Treating Menopause Symptoms: Which Non-Hormonal Therapies Really Work?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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While hormone treatments are the most effective medications for menopausal symptom relief, the thought of them potentially causing breast cancer, stroke or heart disease gives many patients pause. As it turns out, there are many well-studied alternatives to hormones for menopause symptoms. Whether you have insomnia, irritability or vaginal dryness, let’s take a look at your options.



Hot flashes, insomnia and mood changes

Common non-hormone options here include SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors) and anti-epileptics. Read on.


SSRI and SNRI antidepressants

Antidepressants in the SSRI and SNRI drug classes are some of the most effective alternatives to hormone therapy for hot flashes, insomnia and mood changes during menopause. And cool fact: SSRIs and SNRIs tend to work faster for menopause symptoms (days) than for depression (weeks). 

The following antidepressants seem to have similarly modest benefits for hot flashes. Since hot flashes eventually go away in postmenopausal women, these antidepressants can be gradually tapered after one to two years.




Anti-epileptic medications like gabapentin (Neurontin) and pregabalin (Lyrica) are another good non-hormone option for women with hot flashes from menopause.


Vaginal atrophy

Vaginal dryness, irritation and pain during intercourse (known as dyspareunia) are common symptoms of vaginal atrophy, a hallmark sign of menopause. Vaginal atrophy is where the vaginal tissues become thin as a result of low estrogen levels. Vaginal lubricants, vaginal moisturizers and CO2 laser therapy may be helpful here.


What has worked for you?


Dr O.


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