer therapies, anticoagulants and antiepileptics”.3

Effective

What non-hormonal therapies have evidence to prove they are effective?

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Non-Hormonal Options With Evidence To Support Efficacy, the authors also note:

“The following non-hormonal therapies have evidence to support their use to alleviate VMS.

The selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are effective in some, but not all, women with VMS…

Fezolinetant is a neurokinin 3B receptor antagonist that acts centrally in the brain to reduce VMS. It may improve sleep quality by reducing nocturnal VMS. Fezolinetant has been approved for the treatment of VMS at a dose of 45 mg/day in some countries.

Low-dose oxybutynin has been found to be effective for treatment of VMS either as a standard low-dose or extended-release formulation.

Other potential, but probably less effective, options include clonidine and gabapentin/pregabalin. Clonidine may be prescribed for VMS for women who cannot take estrogen at a dose of 100–150 μg/day, although the effect is modest and it is not consistently recommended…

Hypnosis may diminish VMS frequency and severity in postmenopausal women and can be considered a treatment option for women who are unable to take MHT.

Cognitive behavior therapy employs psychotherapeutic behavior modification to help women deal with VMS. Cognitive behavior therapy has been shown to significantly reduce VMS.

Stellate ganglion blockade at the anterolateral aspect of the C6 vertebra on the right side under fluoroscopy can alleviate severe VMS for up to 12 weeks. This procedure requires a highly skilled practitioner and availability is scant”.4

Non Hormone Treatments for Hot Flashes and Night Sweats

What does the North American Menopause Society’s (NAMS) Non Hormone Treatments for Hot Flashes and Night Sweats explain about nonhormone treatments?

On pages one and two in Nonhormone Treatments for Hot Flashes and Night Sweats, published July 2023, the North American Menopause Society (NAMS) now (the Menopause Society) explain:

Hormone Therapy AlternativesNonhormone Treatment Options

Recommended
The treatments with research showing they are effective for treating VMS include:

  • Clinical Hypnosis…
  • Cognitive-Behavioral Therapy…
  • Fezolinetant
  • Gabapentin
  • Oxybutynin
  • SSRIs/SNRIs
  • Stellate Ganglion Block
  • Weight Loss

Not Recommended

Treatments not recommended for VMS either because there is evidence showing that they do not reduce VMS or because there is not enough evidence showing that they are effective in reducing VMS include acupuncture, paced respirations, supplements/herbal remedies, cooling techniques, avoidance of triggers, dietary modification, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, cannabinoids, calibration of neural oscillations, chiropractic interventions, clonidine, and pregabalin”.5

2023 Nonhormone Therapy Position Statement of The North American Menopause Society

What were the Results in the 2023 Nonhormone Therapy Position Statement of the NAMS?

On page one in The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society: Abstract – Results, published May 2023, the results were:

Results: Evidence-based review of the literature resulted in several nonhormone options for the treatment of vasomotor symptoms.

Recommended: Cognitive-behavioral therapy, clinical hypnosis, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, gabapentin, fezolinetant (Level I); oxybutynin (Levels I-II); weight loss, stellate ganglion block (Levels II-III).

Not recommended: Paced respiration (Level I); supplements/herbal remedies (Levels I-II); cooling techniques, avoiding triggers, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, soy foods and soy extracts, soy metabolite equol, cannabinoids, acupuncture, calibration of neural oscillations (Level II); chiropractic interventions, clonidine; (Levels I-III); dietary modification and pregabalin (Level III)”.6

What do the Levels mean in the 2023 Nonhormone Therapy Position Statement of The North American Menopause Society?

On page one in the The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society: Abstract – Methods the North American Menopause Society (NAMS) elaborate on:

Methods: The panel assessed the most current and available literature to determine whether to recommend or not recommend use based on these levels of evidence:

  • Level I, good and consistent scientific evidence
  • Level II, limited or inconsistent scientific evidence
  • Level III, consensus and expert opinion”.7

Where may I find Links related to the 2023 Nonhormone Therapy Position Statement of The North American Menopause Society?

