Hormone Replacement Therapy Alternatives

Medically Reviewed

What if you can’t use hormone replacement therapy (also called menopausal hormonal therapy) for the symptoms of menopause because you are in a high-risk category or are apprehensive about its potential risks and side effects? Alternative remedies are available, although most aren’t as effective. But you may find they relieve symptoms to your satisfaction—without hormone therapy’s risks. Your options include:

Antidepressants. Two types of anti-depressant drugs, selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), can help relieve hot flashes. The U.S. Food and Drug Administration has approved the SNRI paroxetine (Brisdelle, Paxil) to treat vasomotor symptoms, but doctors may prescribe other antidepressants, such as venlafaxine (Effexor), citalopram (Celexa), and escitalopram (Lexapro), off label.

Few studies have been undertaken to compare various antidepressants specifically against each other for symptom relief. Antidepressant side effects can include dizziness, dry mouth, stomach upset, drowsiness, sweating, sexual dysfunction, and nervousness. You should work with your doctor to alleviate any effects you may be experiencing by lowering dosage; the effects may also go away on their own in time.

Antiseizure medication. Gabapentin (Neurontin, Gralise) and pregabalin (Lyrica) are anticonvulsants that can relieve vasomotor symptoms. Potential side effects include dizziness, drowsiness, and impaired memory. Because gabapentin has a sedating effect, it’s best taken at bedtime by women whose night sweats typically awaken them.

Blood pressure medication. Clonidine (Catapres, Kapvay), an antihypertensive drug, has been shown to relieve vasomotor symptoms, but not as effectively as antidepressants or anticonvulsants. Side effects include low blood pressure, dizziness, headache, dry mouth, sedation, and constipation. Consider clonidine if you can’t tolerate other nonhormonal therapies.

Over-the-counter vaginal moisturizers and lubricants. You can relieve vaginal dryness and painful sexual intercourse by employing an intravaginal moisturizer every two to three days or a lubricant just before intercourse.

Lifestyle changes. Although no evidence proves the effectiveness of lifestyle changes, most experts agree certain steps can provide relief, such as avoiding hot-flash triggers, like spicy and hot foods and alcohol and caffeine. Wearing loose, light, layered clothing; drinking cool beverages; keeping your bedroom cool; using fans; reducing stress; and losing weight can help keep you comfortable when hot flashes strike.

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