“If you’re unable to take hormone replacement therapy (HRT) or decide not to, you may want to consider alternative ways of controlling your menopausal symptoms”.²

“Many natural products have been studied for menopause symptoms. However, none has clearly been shown to be helpful. There’s little information on the long-term safety of natural products, and some can have harmful side effects or interact with drugs”.³

“Only a small amount of research has been done on most mind and body practices for menopause symptoms. However, the limited evidence currently available suggests that some of these practices might help to relieve symptoms or make them less bothersome”.⁴

• “Natural Products…
  • Phytoestrogens
  • Black Cohosh…
  • DHEA…
  • Dong Quai…
  • Vitamin E…
  • Other Natural Products…
• Mind and Body Practices…
  • Acupuncture…
  • Hypnotherapy…
  • Mindfulness Meditation…
  • Yoga…
• Other Complementary Approaches
  • Bioidentical Hormones…”.⁵

• “Lifestyle Measures…
• Tibolone…
• Antidepressants…
• Clonidine…
• Bioidentical or “Natural” Hormones
• Complementary Therapies…”.⁶

• “Cognitive Behavioural Therapy (CBT)…
• Herbal Treatments…
  • Black Cohosh…
  • St John’s Wort…
• Isoflavones and Soya Products (Plant substances found in the diet including red clover supplements)
• Acupuncture
• Non Hormonal Prescribed Treatments…
  • Selective Serotonin Re-uptake Inhibitors (SSRI) [Fluoxetine, Paroxetine, Citalopram, Sertraline] and the Serotonin Noradrenaline Re-Uptake Inhibitor/Selective Serotonin Re-Uptake Inhibitors (SSRI-SNRI) [Venlafaxine]…
  • Gamma Aminobutyric Acid (Gabapentin)…
  • Clonidine…
• Treatments for breast cancer survivors…”.⁷

• “Lifestyle Changes…
• “Alternative” or Herbal Therapies…
• Vitamin E…
• Antidepressants…
• Gabapentin
• Clonidine…”.⁸

“Management and treatment of menopausal symptoms depend on each individual woman’s experience.

Healthy living, herbal and complementary therapies (including herbs and phytoestrogens), menopausal hormone therapy, or MHT (formerly called hormone replacement therapy, or HRT), or some non-hormonal prescription medications may assist with symptoms”.⁹

“Diet and lifestyle changes may not only help to reduce early symptoms, but improve later health with beneficial effects on bone health and heart health. In particular, weight loss in general and healthy dietary changes with increased fruit, vegetables and grains instead of saturated fats and processed foods has been shown to be associated with reduced vasomotor symptoms, psychological symptoms and sleep disturbance”.¹⁰

“Cognitive Behavioural Therapy has been shown to reduce vasomotor and psychological symptoms, as well as sleep disturbance”.¹¹

• “If you cannot take MHT, other medications such as antidepressants – selective serotonin (SSRIs) or norepinephrine reuptake inhibitors (SNRIs) – and a chronic pain medicine can reduce hot flushes”.¹²

“A group of antidepressants called SSRIs/SNRIs (selective serotonin or serotonin-norepinephrine reuptake inhibitors – for example, venlafaxine, paroxetine, escitalopram and fluoxetine) have been studied and found to relieve hot flushes. If these medications are going to be effective in reducing hot flushes, they will do so quite quickly. Like all medications, these can have side effects, some examples being nausea, dry mouth and/or insomnia. Paradoxically, sometimes these medications can cause sweats. In breast cancer survivors on tamoxifen, paroxetine and fluoxetine should not be taken as they can reduce the effectiveness of the tamoxifen”.¹³

“A low-dose form of paroxetine (Brisdelle) is the only nonhormone treatment for hot flashes approved by the U.S. Food and Drug Administration. Other antidepressants that have been used to treat hot flashes include:

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

These medications aren’t as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can’t use hormones. Possible side effects include nausea, difficulty sleeping or drowsiness, weight gain, dry mouth or sexual dysfunction”.¹⁴

“Other medications that might offer relief for some women include:

• Gabapentin (Neurontin, Gralise, Others). Gabapentin is an anti-seizure medication that’s moderately effective in reducing hot flashes. Side effects can include drowsiness, dizziness, water retention in the limbs (edema) and fatigue
• Pregabalin (Lyrica). Pregabalin is another anti-seizure medication that can be effective in reducing hot flashes. Side effects can include dizziness, drowsiness, difficulty concentrating and weight gain
• Oxybutynin (Ditropan XL, Oxytrol). Oxybutynin is a pill or patch most often used to treat urinary conditions like overactive bladder. It may also help relieve hot flashes in some women. Side effects can include dry mouth, dry eyes, constipation, nausea and dizziness
• Clonidine (Catapres, Kapvay, Others). Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes. Side effects include dizziness, drowsiness, dry mouth and constipation”.¹⁵

“Fortunately, a new group of nonhormonal drugs, called NK3R antagonists, has emerged as a viable alternative to hormone therapy. These drugs disrupt a signaling pathway in the brain implicated in the development of hot flashes. They have shown promise in clinical trials for relieving moderate to severe menopausal hot flashes as effectively as hormones. While additional studies are needed to fully understand the effectiveness and safety profile of these new drugs, it is clear that the next generation of nonhormonal treatments for menopausal hot flashes is on the horizon”.¹⁶

• “If MHT is contraindicated or not desired for treatment of VMS, selective serotonin reuptake inhibitors and serotoninnorepinephrine reuptake inhibitors such as paroxetine, escitalopram, venlafaxine and desvenlafaxine, which have been shown to be effective in randomized controlled trials (RCTs), may be considered. Gabapentin may also be considered”.¹⁷

“Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy”.¹⁸

• “The use of custom-compounded hormone therapy is not recommended because of lack of regulation, rigorous safety and efficacy testing, batch standardization, and purity measures”.¹⁹

“Compounding is generally a practice in which a pharmacist or a doctor combines ingredients to create medications that meet the needs of individual patients, including those who are allergic to ingredients in FDA-approved medicines or who cannot swallow an FDA-approved pill. But consumers need to be aware that compounded drugs are not FDA approved. This means that FDA does not review applications for compounded drugs to evaluate their safety, effectiveness, or quality”.²⁰

• “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?”²¹

• “What types of treatments are suitable for my symptoms?
• What are the benefits and risks of different treatments?
• Are there any complementary therapies that could help?
• I use complementary therapies for my symptoms – are these safe to take alongside other treatments?…”.²²

“One of the powerful messages coming from the NICE Guidelines is that herbal remedies which are not regulated by a medicine authority should not be considered safer, as there is much variety in their effectiveness and potency and that there may be significant side effects. The same warning is given for bio-identical hormones which are compounded and again not regulated or subject to quality control”.²³