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. 
• Limited research has shown that the drug oxybutynin—which is currently approved for treating overactive bladder—may reduce hotflashes. 

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 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.