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Nonhormonal Management of Menopause Symptoms

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A 2015 article in Menopause lists the five most common menopause-related symptoms: vaginal dryness, hot flashes, night sweats, disrupted sleep, and weight gain. The list goes on to include 11 more symptoms. Only 1 percent of the women studied said they had no symptoms. On average, these symptoms persisted 4 to 5 years after the last period but up to 12 years for some women.

Hormonal approaches to treatment (estrogen-only or estrogen plus progestin or new and recently approved products) are extremely effective in alleviating most symptoms, but some women cannot or choose not to take any hormones. How effective are nonhormonal approaches to treating menopause-related symptoms?

Fortunately, we have very new information published in November 2015 – a Position Statement by NAMS (North American Menopause Society). Their statement reflects a consensus of NAMS experts and is based on study data (as opposed to clinical opinion). The nonhormonal therapies they considered include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and several others. After an extensive review of available studies, NAMS has categorized various therapies as either “recommended,” “recommended with caution,” or “do not recommend at this time.”


  1. Cognitive-behavioral therapy and “to a lesser extent” clinical hypnosis
  2. Paroxetine salt: the only non-hormonal drug approved by the FDA to treat menopause-related symptoms (for more information on this drug, which is usually prescribed to treat depression, click here)
  3. Gabapentinoids: used to treat some seizures and for shingles nerve pain
  4. Clonidine: used to lower blood pressure and to treat ADHD

Recommended with Caution (additional studies needed):

  1. Weight loss
  2. Mindfulness-based stress reduction
  3. The S-equol derivatives of soy isoflavones
  4. Stellate ganglion block: an anesthetic injection usually for pain

Not Recommended at this Time:

Negative, insufficient, or inconclusive data suggest that the following are NOT proven therapies for treating what doctors and researchers call menopause-associated vasomotor symptoms.

  1. Cooling techniques
  2. Avoidance of triggers
  3. Exercise
  4. Yoga
  5. Paced respiration
  6. Relaxation
  7. Over-the-counter supplements and herbal remedies
  8. Acupuncture
  9. Calibration of neural oscillations
  10. Chiropractic interventions

It is important to note the category “not recommended” means there is no evidence that a particular treatment is any better than a placebo. It should not be construed to mean there is no chance the treatment might help some women feel better; even placebos can have a beneficial effect, although that effect tends to be transient. 

Neither does NAMS say the “not recommended” treatments are dangerous. The only risks in trying those treatments are that they are less likely to be effective.  They may also be considered a waste of time and money if used instead of a treatment found to be effective through NAMS comprehensive review of available therapies.

The NAMS position statement adds an important note: “Clinicians need to be well-informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies.”

If you feel that you are not well-informed about which nonhormonal therapy to choose, you are not alone. Between 50 and 80 percent of women use one or more of these therapies, but most tell researchers they feel they don’t know enough and have many concerns about choosing a therapy.

It is important to remember that in addition to symptoms, women must deal with the fact that the estrogen-deficiency associated with menopause can lead to serious diseases such as osteoporosis, depression, cardiovascular disease, vulvovaginal atrophy, and perhaps Alzheimer’s. Many of these can be serious if left untreated. Some form of hormonal therapy may be your best choice if appropriate for you. The EmpowHer site has several relevant articles that can be helpful. Consult with a knowledgeable health care professional. NAMS has a program that certifies trained menopause practitioners. See the NAMS website to find a practitioner near you.


Minkin, MJ, Reiter, S. and Maamari, R. Prevalence of postmenopausal symptoms in North America and Europe; Menopause, Vol.22, No 11. pp.1231 1238, 2015. http://mobile.journals.lww.com/menopausejournal/_layouts/oaks.journals.mobile/articleviewer.aspx?year=2015&issue=11000&article=00012

Nonhormonal management of menopause-associated vasomotor symptoms:2015 position statement of The North American Menopause Society; Vol.22, No.11, pp.1155 1174, 2015. http://www.menopause.org/docs/default-source/professional/pap-pdf-meno-d-15-00241-minus-trim-cme.pdf

Reviewed January 21, 2016
By Michele Blacksberg RN

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.


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