Your Country may have Links similar to:

Fezolinetant (Veozah), United States

In the United States, has Fezolinetant (Veozah) been approved for the treatment of moderate to severe vasomotor symptoms, or hot flashes, caused by menopause?

In FDA Approves Novel Drug To Treat Moderate To Severe Hot Flashes Caused By Menopause, published 12 May 2023, the (United States) Food and Drug Administration (FDA) explain:

“Today, the U.S. Food and Drug Administration approved Veozah (fezolinetant), an oral medication for the treatment of moderate to severe vasomotor symptoms, or hot flashes, caused by menopause. Veozah is the first neurokinin 3 (NK3) receptor antagonist approved by the FDA to treat moderate to severe hot flashes from menopause. It works by binding to and blocking the activities of the NK3 receptor, which plays a role in the brain’s regulation of body temperature”.8

Where may I find Links to Fezolinetant?

Your Country may have Links similar to:

Healthy Lifestyle

Can a healthy lifestyle improve menopause symptoms?

On page one in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published online 10 June 2022, one of the recommendations is:

  • “Women should be advised that implementing or maintaining a healthy lifestyle can improve menopause symptoms. A healthy diet (one low in saturated fat and salt and rich in calcium and vitamin D), stopping smoking, reducing alcohol intake and including regular exercise can be beneficial. Reducing caffeine intake may also improve symptoms”.9

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Considerations for All Women At Menopause the authors explain:

“The importance of improving lifestyle factors such as good nutrition, being physically active, cessation of smoking, limiting alcohol and stress management should be highlighted, as healthy behaviors confer benefits to all women”.10

Cognitive Behavioral Therapy

Is Cognitive Behavioural Therapy (CBT) effective in managing hot flushes?

In Harness the Power of Your Mind To Beat Hot Flushes: It’s the Symptom That Plagues So Many Menopausal Women — and Now Here’s A Drug-Free Way That’s Proven To Tackle It the authors elaborate on:

Cognitive Behavioural Therapy“…CBT, by changing behaviours and thought patterns surrounding hot flushes, can dramatically reduce their frequency, duration and intensity. It can also help ease menopausal symptoms such as low mood and poor sleep. It effectively targets the vicious cycle so symptoms become more manageable and mood improves”.11

Dietary Supplements

Can dietary supplements improve menopause symptoms?

On page two in Nonhormone Treatments for Hot Flashes and Night Sweats the NAMS explain:

“There are many dietary supplements available over the counter and advertised as remedies for relief of hot flashes and night sweats. There are limited studies showing that these supplements are effective at relieving VMS, and there is a lack of government regulation ensuring their safety and purity, so none of these are recommended treatments for hot flashes and night sweats.

Despite the lack of evidence supporting their use for VMS, if you plan to use dietary supplements, let your health care professional know so they can ensure they are safe for you, that they don’t interact with any of your medications, and so that they can be appropriately monitored”.12

Antidepressants

Can some antidepressants reduce menopause symptoms?

In Menopause Management Options: Non-Hormonal Prescription Medications – Antidepressants the (Australian) Jean Hailes for Women’s Health note:

“Some antidepressants have been shown to relieve hot flushes. For example, venlafaxine, paroxetine, escitalopram and fluoxetine. Side effects may include nausea, dry mouth, hot flushes, sweats and insomnia.

Note that paroxetine and fluoxetine can reduce the effectiveness of some cancer treatment medicines”.13

In Hot Flashes: Diagnosis & Treatment – Treatment: Antidepressants, dated 04 March 2025, the (United States) Mayo Clinic elaborate on:

“The U.S. Food and Drug Administration approves only one treatment that doesn’t use hormones for hot flashes. The treatment is a low-dose form of paroxetine (Brisdelle).

Other antidepressants that have been used to treat hot flashes include:

  • Venlafaxine (Effexor XR)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)

Antidepressants don’t work as well as hormone therapy for strong hot flashes. But they can help people who can’t use hormones. Possible side effects include nausea, trouble sleeping or feeling sleepy, weight gain, dry mouth or trouble having sex”.14

Other Medications

Apart from antidepressants, can some other medications improve menopause symptoms?

