How to Treat Menopause Symptoms without Hormones
Learn what your non-hormonal options are when treating your menopausal symptoms.
Last week, I wrote about the controversy over giving menopausal women hormone replacement therapy. As I discussed, it’s not without risks. So are you completely optionless if you decide not to take HRT? No! There are various other ways to treat menopausal symptoms.
How to Treat Menopause Symptoms without Hormones
Like I said in my earlier article, most menopausal symptoms resolve within four years. But for those whose symptoms are truly unbearable and actually decrease quality of life, we do have a few tricks up our sleeves. But because we won’t be replacing the estrogen levels that diminish with menopause and cause all those symptoms, we’ll instead try to tackle symptoms individually, starting with those symptoms that drive you the most crazy.
How to Treat Menopause without Hormone Replacement Therapy (HRT)
So here’s a list of common menopausal symptoms and how you can treat them:
- Dry vaginal tissue or pain with intercourse: As estrogen declines, it stops feeding our genital system, and this area becomes very dry–we call it “atrophic vaginitis,” because the tissue in the vagina literally atrophies a tad, frequently causing intercourse to become painful and unpleasant. I often suggest using extra lubrication during sex, including types with a warming effect. An over-the-counter vaginal moisturizer, such as Replens, used three times a week may also be helpful. But for some, those methods may not be sufficient. In those cases, there are various prescription intravaginal estrogen preparations you can use that are available as a cream, a tablet, and even as a plastic ring that is self-inserted. It tends to work very well, however, it can take up to eight weeks to start feeling a difference.
- Mood swings: When estrogen levels drop, women just don’t feel well and often report having mood swings or depression. I hear this from women nearly every single day. In fact, it’s such a frequent complaint that I make sure to keep a box of tissues in my exam rooms just for this. Hormone levels can change our moods. We just don’t feel “right”. I do find that some anti-depressants seem to work well for my patients with mood changes, depression, and anxiety. These medications take four to six weeks to kick in, but they’re well worth the wait. Relaxation techniques, yoga, meditation, acupuncture, and counseling/therapy are other ways I try to treat my patients’ menopausal mood changes.
- Osteoporosis: Estrogen builds bone. So when it drops, women often experience more of a bone mass decline. Screening for osteoporosis is currently recommended for all women age 65 and higher, or for younger women who have any big risk factors. For more information on how to treat this important health condition, refer to my osteoporosis podcast.
- Hot flashes: I’ll be honest and tell you that nothing seems to work quite as well as HRT for those severe, debilitating hot flashes. And that is the biggest reason women end up taking HRT, hands down. But if you have a history of breast cancer or blood clots, or if you have risk factors for heart attacks or strokes, you may choose not to take HRT—and you’ll have to have that conversation with your doctor. If you choose not to, here are some other options to try:
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Anti-depressants: Anti-depressants such as venlafaxine, fluoxetine, and paroxetine have been shown to reduce hot flashes in some women. And as a bonus, they may improve the mood swings as well!
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Nerve pain/anti-seizure meds: Gabapentin is a medication often used to treat neuropathic pain or seizures that surprisingly may improve hot flashes in some women.
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Anti-hypertensives: Originally a blood pressure medicine, clonidine is typically prescribed as a pill or patch that may help those with hot flashes. Some patients are unable to tolerate its side effects of dry mouth, constipation, and dizziness, however. And it may be a good idea to monitor your blood pressures to make sure it doesn’t go too low while on it.
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Soy products: Products containing soy, like soy milk, have a natural estrogen-like derivative. Naturally, you might think they could possibly help with hot flashes, right? The jury is out on that one, but soy products may be worth a good try!
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Herbals: Herbal products, such as black cohosh, have also been suggested as treatments. The evidence behind these products is also not so strong. And over-the-counter herbal products are not FDA regulated, so we may not be able to tell how harmful they may be, if any. But I do have a few patients who swear by them. Who knows…
A Word About Bioidentical Hormones
If you have suffered from menopausal symptoms, you must have heard the term “bioidentical hormones” by now. The media seems to really have had a field day with this term in recent times, so you may be wondering what biodentical hormones really are. The bioidentical part of the phrase refers to estrogen derivatives from plants and soy, and the hormone part refers to the fact that these derivatives are then modified to look structurally identical to human estrogen–hence the word “hormones.”
There’s a perception that because they are derived from more “natural” means, that they are safer. However, there is no good evidence to support this claim. And many of the national health organizations, including the U.S. Food and Drug Admnistration (FDA) and American College of Obstetricians and Gynecologists (ACOG), have released statements that report on the limited safety and effectiveness of these preparations. These hormones may have similar negative effects as HRT, and we just don’t know it yet. Remember, just because something is labeled as “natural,” it doesn’t mean it’s better or safer.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
Sad Woman image courtesy of Shutterstock
About the Author
Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women’s health and patient education.
