It is hard to believe we are at Part 5 of our Menopause Series Are there non-hormone options for menopause? I am hesitant to say final part of the menopause series as I do not think we will ever stop learning about menopause, in fact I hope to continue to learn how to better deal with this life change. In fact I hope you have found useful and valuable information while walking through this series with me.  

As we have reviewed, hormone replacement to treat the hormone-deficient symptoms of menopause while under the supervision of a healthcare provider is very safe and effective.  But there may be reasons that one chooses not to use hormones and approach menopause treatment in other ways.

The most important and safest non-hormone approach involves lifestyle modification.  We know that regular exercise, weight management, smoking cessation and avoidance of known triggers such as hot drinks and alcohol can be safely recommended to manage menopausal symptoms.  Unfortunately, many physicians do not have the time to elaborate on these important wellness regimes.  For whatever reason, our healthcare system has evolved to treat disease and not, necessarily, to heal people.  This may seem counter-intuitive; it does to us.  Within the current system, physicians are afforded very little time to spend discussing ailments, and to conduct a review in physiology or lecture on diet and exercise would detract from answering the, seemingly, more relevant questions that women bring into the office.   As physicians, we are left with a difficult choice of treating a patient for her presenting condition (the one she is asking about), or providing countless hours of support to augment the change necessary to alter lifestyle choices.  Using menopausal symptoms as an impetus to discuss the optimization of healthy eating and exercise habits goes a long way with women interested in avoiding medication.  It is known that decreased fat intake with increased dietary consumption of fruits and vegetables helps to eliminate menopausal vasomotor symptoms and that weight loss also has beneficial effects.  There is mounting evidence that a healthy diet plays an important role in reduction of heart disease, hypertension, diabetes, stroke and various cancers.  

Beyond lifestyle, there are several available options to treat menopausal concerns, however, large, high-quality, long-term data on these preparations is lacking.  Each of these treatments have dosing and side effects considerations and should, also, be taken under the care and supervision of a healthcare provider.  Be sure to tell your provider if you are taking any of these products.

1.Studies on soy and yam products previously revealed some promise in reducing vasomotor symptoms and make theoretical sense given that they are the precursor for many hormones utilized in medicinal products today.  However, the human body lacks the enzymes need to convert these compounds into steroids (hormones) and, therefore, ingesting these phytoestrogens is not effective at reducing menopausal symptoms.

2.Black Cohash (Cimicifuga racemosa), originally an aboriginal remedy, has been found to improve hot flashes and mood in small, short-term studies.  Dosing is difficult due to a lack of regulation of the over-the-counter preparations but usually starts at 20mg tablets taken twice per day and women can expect to wait 2-4 weeks to notice improvements.

3.Evening primrose oil has been well studied and has not proven beneficial for the treatment of vasomotor symptoms.

4.Anti-depressants, namely, selective serotonin re-uptake inhibitors (SSRIs) or selective norepinephrine re-uptake inhibitors (SNRIs) have been found to reduce vasomotor symptoms and stabilize mood for some women.  No single regime has been identified to be better than others and side effects may render these treatments ineffective.  Specifically, SSRI and SNRIs are known to have detrimental effects on sexual response and who needs to deal with that on top of being ragingly menopausal?

5.Gabapentin (Neurontin) is an anti-epileptic medication that seems to quiet vasomotor symptoms in menopause.  It is unclear how it works and use for menopausal treatment in the U.S. remains off-label (not approved).

6.Clonidine decreases hot flushes by quieting the nervous system that makes us feel excited and worked up (sympathetic).  Often used as a treatment for high blood pressure, this medication can cause low blood pressure and other side effects.

7.Vaginal moisturizers are available in non-hormonal compounds.  These can be utilized as a regular, long-acting, treatment for daily vaginal irritation while different, shorter-acting, preparations are available for use specifically for sexual dryness.  Crisco lard, coconut oil, olive oil and vitamin E have been used with some success for personal lubrication and seem quite safe to put into or onto our bodies.

With more women entering menopause than ever before, we can expect the introduction of many new products to the market.  As with all treatments, I recommend watching for FDA approval and bringing questions to your healthcare provider before commencing something new.