“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

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?

On pages one and two in Nonhormone Treatments for Hot Flashes and Night Sweats, published July 2023, the NAMS 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”.2

What are VMS?

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

2023 Nonhormone Therapy Position Statement of The North American Menopause Society

What were the Results 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 – 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)”.3

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”.4

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”.5

Where may I find Links to Fezolinetant?

Your Country may have Links similar to:

Fezolinetant (Veozah), United Kingdom

Where may I find Links about the (United Kingdom) Medicines & Healthcare Products Regulatory Agency (MHRA) licensing Veozah?

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”.6

Alternative Therapies

Can alternative therapies 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 one of the recommendations is:

  • “Alternative therapies, including cognitive behavioural therapy, may also improve hot flushes, nights sweats and other menopausal symptoms and can be considered in women who do not wish to take HRT or have contraindications to taking HRT”.7

What is HRT?

HRT can be an abbreviation for Hormone Replacement Therapy.

What do the EMAS note about some 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”.8

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”.9

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”.10

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: Paroxetine and fluoxetine can reduce the effectiveness of some cancer treatment medications”.11

In Hot Flashes: Diagnosis & Treatment – Treatment: Antidepressants, dated 12 December 2023, the (United States) Mayo Clinic elaborate on:

“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”.12

Other Medications

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

In Hot Flashes: Diagnosis & Treatment – Treatment: Other Prescription Medications the Mayo Clinic explain:

“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
  • Fezolinetant (Veozah). Veozah is a medicine for treating menopause hot flashes. It doesn’t have any hormones. It works by blocking a pathway in the brain that helps to regulate body temperature. You take a pill once a day by mouth. Side effects include belly pain, diarrhea, difficulty sleeping, back pain, hot flushes and elevated liver enzymes. People with liver disease should not take this medicine”.13

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”.14

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”.15

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”.16

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 known as stellate ganglian block has shown promise for treating moderate to severe hot flashes, but more research is needed. It involves injecting an anesthetic into a nerve cluster in the neck. The treatment has 8been used for pain management. Side effects include pain and bruising at the injection site”.17

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?”18

In the NICE Guideline Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause the (British) National Institute for Health and Care Excellence (NICE), include these and more questions to ask about Treatment for Menopausal Symptoms:

  • “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?…”.19

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”.20

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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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: 12 December 2023
  2. Nonhormone Treatments for Hot Flashes and Night Sweats. July 2023:1-2. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/nonhormone-treatment-menonote.pdf Accessed: 12 December 2023
  3. 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: 12 December 2023
  4. 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: 12 December 2023
  5. 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: 12 December 2023
  6. 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. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 12 December 2023
  7. 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: 12 December 2023
  8. 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: 12 December 2023
  9. 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: 12 December 2023
  10. Nonhormone Treatments for Hot Flashes and Night Sweats. July 2023:2. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/nonhormone-treatment-menonote.pdf Accessed: 12 December 2023
  11. Menopause Management Options: Non Hormonal Prescription Medications: Antidepressants. Last Updated: 07 December 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 12 December 2023
  12. Hot Flashes: Diagnosis & Treatment – Treatment: Antidepressants. 12 December 2023. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 12 December 2023
  13. Hot Flashes: Diagnosis & Treatment – Treatment: Other Prescription Medications. 12 December 2023. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 12 December 2023
  14. 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: 12 December 2023
  15. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement. 07 July 2022. North American Menopause Societyhttps://www.menopause.org/docs/default-source/press-release/ht-position-statement-release.pdf Accessed: 12 December 2023
  16. 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: 12 December 2023
  17. Hot Flashes: Diagnosis & Treatment – Treatment: Nerve Block Procedures. 12 December 2023. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 12 December 2023
  18. Menopause Treatment: Questions for Your Healthcare Provider. 24 January 2022. Endocrine Society https://www.endocrine.org/patient-engagement/endocrine-library/menopause-treatment Accessed: 12 December 2023
  19. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause. Treatment for Menopausal Symptoms. Published Date: 12 November 2015. Last Updated: 05 December 2019. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/NG23/ifp/chapter/Questions-to-ask-about-menopause Accessed: 12 December 2023
  20. Complementary & Alternative Therapies: Non Hormonal Treatments for Menopause Symptoms. Review Date: November 2023. Women’s Health Concern https://www.womens-health-concern.org/help-and-advice/factsheets/complementaryalternative-therapies-menopausal-women/ Accessed: 12 December 2023
Topic Last Updated: 29 December 2023 – Topic Last Reviewed: 12 December 2023

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