If you’ve had had breast cancer, a heart attack or stroke, you will likely have been advised to avoid menopausal hormone therapy (MHT).  Or maybe you are over the age of 60 and have not had hormone therapy before and have some vascular risk factors and would thus prefer to use non-hormonal therapies.  It is still helpful to see your doctor to discuss treatment options for menopausal symptoms and here are options other than MHT that can help. 

Lifestyle

Stress and sleep deprivation can often worsen menopausal symptoms, so working on these two areas can be helpful.  Some people find reducing alcohol and coffee can be helpful for hot flushes sweats and insomnia too.

Vaginal dryness and urinary frequency

Vaginal moisturisers such as Replens can be helpful for vaginal dryness.  If you have urinary frequency, especially at night, treating this is helpful in improving sleep and therefore other menopausal symptoms.  Vaginal oestrogen cream (eg. Ovestin) is a hormonal treatment but minimally absorbed into the bloodstream, and is very effective when used regularly. If you have had breast cancer it is important to check with your oncologist before using any oestrogen-containing product, but often (unless you are on an aromatase inhibitor treatment) it may be decided that the benefits of using vaginal/urethral oestrogen cream may outweigh risks. Read more here.  

SSRIs and SNRIs (Serotonin-reuptake inhibitors and Serotonin-norepinephrine reuptake inhibitors)

Because hot flushes and sweats are the response of the nervous system to the low oestrogen of menopause, some medications that modulate actions of the nervous system such as the SSRI and SNRI families of antidepressants can be be helpful for hot flushes and sweats and can be a good option for women who also have low mood symptoms.  Examples of SSRIs include Escitalopram and Citalopram, and Venlafaxine is an SNRI that can be helpful for hot flushes and sweats.

Gabapentin

 Another medication that can help with hot flushes and sweats by modulating actions of the nervous system is Gabapentin.  This is a medication that is often used  for nerve pain, and can be sedating, so may be a good option for women who have aches and pains or trouble sleeping.  If needed, Gabapentin can be used together with an SSRI or SNRI.

Oxybutynin

Oxybutynin is a medication traditionally used for an overactive
bladder. Studies show that a dose of 5 mg twice daily will help about
40% of women with flushes and sweats. Side effects of this
medication include a dry mouth, difficulty urinating and abdominal
pain.

Fezolinetant

This is a neurokinin 3 inhibitor, which is a non-hormonal medication that works on the thermoregulatory centre in the brain to reduce flushes. Fezolinetant is not yet registered for use in New Zealand and comes
into the country on a section 29 and is not funded, but can be ordered from some pharmacies.Liver function tests should be normal prior to starting and checked 3 months after starting this
medication.

Stellate ganglion block

This is a “nerve block technique” done by an interventional radiologist (available at the time of writing this article in New Zealand in Christchurch and Auckland).  The procedure involves having some local anaesthetic injected into the stellate ganglion (a nerve bundle in the neck) under ultrasound guidance.  It is not always effective, but for those who find it helpful, the effects of stopping hot flushes can last for 6-12 months or more.  

Finally, good medical care is about weighing the risks and benefits for each person, and regularly reassessing the balance of risks and benefits, rather than applying blanket rules, so if your symptoms persist despite having tried various non-hormonal therapies, you can ask to be referred to a specialist endocrinologist to discuss whether, depending on your particular history and symptoms, there are any adjustments to non-hormonal regimes that may be useful or whether the benefits of MHT might outweigh risks for you, and what regime and monitoring would be safest for you.    

The take-home message is, even if you have been advised not to use hormonal therapies, it’s good to talk to your doctor if you are having troublesome menopausal symptoms as there are a number of non-hormonal treatment options available. 

If you’re looking for even more guidance on navigating perimenopause and menopause, keep an eye out for our App-based course. You can find more info here. 

https://erhassociates.co.nz/empowered-menopause