In this post, our private GPs have summarised some of the symptoms you may experience during the menopause and some non-hormonal approaches for managing them. Members of the British Menopause Society, our private doctors Hala and Lucy have a special interest in the menopause.
Many women opt to avoid using Hormone Replacement Therapy (HRT) during the peri-menopause and menopause due to concerns about risk (which we address in this blog post). This may be due to personal or family history of breast or gynaecological cancers.
Vaginal oestrogen creams, pessaries or a vaginal ring which contains oestradiol can treat Vaginal dryness. This mimics the oestrogen a woman would produce before becoming menopausal. Unlike HRT, there is no systemic absorption so these don’t carry the risks that HRT would.
Vaginal rings can help prevent recurrent urine infections women can be plagued with following the menopause. Vaginal moisturiser and silicone-based lubricants are also very good if sex has become painful.
Ospemifene is a selective oestrogen receptor modulator that has an oestrogen-like effect in the vagina. It is non-hormonal and is being used to treat vaginal atrophy, and it may prove invaluable for oestrogen receptor-positive breast cancer sufferers.
Prescriptible Drugs for Hot Flushes and Sweats
The jury is still out about this, but low doses of SSRIs and SNRIs (forms of antidepressants) have been shown to reduce hot flushes and night sweats, as has a drug called Gabapentin which is often used for atypical pain or epilepsy.
Pregabalin is a controlled drug which has similar results to Gabapentin. It seems to be better tolerated but is more expensive. Clonidine is the only licensed medication at present but isn’t suitable for patients with a low baseline blood pressure.
Potential Alternatives to HRT
Always seek a medical professional to discuss the management of menopause symptoms. If you’d like to speak to one of our private GPs about the alternatives to HRT, please call our practice on 0333 050 7338.
- Pregnenolone – This seems to work well for the ‘mind fog’: poor concentration, poor memory, and poor sleep cycle associated with perimenopause and menopause. This is a non-licensed drug via private prescription only.
- 5HTP – This is a non-licensed drug via private prescription only. The dosage is 100mg at night; it is also said to be good for sleep.
- Vitamin D – Low levels of vitamin D are associated with low bone density and tiredness. It’s an essential vitamin to take especially during the British winter. 800-1000 units a day are recommended for maintenance therapy.
- Evening primrose and fish oil – This works well for breast tenderness.
- Magnesium – This proves to be good for anxiety and labile mood.
- Chromium – Good for sugar cravings.
- Multi-Vitamin B – Some evidence suggests that vitamin B may help with stress-induced anxiety.
- Black cohosh, isoflavones and St. John’s wart – the jury is still out on this. Don’t take this without telling a doctor as it can interfere with liver metabolism and stop other important prescription medication from working. Breast cancer survivors should not use them.
- Acupuncture – women do report some improvement in symptoms after having acupuncture treatment but studies show this is likely to be a placebo effect.
- CBT – there’s good evidence that CBT can help with low mood and anxiety caused by the menopause.
One of the most important factors to consider is lifestyle as this can play a huge part in symptom relief. Cutting back on alcohol, spicy food and caffeine will help ease symptoms. Plus, weight loss (if BMI is over normal range) can be very helpful.
Smoking will make hot flushes worse and increase cardiovascular risk. Aerobic and weight-bearing exercise reduces flushes and sweats and it could increase bone density.
Fezolinetant is a new drug; it’s undergoing studies and currently only available in research settings. However, all of the evidence is pointing toward the fact it may help with hot flushes and sweats in women who cannot have hormonal treatment.