Beyond Hormones: Alternative & Non-Hormonal Treatments for Menopause
Not Ready for Hormone Therapy? You Still Have Options
Menopause is a major transition, and while hormone therapy (HT) is the gold standard for symptom relief, it’s not for everyone. Some women have medical contraindications, while others prefer non-hormonal or alternative approaches to managing hot flashes, mood swings, sleep disturbances, and vaginal discomfort.
The good news? Research supports a range of effective non-hormonal options—from prescription medications to alternative therapies. This blog explores the latest evidence-based treatments to help you find the right approach for your menopause journey.
Non-Hormonal Prescription Treatments for Menopause
While hormone therapy replaces estrogen, these non-hormonal prescription medications work by targeting the nervous system pathways that trigger hot flashes, sleep disturbances, and mood swings.
1. Antidepressants (SSRIs & SNRIs) for Hot Flashes & Mood
Certain antidepressants have been shown to reduce hot flashes by 50-60% by modulating serotonin and norepinephrine, two neurotransmitters involved in temperature regulation.
Paroxetine (Brisdelle) – FDA-approved for menopause-related hot flashes
Venlafaxine (Effexor) & Desvenlafaxine (Pristiq) – Shown to reduce hot flash frequency and severity
Citalopram (Celexa) & Escitalopram (Lexapro) – Improve mood and hot flashes with fewer side effects
These can be an excellent option for women who also struggle with menopause-related anxiety or depression.
2. Gabapentinoids for Hot Flashes & Sleep
Gabapentin (Neurontin) & Pregabalin (Lyrica) – Originally designed for nerve pain, these help reduce hot flashes and improve sleep.
Best for: Women who can’t take hormone therapy and experience hot flashes & night sweats that disrupt sleep.
3. Clonidine for Hot Flashes & Blood Pressure Support
A blood pressure medication that can modestly reduce hot flashes.
Not the first-line option, but may be helpful for women who also have high blood pressure.
4. New Non-Hormonal Therapies: NK3R Antagonists
Fezolinetant (Veoza) – A new class of medication that directly targets hot flashes by blocking neurokinin B receptors in the brain.
Studies show it reduces hot flashes by up to 73% within 3 days!
Currently in clinical trials, but represents an exciting new option.
Alternative & Complementary Approaches to Menopause
Beyond medications, many women turn to alternative treatments for menopause relief. Here’s what the latest research says:
1. Plant-Based Therapies (Phytoestrogens & Herbal Remedies)
Soy Isoflavones & Red Clover – Contain plant-based estrogens that may help reduce hot flashes, but effects are mild and take time to build up.
Black Cohosh – Popular but inconsistent evidence on effectiveness, and some concerns over liver toxicity.
Evening Primrose Oil & Ginseng – No strong evidence for menopause symptom relief, but may help with mood & stress.
Verdict? Soy and red clover have the best research for reducing mild symptoms, but not as effective as hormone therapy.
2. Mind-Body Therapies: Proven Benefits for Menopause
Cognitive Behavioral Therapy (CBT) – Reduces hot flashes, sleep issues, and mood disturbances by changing thought patterns and stress responses.
Clinical Hypnosis – Studies show it reduces hot flashes by up to 74% by promoting deep relaxation.
Yoga & Meditation – Some evidence suggests benefits for mood, sleep, and stress, but minimal impact on hot flashes.
Verdict? CBT and hypnosis are backed by strong evidence, while yoga and meditation are great for stress and overall wellness.
3. Acupuncture: Placebo or Real Relief?
Acupuncture appears to help reduce hot flashes, but when compared to sham acupuncture, the benefits are minimal—suggesting a strong placebo effect.
No harm in trying if you find it relaxing and beneficial.
Verdict? Results are mixed, but some women swear by it for symptom relief.
What About Vaginal & Sexual Health?
Menopause-related vaginal dryness, painful intercourse, and changes in libido are common but highly treatable—even without hormone therapy. Here are the most effective non-hormonal options:
Vaginal Moisturizers & Lubricants
Long-acting vaginal moisturizers (e.g., Revaree, Hyalo GYN) help restore hydration and improve tissue elasticity.
Silicone-based lubricants provide longer-lasting moisture during intercourse compared to water-based formulas.
Prescription Non-Hormonal Treatments
Ospemifene (Osphena) – A non-hormonal oral medication that improves vaginal tissue elasticity and reduces painful intercourse by acting as a selective estrogen receptor modulator (SERM).
Vaginal Laser Therapy – An emerging treatment that stimulates collagen production to improve vaginal tone and function (research is still ongoing).
Best for: Women who can’t or don’t want to use vaginal estrogen.
Non-Hormonal Medications for Low Libido (HSDD)
For women experiencing low sexual desire (Hypoactive Sexual Desire Disorder – HSDD), two FDA-approved treatments are available:
Flibanserin (Addyi) – A daily oral medication that modulates dopamine and serotonin to improve sexual desire in premenopausal women.
Bremelanotide (Vyleesi) – A self-injectable medication used as needed, which activates melanocortin receptors to enhance sexual desire in premenopausal women.
Which Non-Hormonal Treatment is Right for You?
The best approach depends on your symptoms, medical history, and personal preferences. At Evolve, we take a personalized, science-backed approach to menopause wellness, offering:
Comprehensive evaluations & symptom tracking
Personalized non-hormonal & alternative treatment plans
Ongoing support & expert guidance
You deserve relief—without compromise.