In Hot Flashes: Diagnosis & Treatment – Treatment: Other Prescription Medicines, dated 04 March 2025, the Mayo Clinic also explain:

“Other medicines that might offer relief for some people include:

  • Gabapentin (Neurontin, Gralise, Others). This antiseizure medicine helps ease hot flashes. Side effects can include being drowsy, dizzy or tired and swelling in the arms and legs, called edema
  • Pregabalin (Lyrica). This is another anti-seizure medicine that can help ease hot flashes. Side effects can include being drowsy and dizzy, having trouble focusing, and gaining weight
  • Oxybutynin (Oxytrol). This is a pill or patch most often used to treat urinary conditions like overactive bladder. It also may help ease hot flashes in some people. Side effects can include dry mouth, dry eyes, having nausea, and being constipated and dizzy
  • Clonidine (Catapres-TTS 1, Nexiclon Xr, Others). This pill or patch mostly used to treat high blood pressure, might give some relief from hot flashes. Side effects include being dizzy, drowsy and constipated and having a dry mouth
  • Fezolinetant (Veozah). This daily pill treats menopause hot flashes without hormones. It works by blocking a pathway in the brain that helps to manage body temperature”.15

Bioidentical Hormone Therapy

Can bioidentical hormone therapy improve menopause symptoms?

On page four in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published online 10 June 2022, one of the recommendations is:

  • “The use of compounded bioidentical hormone replacement therapies is not recommended given the issues related to their purity, potency and safety. The potential benefits of bioidentical hormone therapy can be achieved using conventionally licensed products available through NHS prescribing without having to resort to compounded varieties from specialist pharmacies”.16

On page two in the The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement the NAMS also note:

“Compounded bioidentical hormone therapy presents safety concerns, such as minimal government regulation and monitoring, overdosing or underdosing, presence of impurities or lack of sterility, lack of scientific efficacy and safety data, and lack of a label outlining risks”.17

In Is It Really ‘FDA Approved?’ The FDA Doesn’t Approve Compounded Drugs the FDA caution:

“Be aware that compounded drugs are not FDA approved”.18

Nerve Block Procedure

Can a nerve block procedure be used to treat moderate to severe hot flushes?

In Hot Flashes: Diagnosis & Treatment – Treatment: Nerve Block Procedure the Mayo Clinic note:

“A procedure called a stellate ganglion block has shown promise for treating moderate to strong hot flashes. It involves shooting a numbing medicine into a nerve cluster in the neck”.19

Questions To Ask

What may be questions to ask about HT alternatives?

In Menopause Treatment: Questions for Your Healthcare Provider the (United States) Endocrine Society include:

  • “What do you think are possible triggers for my hot flashes?
  • Are there any lifestyle or dietary interventions that may diminish my symptoms?
  • Should I consider medication for treatment of my symptoms? Hormonal or non-hormonal?
  • If you are interested in hormonal therapy: Am I a good candidate for hormonal therapy, specifically are my cardiovascular and breast cancer risks low?
  • Which lifestyle changes can I make that will decrease my menopause symptoms without medicine?
  • Are there any alternative medicine treatments you would recommend I try for relief of my menopause symptoms?
  • Are there any alternative medicines I should not use because they could interfere with medicines I take?”20

Health Care Provider

What if I would like to find out about HT alternatives?

If you would like to find out about HT alternatives, it may be in your best interest to choose to talk to your health care provider about this. Together you can discuss your options and if required, agree on who may be the most appropriate health care provider to help you.

On page one in Complementary & Alternative Therapies: Non Hormonal Treatments for Menopause Symptoms the (British) Women’s Health Concern caution:

“One of the powerful messages coming from the NICE Guideline is that herbal remedies which are not regulated by a medicine authority should not be considered safe for all, as there is much variety in their effectiveness and potency and that there may be significant side effects or interactions. The same warning is given for compounded bioidentical hormone therapy which is also not regulated or subject to the same quality control as conventional HRT”.21

Health Topics A-Z

Where may I find Health Topics A-Z related to Hormone Therapy Alternatives?

