“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…”.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

Alternatives

Apart from hormone therapy (HT), are there alternative ways of controlling menopause symptoms?

Yes. The (United Kingdom) NHS note:

“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

Natural Products

What does the (United States) National Center for Complementary and Integrative Health (NCCIH) explain about natural products for menopause symptoms?

In Menopausal Symptoms: In Depth – What the Science Says About Complementary Health Approaches for Menopause Symptoms: Natural Products the NCCIH explain:

“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

Mind and Body Practices

What does the NCCIH explain about mind and body practices for menopause symptoms?

In Menopausal Symptoms: In Depth – What the Science Says About Complementary Health Approaches for Menopause Symptoms: Mind and Body Practices the NCCIH explain:

“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

Complementary Health Approaches

What are some complementary health approaches for menopause symptoms?

In Menopausal Symptoms: In Depth – What the Science Says About Complementary Health Approaches for Menopause Symptoms the NCCIH elaborate on:

Hormone Therapy Alternatives

  • “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

In Hormone Replacement Therapy (HRT): Alternatives the NHS elaborate on:

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

In Complementary/Alternative Therapies for Menopausal Women: Complementary and Alternative Treatments the (British) Women’s Health Concern (WHC) elaborate on:

  • “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

In NonHormonal Treatments for Menopausal Symptoms the Australasian Menopause Society elaborate on:

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

In Menopause Management the (Australian) Jean Hailes for Women’s Health (JH) elaborate on:

“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

What diet and lifestyle changes may relieve menopause symptoms?

In Managing Menopausal Symptoms—Hormone Replacement Therapy Is Not the Only Option! published on 12 November 2021, the author notes:

“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

What diet and lifestyle changes may relieve menopause symptoms?

In Managing Menopausal Symptoms—Hormone Replacement Therapy Is Not the Only Option! the author also notes:

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

NonHormonal Medications

What nonhormonal medications are available to relieve menopause symptoms?

On page two in Menopause: What Can You Do To Help With Menopause? the JH explain:

  • “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

SSRIs

What are selective serotonin-reuptake inhibitors (SSRIs)?

In Menopause Management: Non-Hormonal Prescription Medications – Antidepressants the JH explain:

“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

In Hot Flashes: Diagnosis & Treatment – Treatment: Antidepressants the (United States) Mayo Clinic explain:

“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 Prescription Medications

What are some other prescription medications?

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”.15

Revised Global Consensus Statement

What is one of the points of consensus about the use of menopausal hormone therapy (MHT) alternatives?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefits/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

  • “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”.16

What is VMS?

VMS can be an abbreviation for Vasomotor Symptoms.

NAMS Position Statement

What is one of the NAMS conclusions in their position statement NonHormonal Management of Menopause-Associated Vasomotor Symptoms?

One of the NAMS conclusions in NonHormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society – Abstract: Conclusions – Recommended is:

“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”.17

Bioidentical Hormone Therapy

What is one of the points of consensus about the use of custom-compounded bioidentical hormone therapy?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT is:

  • “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”.18

In Is It Really ‘FDA Approved?’ FDA Doesn’t Approve Compounded Drugs the (United States) Food and Drug Administration (FDA) caution:

“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”.19

Questions To Ask

What may be questions to ask about HT alternatives?

In Alternative Medicine for Menopause Treatment: Questions To Ask Your Healthcare Team the (United States) Hormone Health Network include:

  • “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?
  • Does my health insurance plan cover the cost of any alternative medicine treatments?
  • Should I see an endocrinologist to help me with my menopause symptoms?”20

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?…”.21

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.

In Complementary/Alternative Therapies for Menopausal Women the WHC caution:

“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”.22

Health Topics A-Z

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Sources

Where may I find the Sources quoted?

