NonHormonal Treatments for Menopausal Symptoms

KEY POINTS

  • Most non-hormonal treatments only treat hot flushes and night sweats.
  • There is a substantial placebo effect.
  • Non-prescription remedies have generally shown no or minimal benefit.
  • There is evidence that some antidepressants, gabapentin and clonidine all reduce hot flushes.

pdfAMS Nonhormonal Treatments for Menopausal Symptoms459.41 KB

Many women request non-hormonal treatments for menopausal symptoms. This information sheet addresses the evidence concerning safety and efficacy of currently available non-hormonal treatments for menopausal symptoms. These treatments are largely prescribed “off-label” Off-label means use outside the specific purpose for which the drug was approved by Australia’s medicines regulator, the Therapeutic Goods Administration. Doctors prescribing off-label have a responsibility to be well-informed about the product and base its use on scientific evidence. Most non-hormonal treatments only treat hot flushes and night sweats. There are also non-hormonal treatments for vaginal dryness. (Please refer to AMS information sheets Vulvovaginal symptoms after menopause Vaginal health after breast cancer: A guide for patients).

Hot Flushes and Night Sweats (Vasomotor Symptoms)

A hot flush is a sensation of heat involving the whole body and may be associated with redness and sweating. Night sweats are episodes of profuse sweating at night, either alone or just after a hot flush. These symptoms range in severity from minor irritation to a major disruption in quality of life.

Causes:

Non-Hormonal Treatments for Vasomotor Symptoms:

Some cautions:

Lifestyle Changes

Many women will benefit from lifestyle changes, stopping smoking, improving diet and regular exercise. These do not necessarily reduce symptoms but improve overall wellbeing and can make symptoms easier to tolerate. (Please refer to AMS Information Sheet Lifestyle and behavioural modifications for menopausal symptoms). Dressing in layers, avoiding spicy food and avoiding excess alcohol and caffeine may also assist.

“Alternative” or Herbal Therapies  

(Please also refer to AMS Information Sheet Complementary And Herbal Therapies for Hot Flushes).

Vitamin E

Vitamin E is a non-prescription fat-soluble vitamin.

Antidepressants

Several types of antidepressants (SNRI and SSRIs explained below) have been noted in small, short-term studies to reduce hot flushes. Relief, if any, is rapid, unlike for depression where the effect of the medication is often not observed for six to eight weeks. Four weeks is sufficient to establish whether these products will be effective in reducing hot flushes.  These medications should not be taken with any other antidepressants or any substance containing St. John’s Wort and discontinuation should be tapered.

Gabapentin

Gabapentin is an anticonvulsant (an analogue of gamma-aminobutyric acid). It is approved to treat neurological disorders such as seizures and neuropathic pain.

Clonidine

Clonidine is a centrally-acting alpha adrenergic agonist which stimulates particular brain receptors and has been used for many years to lower blood pressure and prevent migraine as well as treat hot flushes.

Ongoing treatment and follow-up

Any treatment for hot flushes needs to be evaluated periodically. Before switching from one treatment to another there may need to be a gradual tapering of medication.

Content updated August 2016

Additional reading – Position Statements.

https://www.menopause.org.au/hp/position-statements/332-emas-position-statement-non-hormonal-management-of-menopausal-vasomotor-symptoms

https://www.menopause.org.au/hp/position-statements/597-nonhormonal-management-of-menopause-associated-vasomotor-symptoms-2015

References

1.   Hickey M, Saunders CM, Stuckey BG. Management of menopausal symptoms in patients with breast cancer: an evidence-based approach. Lancet Oncol 2005;6:687-95.

2.   Franco OH, Chowdhury R, Troup J, et al. Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis. Jama 2016;315:2554-63.

3.   Laakmann E, Grajecki D, Doege K, zu Eulenburg C, Buhling KJ. Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review. Gynecol Endocrinol 2012;28:703-9.

4.   Rada G, Capurro, D., Pantoja, T., Corbalán, J., Moreno, G., Letelier, L.M., Vera, C. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev 2011;Sept 8:CD004923.

5.   Joffe H, Guthrie, K.A., LaCroix, A.Z., Reed, S.D., Ensrud, K.E., Manson, J.E., Newton, K.M., Freeman, E.W., Anderson, G.L., Larson, J.C., Hunt, J., Shifren, J., Rexrode, K.M., Caan, B., Sternfeld, B., Carpenter, .J.S, Cohen, L. Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: a randomized clinical trial. JAMA Intern Med 2014;174:1058-66.

6.   Johns C, Seav SM, Dominick SA, et al. Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions. 2016;156:415-26.

7.   Haque R, Shi J, Schottinger JE, et al. Tamoxifen and Antidepressant Drug Interaction in a Cohort of 16,887 Breast Cancer Survivors. J Natl Cancer Inst 2016;108.

8.   Boekhout AH, Vincent, A.D., Dalesio, O.B., van den Bosch, J., Foekema-Töns, J.H., Adriaansz, S., Sprangers, S., Nuijen, B., Beijnen, J.H., Schellens, J.H. Management of hot flashes in patients who have breast cancer with venlafaxine and clonidine: a randomized, double-blind, placebo-controlled trial. J Clin Oncol 2011;29:3862-8.

 

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This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.  

Content updated September 2018

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