In Health Topics A-Z you may find:

Links

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Your Country may have Links similar to:

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published Online 10 June 2022:1-2. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 27 April 2025
  2. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Non-Hormonal Options With Evidence To Support Efficacy. First Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 27 April 2025
  3. Lambrinoudaki et al. Menopause Wellbeing and Health: A Care Pathway From the European Menopause and Andropause Society: 11. Complementary and Alternative Therapies. Published: 12 May 2022. https://www.maturitas.org/article/S0378-5122(22)00090-1/fulltext Accessed: 27 April 2025
  4. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Non-Hormonal Options With Evidence To Support Efficacy. First Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 27 April 2025
  5. Nonhormone Treatments for Hot Flashes and Night Sweats. July 2023:1-2. North American Menopause Society https://menopause.org/wp-content/uploads/default-document-library/nonhormone-treatment-menonote_f5afc19f-211e-4c1f-8a04-b2d558c6fa66.pdf Accessed: 27 April 2025
  6. The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society: Abstract – Results. May 2023. North American Menopause Society https://journals.lww.com/menopausejournal/Abstract/2023/06000/The_2023_nonhormone_therapy_position_statement_of.4.aspx Accessed: 27 April 2025
  7. The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society: Abstract – Methods. May 2023. North American Menopause Society https://journals.lww.com/menopausejournal/Abstract/2023/06000/The_2023_nonhormone_therapy_position_statement_of.4.aspx Accessed: 27 April 2025
  8. FDA Approves Novel Drug To Treat Moderate To Severe Hot Flashes Caused By Menopause. 12 May 2023. Food and Drug Administration https://www.fda.gov/news-events/press-announcements/fda-approves-novel-drug-treat-moderate-severe-hot-flashes-caused-menopause Accessed: 27 April 2025
  9. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published Online 10 June 2022:1-2. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 27 April 2025
  10. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Considerations for All Women At Menopause. First Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 27 April 2025
  11. Hunter, M. and Smith, M. Harness the Power of Your Mind To Beat Hot Flushes: It’s the Symptom That Plagues So Many Menopausal Women — and Now Here’s A Drug-Free Way That’s Proven To Tackle It. 26 January 2021 https://www.dailymail.co.uk/health/article-9185969/Harness-power-mind-beat-hot-flushes.html Accessed: 27 April 2025
  12. Nonhormone Treatments for Hot Flashes and Night Sweats. July 2023:2. North American Menopause Society https://menopause.org/wp-content/uploads/default-document-library/nonhormone-treatment-menonote_f5afc19f-211e-4c1f-8a04-b2d558c6fa66.pdf Accessed: 27 April 2025
  13. Menopause Management Options: Non Hormonal Prescription Medications: Antidepressants. Last Updated: 24 April 2025 | Last Reviewed: 22 April 2025. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 27 April 2025
  14. Hot Flashes: Diagnosis & Treatment – Treatment: Antidepressants. 04 March 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 27 April 2025
  15. Hot Flashes: Diagnosis & Treatment – Treatment: Other Prescription Mediciness. 04 March 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 27 April 2025
  16. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published Online 10 June 2022:4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 27 April 2025
  17. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement. 07 July 2022:2. North American Menopause Society https://menopause.org/wp-content/uploads/press-release/ht-position-statement-release.pdf Accessed: 27 April 2025
  18. Is It Really ‘FDA Approved?’ FDA Doesn’t Approve Compounded Drugs. Content Current As of: 10 May 2022.  Food and Drug Administration https://www.fda.gov/forconsumers/consumerupdates/ucm047470.htm Accessed: 27 April 2025
  19. Hot Flashes: Diagnosis & Treatment – Treatment: Nerve Block Procedures. 04 March 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 27 April 2025
  20. Menopause Treatment: Questions for Your Healthcare Provider. 24 January 2022. Endocrine Society https://www.endocrine.org/patient-engagement/endocrine-library/menopause-treatment Accessed: 27 April 2025
  21. Complementary & Alternative Therapies: Non Hormonal Treatments for Menopause Symptoms. Review Date: November 2024. Women’s Health Concern https://www.womens-health-concern.org/help-and-advice/factsheets/complementaryalternative-therapies-menopausal-women/ Accessed: 27 April 2025
Topic Last Updated: 30 April 2025 – Topic Last Reviewed: 27 April 2025