ALTERNATIVES TO MENOPAUSAL HORMONE THERAPY (MHT)
While menopausal hormone therapy (MHT) is the most effective treatment for the symptoms of menopause, it is not suitable for all women. In these cases, the following alternatives can be considered.
LIFESTYLE CHANGES AND NON-MEDICATION ALTERNATIVES
There is limited good-quality research about whether lifestyle and non-medication options improve menopausal symptoms. However, they may improve the tolerability of symptoms for some women while improving general health and wellbeing. Frequently discussed options include:
- Maintaining a healthy weight through a healthy diet and regular exercise.
- Avoiding any triggers you notice, such as spicy foods, alcohol, or smoking.
- Controlling your temperature, for example, by dressing in layers, wearing natural, breathable fabrics, or using a fan or air-conditioning.
- Cognitive behavioural therapy (CBT), a specific type of psychological therapy, can help reduce the impact of menopausal symptoms while improving general wellbeing.
- Hypnosis has been used by some women to reduce their menopause symptoms and improve sleep.
In contrast to the above, therapies such as acupuncture, chiropractic manipulations, reflexology and magnetic therapy have not shown any benefit. If individuals find these methods helpful, continue in conjunction with hormone and non-hormonal medication in the management of menopausal symptoms.
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Supplements can have side effects just like prescribed medications.
NON-HORMONAL MEDICATIONS FOR VASOMOTOR SYMPTOMS
There are various medications that can help manage the symptoms of menopause for women who cannot, or choose not to, take MHT. Though none are as effective as MHT, they are generally safe for those women who cannot take oestrogen.
They include:
- Fezolinetant, known as Veoza in Australia, was specifically designed as a non-hormonal treatment for menopausal symptoms and reduces both the severity and frequency of hot flushes.
- Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and noradrenaline reuptake inhibitors (SNRIs) are used for various conditions, including the treatment of anxiety and depression. For some women, they can reduce the frequency and severity of hot flushes.
- Gabapentin is a drug that is typically used to treat certain types of pain, but it can also reduce hot flushes.
- Oxybutynin is available in patches and tablets and is primarily used to manage incontinence. Additionally, it effectively reduces the frequency and severity of hot flushes, making it particularly helpful for those who experience significant sweating.
- Stellate ganglion block involves an anaesthetic injection around certain nerves in the neck and is an established treatment for pain and migraines. It can also reduce hot flushes for some women.
- Vitamin E may provide some relief from mild hot flushes and sleep disturbances. High doses can increase the risk of bleeding in some women, particularly those taking blood-thinning medications, so it’s important to let your doctor know if you plan to take it. Further research is needed to confirm the benefits and establish guidelines for vitamin E supplementation in menopause management.
These medications can be effective for some women, but not others. They also have their own side effects. It’s therefore important to discuss the options with your doctor and determine the best options for your situation.
Clonidine, commonly prescribed for high blood pressure and migraines, is no longer recommended for treating vasomotor symptoms (VMS) associated with menopause, despite its listing on the Pharmaceutical Benefits Scheme (PBS).
ALTERNATIVE AND COMPLEMENTARY MEDICINE
Alternative and complementary medicines generally have not been shown to be considered effective or safe. They often contain active ingredients that may be plant-based, which can interact with the hormones in your body or other medications you are taking.
Frequently discussed alternative therapies include black cohosh and phytoestrogens (plant-based oestrogens) such as red clover. Evidence suggests that black cohosh may help reduce the frequency and severity of menopausal symptoms like hot flushes and mood disturbances, though results vary and further research is needed. Similarly, red clover isoflavones have shown promise in alleviating menopausal symptoms and possibly benefiting bone density and cardiovascular health, but more consistent evidence is required. Both treatments are generally considered safe, though they should be used under medical supervision, particularly for individuals with breast cancer, as they may interfere with conventional breast cancer treatments.
Long-term safety and efficacy have not been demonstrated for wild yam cream, evening primrose oil, flaxseed, maca, ginseng, kava or dong quai. Importantly, some of these products have potentially dangerous interactions with commonly used medications.
Makers of “bioidentical” compounded hormones claim they are chemically identical to those your body produces. However, there is no evidence supporting either their safety or efficacy. They are often unregulated, so the true hormone dose and the purity of the products may not always be clear. Furthermore, as hormonal products, they carry the same risks as approved MHT products and are not suitable for women who cannot take MHT due to medical reasons. Most experts recommend avoiding their use.
Alternative treatments can have side effects, just like prescribed medications, and there is not enough evidence to establish if they are safe and effective. Some can be dangerous and can interact with other medications, which can be risky. It is essential to speak to your GP or gynaecologist before taking these.
TREATMENTS FOR VAGINAL DRYNESS
A lack of oestrogen in your vagina and vulva can cause dryness, itchiness, inflammation and discomfort during sex. For some women with severe symptoms who cannot take conventional MHT, vaginal oestrogen creams or pessaries may be an effective option. There are also several non-hormonal treatments available, including vaginal moisturisers, lubricants, and gels. If sexual function is a concern, it can often be useful to talk with a sex therapist and engage your partner in the discussion.
The contents of approved prescription medications are strictly regulated, and the introduction of a new medication requires research and evidence showing its efficacy (that it works) and safety. They are also subject to ongoing monitoring after their introduction to ensure no new risks appear. For this reason, it is recommended to use approved prescription medications for menopausal hormone therapy.
You may see “natural” hormones marketed for the management of menopausal symptoms, but it is important to recognise that these are not governed by the same strict requirements as conventional medications and generally lack evidence of either their efficacy or safety. Furthermore, they may interact with other medications you are taking or might be dangerous, depending on your health background. MHT, as prescribed by your doctor, has been extensively researched over many decades, and its efficacy and safety profile are clear. If you are thinking about using alternative medications, we recommend you discuss this with your doctor.