Non-Hormonal Alternatives For Menopausal Symptoms

Taken from the November/December 2014 issue of the Women's Health Activist Newsletter.

As a result, menopausal women suffering from hot flashes and night sweats now have an even greater impetus to find alternatives to treat their symptoms. The good news is, there are many effective therapies that don’t involve taking hormones!

Non-Drug and Lifestyle Factors

The WHI provided a lot of information about strategies to maintain health after menopause. In addition to the Hormone Therapy (HT) trials, researchers also evaluated a low-fat dietary pattern for the prevention of breast cancer and heart disease. While symptom relief was not the WHI’s primary focus, the investigators reported in 2012 that women who were randomized to the low-fat diet and who had menopausal symptoms at baseline were 14 percent more likely to be asymptomatic after 1 year, compared to the control group.1 This eight-year long trial was important for several reasons: first, that simply studying a major dietary intervention in a large group of people was even possible, and second, that it proved to be risk-free, unlike taking HT. So if women want a safe, hormone-free option to reduce their symptoms, a low-fat diet is a proven alternative — and has the added benefit of lowering ovarian cancer risk.2

In addition to dietary strategies, other trials have examined lifestyle choices and interventions as a means of controlling symptoms, and many of them also work. Simply losing weight (regardless of dietary components) helps greatly as overweight and obesity both contribute to more severe symptoms, based on data from the Study of Women’s Health Across the Nation (SWAN).3 Additionally, the WHI also showed that women on a low-fat diet had an even greater likelihood of symptom elimination if they lost weight (25% and 30% depending on percentage of weight lost).4

Along with diet and weight control, exercise may have a role in symptom control, especially for the most active women. Again, using data from the SWAN cohort, several positive associations were observed for the effect of physical activity (including the practice of yoga) on a variety of symptoms, including hot flashes, pain, total physical functioning, and even psychological well-being. Although this observational study was not conclusive in terms of menopausal symptoms, it adds to the growing body of evidence that staying physically active helps women during the menopausal transition — and provides several subjective and objective health benefits as well, including reduced stress, better mental well-being, improved physical function, higher bone density, and a reduced risk of breast cancer.5 While not a purely scientific declaration, exercising and staying physical active are no-brainers when it comes to maintaining one’s health!

Drug Therapies

When all else fails, women who are still debilitated by menopausal symptoms can try certain drug therapies. They should be aware, however, that these drugs, unlike the aforementioned lifestyle factors, are not completely risk free. Women will need to balance the benefits with the potential side effects in consultation with their doctor.

That said, probably the most well-studied non-hormonal drug treatments for hot flashes are anti-depressants. Interestingly, a majority of the studies were done in women with breast cancer, who are known to have particularly troubling symptoms and also have specific contraindications to HT. Based on the studies, it appears that venlafaxine (Effexor) and paroxetine (Paxil) are the most effective anti-depressants for treating hot flashes.6,7

Paroxetine, a selective serotonin reuptake inhibitor (SSRI), was recently approved by the Food and Drug Administration (FDA) as the only non-hormonal treatment for hot flashes and night sweats; is now available in a repackaged, low-dose formula, named "Brisdelle.”8,9,10 The dosage is 7.5 mg, which is much lower than those used to treat depression and anxiety disorders. And, while the study was large, comprising almost 1,200 women and lasting approximately 6 months, long-term effects aren’t yet known.

There is also particular concern about the use of paroxetine by women who have with breast cancer, as the National Cancer Institute has cautioned that the drug may decrease the effectiveness of tamoxifen and worsen their prognosis.11 Another very important concern about SSRIs and related drugs is that the FDA has required this entire class of medications to carry a black box warning label about possible risk of suicide.

Two other drug therapies that have been evaluated as potential hot flash treatments: the anti-seizure medication Neurontin (gabapentin) and the blood pressure drug Catapres (clonidine). Statistically speaking, both drugs do work. Neurontin seems to require an especially high dose to achieve effectiveness, however, and Catapres, while better than a placebo, has only a small benefit compared to lifestyle interventions or even standard-dose HT.12,13 As with SSRIs, long-term trials of these drugs have not been conducted in symptomatic menopausal women, so it may be best to limit their usage to the shortest time possible.

The bottom line is that women have several proven options to choose among for managing menopausal symptoms. Of course, HT remains the gold standard for symptom relief, but — in light of the drugs’ well-known risks and KEEPS’ reaffirmation that they have no role in preventing heart disease — alternatives for symptom relief deserve more recognition. Lifestyle factors not only work, but also have numerous other health benefits. Non-HT drug therapies are certainly an option, but should be approached with caution until we learn more about their long-term effects.

Jonathan Raymond is a long time member, supporter, and independent writer for the Network. He earned a Graduate Certificate in Women's Health (Clinical) from Chicago Medical School.

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