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Non-hormonal treatments for menopause are sometimes overshadowed, but not everyone can or wants to take HRT. This blog will cover the non-hormonal treatments for menopause that are available, including for those with hormone sensitive breast cancer and menopause.
I’ll be focusing on prescribed medications, what’s available now and new developments that are coming soon. Much of the available evidence is for vasomotor symptoms like hot flushes and night sweats, but some medications can also help with sleep, anxiety, low mood and pain.
Antidepressants for menopausal symptoms
Antidepressants are the most widely used group of non-hormonal treatments for menopause symptoms. Aswell as helping with anxiety and low mood, they can reduce hot flushes by up to 50%. High doses of antidepressants are not usually required to see the benefits. Some women respond better to one antidepressant than others, so it can be a matter of trial and error to see if you respond to a particular medication.
Not all of the antidepressants are suitable for all women with breast cancer to take. Some (Sertraline, Fluoxetine, Paroxetine) can reduce the effectiveness of Tamoxifen treatment. Others (for example Venlafaxine) are safe with Tamoxifen treatment.
Antidepressants are recognised for treatment in women with breast cancer and menopause but not licensed for this use. They are included as recommended options in the British Menopause Society consensus statement “Non-hormonal-based treatments for menopausal symptoms”.
Initial side-effects of antidepressants can include nausea, dizziness and increased anxiety. These effects are usually transient and settle over time. It can help to start with a low dosage. Sexual dysfunction is a recognised possible side-effect of all antidepressants, and unfortunately does not always improve when the medication is stopped.
Gabapentinoids for menopausal symptoms
Gabapentin is used for the treatment of epilepsy and nerve pain. It is used for menopausal symptoms in women with breast cancer but not licensed for this use, and can help with vasomotor symptoms, sleep and pain.
Pregabalin is used for the treatment of epilepsy and anxiety. It is used for menopausal symptoms in women with breast cancer but not licensed for this use, and can help with vasomotor symptoms and low mood.
Both drugs have been designated as controlled drugs due to the risk of abuse, and the effects can be increased by alcohol, leading to drowsiness and sedation. Side-effects can include weight gain, dry mouth, dizziness and drowsiness.
Clonidine for menopausal symptoms
Clonidine is the only licensed non-hormonal treatment for menopausal symptoms.
It reduces blood pressure, and so is not suitable for those who have a low blood pressure. It is important to reduce the dosage gradually on stopping treatment to prevent a rebound increase in blood pressure. Side-effects can include sleep disturbance (especially at higher doses), dry mouth, nausea and fatigue.
Oxybutynin for menopausal symptoms
Oxybutynin is prescribed for urinary frequency, urgency and urge incontinence. In one relatively small randomised controlled trial, oxybutynin improved sleep quality and vasomotor symptoms. It is not currently included in the British Menopause Society consensus statement “Non-hormonal-based treatments for menopausal symptoms”.
Side-effects are common, including a dry mouth, constipation, blurred vision and dizziness. Using oxybutynin in the patch formulation rather than the tablet formulation can moderate these effects.
Neurokinin receptor 3 (NK3) antagonists for menopausal symptoms
The exciting new development is an entirely new class of drug, the NK3 antagonists, which had remarkable effects for some people in the trials “switching off” their hot flushes within just a few days. Currently they are not able to be prescribed in the UK, but will hopefully be approved for use soon. They have been approved for use by the FDA in America.
For more info
Women’s Health Concern