“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

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”.2

In Managing Menopausal Symptoms—Hormone Replacement Therapy Is Not the Only Option! 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”.3

What are vasomotor symptoms?

Vasomotor symptoms include hot flushes and night sweats.

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, first published online 10 June 2022, 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”.4

What is HRT?

HRT can be an abbreviation for Hormone Replacement Therapy.

Natural Products

Can natural products improve 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”.5

Mind and Body Practices

Can mind and body practices improve 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”.6

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…”.7

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

  • “Lifestyle Measures…
  • Tibolone…
  • Antidepressants…
  • Clonidine…
  • Bioidentical or “Natural” Hormones
  • Complementary Therapies…”.8

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…”.9

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

  • “Lifestyle Changes…
  • “Alternative” or Herbal Therapies…
  • Vitamin E…
  • Antidepressants…
  • Gabapentin
  • Clonidine…”.10

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”.11

Cognitive Behavioural Therapy

Can cognitive behavioural therapy reduce 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”.12

Antidepressants

Can some antidepressants reduce menopause symptoms?

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

“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”.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 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”.15

NK3R Antagonists

Can NK3R antagonists improve menopause symptoms?

In Top 10 Medical Innovations for 2022 Unveiled: 7. Non-Hormonal Alternatives for Menopause the (United States) Cleveland Clinic Consult QD elaborate on:

“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

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”.17

On page two in the The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement the North American Menopause Society 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”.18

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

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

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

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  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: 26 November 2022
  2. 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: 26 November 2022
  3. 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: 26 November 2022
  4. 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: 26 November 2022
  5. 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: 26 November 2022
  6. 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: 26 November 2022
  7. 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: 26 November 2022
  8. Hormone Replacement Therapy (HRT): Alternatives. Page Last Reviewed: 09 September 2019. NHS https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/alternatives/ Accessed: 26 November 2022
  9. 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: 26 November 2022
  10. 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: 26 November 2022
  11. 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: 26 November 2022
  12. 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: 26 November 2022
  13. Menopause Management Options: Non Hormonal Prescription Medications: Antidepressants. Last Updated: 08 September 2022 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 26 November 2022
  14. Hot Flashes: Diagnosis & Treatment – Treatment: Antidepressants. 20 May 2022. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 26 November 2022
  15. Hot Flashes: Diagnosis & Treatment – Treatment: Other Prescription Medications. 20 May 2022. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 26 November 2022
  16. Top 10 Medical Innovations for 2022 Unveiled: 7. Non-Hormonal Alternatives for Menopause. Last Updated: 16 February 2022. Cleveland Clinic Consult QD https://consultqd.clevelandclinic.org/top-10-medical-innovations-for-2022-unveiled/ Accessed: 26 November 2022
  17. 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: 26 November 2022
  18. 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: 26 November 2022
  19. 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: 26 November 2022
  20. Menopause Treatment: Questions for Your Healthcare Provider. 24 January 2022. Endocrine Society https://www.endocrine.org/patient-engagement/endocrine-library/menopause-treatment Accessed: 26 November 2022
  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: 26 November 2022
  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: 26 November 2022
Topic Last Updated: 26 November 2022 – Topic Last Reviewed: 26 November 2022

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