Navigating Menopause Without Hormone Replacement Therapy: Exploring Treatment Options

Although Menopause Hormone Replacement Therapy is the gold standard for addressing vasomotor symptoms (VMS)—such as hot flashes and night sweats—osteoporosis prevention, and genitourinary symptoms of menopause (GSM), there are still options available for women who cannot, or choose not to, take hormones. Our overall belief is that women can and deserve to feel well throughout their lives. Let’s review non-hormonal approaches including pharmaceutical and lifestyle tips.

Various conventional pharmaceuticals can help manage VMS, including Fezolinetant (Veozah), and Brisdelle (low-dose paroxetine), both FDA-approved for women transitioning through menopause. Additionally, some medications that are not specifically FDA-approved for menopause treatment may still be effective, such as SSRIs/SNRIs (like venlafaxine), gabapentin, clonidine, and oxybutynin. For those who prefer non-pharmaceutical options, lifestyle changes and supplements can also provide support. We’ll also dive deeper into these alternatives.

Medications:

Fezolinetant (Veozah)
This new drug has shown a significant reduction in VMS in just one week. Clinical trials have demonstrated its effectiveness, with side effects similar to those seen in the placebo group. Fezolinetant works by acting on the thermoregulatory center (the body’s "thermostat") to block the receptors responsible for hot flashes and night sweats. However, it can cause elevated liver enzymes, so regular blood tests are required before starting the medication and at 3, 6, and 9 months thereafter. This medication should not be taken with drugs that utilize the CYP1A2 enzyme, such as theophylline, warfarin, duloxetine, and olanzapine, among others. Be sure to consult your healthcare provider to determine if you’re a candidate for Fezolinetant.

Paroxetine (Brisdelle)
Paroxetine, an SSRI originally developed for anxiety and depression, was reformulated at a lower dose to help manage menopause-related VMS. While the exact mechanism for reducing VMS is unclear, studies show a 50-60% reduction in symptoms within four weeks, with minimal side effects such as nausea, fatigue, dizziness, and sexual dysfunction. However, it’s important to consult your provider, especially if you're taking other medications like Tamoxifen, which may interact with paroxetine.

Both medications can be effective for reducing VMS, but it’s essential to note that they target only those specific symptoms. While hot flashes are a hallmark of menopause, other symptoms, and the increased risk of chronic diseases like osteoporosis and diabetes, may not be addressed by these treatments.

Lifestyle Changes:

Diet
A balanced diet rich in whole foods—such as fruits, vegetables, high-quality proteins, and whole grains—can support health during menopause. Phytoestrogens from plant-based foods help compensate for the body’s declining estrogen levels. High-quality proteins, like organic, grass-fed, or pasture-raised animal products, support muscle mass and metabolism during this time of change. Since declining estrogen increases inflammation, consuming anti-inflammatory and antioxidant-rich foods is crucial.

Recommended foods include:

• Vegetables: Dark leafy greens, asparagus, beets, and broccoli.
• Fruits: Berries, pomegranates, cherries, grapes, and citrus.
• Spices: Turmeric, ginger, cinnamon, and garlic to reduce inflammation.
• Omega-3-rich foods: Salmon, nuts, and seeds.

Tips for getting these in: 

• Adding in chia seeds or flaxseeds to a smoothie in the morning 
• Adding extra spices, like turmeric or ginger, to your food while cooking 
• Eating at least one serving of vegetables with each meal, like an omelet with bell peppers, a green salad with fruits, vegetables and protein for lunch, and salmon with asparagus and broccoli for dinner 

Exercise
As we age, physical activity becomes even more important. The Menopause Society recommends at least 150 minutes of moderate-intensity exercise per week. This can include brisk walking, Pilates, dancing, weight training, or any activity that moves your body. Resistance training is essential to counteract the muscle loss (about 1% per year) that starts around age 30, according to the National Institutes of Health (NIH). Regular exercise helps regulate blood sugar, improve mood, support bone health, and enhance cognitive function.

Stress Recovery
Managing stress is critical during menopause. Chronic stress raises cortisol levels, which can interfere with estrogen and progesterone production, worsening VMS and contributing to weight gain—particularly abdominal fat. Stress recovery helps reset the body’s stress response, preventing it from becoming overwhelming. Activities like mindfulness, meditation, walking, painting, or talking with a loved one can aid in stress recovery. Prioritizing 7-8 hours of sleep each night is also vital for healing and hormone regulation.

If you need guidance in managing stress, you can schedule an appointment with one of our mental health therapists at Uplift For Her here.  

Many women can transition through menopause successfully without the need for hormone therapy. It’s important to find a healthcare provider who listens to your concerns and offers solutions tailored to your lifestyle, rather than a one-size-fits-all approach. To explore personalized options, you can learn more about and book an appointment with our Nurse Practitioner and Menopause Society Certified Provider, Jennifer Falkner, here.