Menopause > Management Without Hormones
Managing menopause without hormones
Although hormone replacement may improve many menopausal symptoms, it is not safe for every woman. Hormone replacement therapy is usually not prescribed to women in the following categories:
- diagnosed with breast, or other hormone-sensitive cancers
- history of blood clots or clotting disorder
- age 60 or older
For women who cannot, or choose not to take hormone replacement, there are nonhormonal options for treating many menopause symptoms. Importantly, in some women, menopausal symptoms may decrease naturally over time. It is important to speak with your doctor and consider referral to a menopause expert to manage persistent symptoms.
Medications
Some of the more common menopausal side effects may respond to non-hormonal medications.
- Hot flashes: Certain antidepressants, called selective serotonin reuptake inhibitors (SSRIs), may relieve hot flashes and other menopausal side effects. Brisdelle is an SSRI with Food and Drug Administration (FDA) approval for treating hot flashes.
- Vaginal symptoms: Vaginal lubricants and moisturizers are widely available and do not require a prescription. Lubricants (e.g. K-Y, Astroglide, and others) can help make sex less uncomfortable, vaginal moisturizers (e.g. K-Y Liquibeads, Replens, Hyalo GYN) are designed to be used on a regular basis (not related to sexual activity).
- Libido: Research has shown the antidepressant, bupropion (Wellbutrin) may improve satisfaction with sexual experience, arousal, and orgasm intensity. Larger studies are needed to confirm these findings.
- Memory or mood changes: Research has shown some benefit from the medication Modafinil, a drug used to treat sleep disorders. Additional research is needed to confirm these findings.
Exercise
Exercise may improve many of the side effects of menopause, including weight gain, sleep disturbances, memory and bone weakening. A type of pelvic muscle strength training known as Kegel exercises may help improve urinary incontinence. Additionally, exercise may help protect against heart disease.It's important to talk with your doctor before starting any exercise routine. Ask for a referral to a licensed physical therapist or exercise physiolgist to help you develop a safe and effective exercise routine.
Supplements
It's important to check with your health care team before taking any supplements.
Vitamins and minerals are important to keep your body functioning properly. Experts recommend trying to get the nutrients needed through a balanced diet. However, in some cases, supplements may be needed. For example, some postmenopausal women may need calcium and vitamin D supplements in order to maintain their bone health.
Companies that make dietary supplements may market them specifically to post-menopausal women. It's important to be cautious of the claims made by these companies. Supplements have shown limited benefit in treating menopausal symptoms, and some supplements may actually be harmful. Because the FDA does not regulate supplements, it cannot guarantee their safety.
Other strategies
- Mindfulness, meditation and cognitive training may improve member and thinking. Hypnosis, yoga, or acupuncture and may relieve hot flashes and improve memory and sleep quality.
- Products such as handheld fans and "chillows" that reduce body temperature have been helpful for some women who experience hot flashes.
- Researchers are studying how well Carbon Dioxide (CO2) laser treatment such as MonaLisa Touch and radiofrequency treatment such as ThermiVa may help. These vaginal treatments do not have FDA approval, and most insurance companies do not cover their costs.
- The North American Menopause Society is an organization for menopause experts. Their website has a tool to help you find a qualified menopause expert in your area.
- The American Physical Therapy Association's ChoosePT.com website allows you to search for a physical therapist in your area.
- The National Certification Commission for Acupuncture and Oriental Medicine has a searchable directory of licensed acupuncturists.
- The American Academy of Sleep Medicine maintains the public-facing website SleepEducation.org that includes a section on finding a sleep center by location.
- Eatright.org, the website for the Academy of Nutrition and Dietetics, has an online tool to find a nutritionist in your area. You can search for nutritionists by specialty, including "cancer," "weight management" and "heart health."
Bone health
- NCT04001088: The Effects of a Novel Probiotic Supplement on Menopausal Symptoms and Bone Health (MPS). This study is will look at the effects of a new supplement on the severity of menopause symptoms (e.g., psychological, somatic, urogenital symptoms) and on bone health in postmenopausal women.
Memory
- NCT03187353: IMProving Executive Function Study (IMPRES). IMPRES is studying the effects of a stimulant medication called Vyvanse® on memory and attention in women who had surgery to remove their ovaries to lower their risk for ovarian cancer (risk-reducing salpingo-oophorectomy or RRSO).
Hot flashes
- NCT04003389: A Study to Find Out How Safe Long-term Treatment With Fezolinetant is in Women With Hot Flashes Going Through Menopause (Skylight 4). The purpose of this study is to find out how safe it is for menopausal women experiencing hot flashes to take fezolinetant long term (up to 52 weeks).
- NCT04003142: A Study to Find Out if Fezolinetant Helps Reduce Moderate to Severe Hot Flashes in Women Going Through Menopause - 2 (Skylight 2.) This study is for women in menopause with moderate to severe hot flashes. The study is looking at different doses of the drug fezolinetant for treating hot flashes.
Vaginal and sexual symptoms
- NCT03520426: Evaluation of Efficacy and Safety of Votiva for Vaginal Rejuvenation. This study will look at the safety and effectiveness of the Votiva device headpieces through radiofrequency for vaginal rejuvenation.
- NCT04001088: The Effects of a Novel Probiotic Supplement on Menopausal Symptoms and Bone Health (MPS). This study is will look at the effects of a new supplement on the severity of menopause symptoms (e.g., psychological, somatic, urogenital symptoms) and on bone health in postmenopausal women.
- NCT03681678: Laser Therapy for Treatment of Urogenital Symptoms in Women. This is a study of women undergoing vaginal treatment with the fractional carbon dioxide (fCO2) laser for various urogenital symptoms.
- NCT03682601: Topical Treatment for Sexual Pain, Vulvar Pain, in Postmenopausal Women Not Taking Estrogens or Similar Hormones. Women on Aromatase Inhibitors or Tamoxifen CAN Enter the Clinical Trial. This trial will study use of topical 10% sinecatechins (a drug derived from green tea) to improve pain during sexual contact or dyspareunia, in postmenopausal women, with vulvovaginal atrophy, not willing or able to use estrogens.