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Sources

  1. Hormone Replacement Therapy (HRT): Alternatives. Page Last Reviewed: 09 September 2019. NHS https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/alternatives/ Accessed: 30 November 2021
  2. Hormone Replacement Therapy (HRT): Alternatives. Page Last Reviewed: 09 September 2019. NHS https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/alternatives/ Accessed: 30 November 2021
  3. Menopausal Symptoms: In Depth – What the Science Says About Complementary Health Approaches for Menopause Symptoms: Natural Products. Last Updated: May 2017. National Center for Complementary and Integrative Health https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth Accessed: 30 November 2021
  4. Menopausal Symptoms: In Depth – What the Science Says About Complementary Health Approaches for Menopause Symptoms: Mind and Body Practices. Last Updated: May 2017. National Center for Complementary and Integrative Health https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth Accessed: 30 November 2021
  5. Menopausal Symptoms: In Depth – What the Science Says About Complementary Health Approaches for Menopause Symptoms. Last Updated: May 2017. National Center for Complementary and Integrative Health https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth Accessed: 30 November 2021
  6. Hormone Replacement Therapy (HRT): Alternatives. Page Last Reviewed: 09 September 2019. NHS https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/alternatives/ Accessed: 30 November 2021
  7. Complementary/Alternative Therapies for Menopausal Women: Complementary and Alternative Treatments. Reviewed: September 2020. Women’s Health Concern https://www.womens-health-concern.org/help-and-advice/factsheets/complementaryalternative-therapies-menopausal-women/ Accessed: 30 November 2021
  8. NonHormonal Treatments for Menopausal Symptoms. Content Updated: September 2018. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/600-nonhormonal-treatments-for-menopausal-symptoms Accessed: 30 November 2021
  9. Menopause Management. Last Updated: 13 July 2021 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 30 November 2021
  10. Curry, H. Managing Menopausal Symptoms—Hormone Replacement Therapy Is Not the Only Option! 19 November 2021. https://journals.sagepub.com/doi/10.1177/20533691211063191 Accessed: 30 November 2021
  11. Curry, H. Managing Menopausal Symptoms—Hormone Replacement Therapy Is Not the Only Option! 19 November 2021. https://journals.sagepub.com/doi/10.1177/20533691211063191 Accessed: 30 November 2021
  12. Menopause: What Can You Do To Help With Menopause? Updated September 2018:2. Jean Hailes for Women’s Health https://jeanhailes.org.au/contents/documents/Resources/Fact_sheets/Menopause.pdf Accessed: 30 November 2021
  13. Menopause Management: Non Hormonal Prescription Medications: Antidepressants. Last Updated: 13 July 2021 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 30 November 2021
  14. Hot Flashes: Diagnosis & Treatment – Treatment: Antidepressants. 31 August 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 30 November 2021
  15. Hot Flashes: Diagnosis & Treatment – Treatment: Other Prescription Medications. 31 August 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 30 November 2021
  16. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 30 November 2021
  17. NonHormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society – Abstract: Conclusions – Recommended. Menopause, Vol. 22, No. 11, 2015:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/pap-pdf-meno-d-15-00241-minus-trim-cme.pdf Accessed: 30 November 2021
  18. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314  https://www.imsociety.org/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 30 November 2021
  19. Is It Really ‘FDA Approved?’ FDA Doesn’t Approve Compounded Drugs. Content Current As of: 17 January 2017.  Food and Drug Administration https://www.fda.gov/forconsumers/consumerupdates/ucm047470.htm Accessed: 30 November 2021
  20. Alternative Medicine for Menopause Treatment: Questions To Ask Your Healthcare Team. Hormone Health Network https://www.hormone.org/diseases-and-conditions/menopause/menopause-treatment/alternative-medicine-for-menopause-treatment Accessed: 30 November 2021
  21. 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: 30 November 2021
  22. Complementary/Alternative Therapies for Menopausal Women. Reviewed: September 2020. Women’s Health Concern https://www.womens-health-concern.org/help-and-advice/factsheets/complementaryalternative-therapies-menopausal-women/ Accessed: 30 November 2021

Topic Last Updated: 30 November 2021 – Topic Last Reviewed: 30 November 2021
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