Nonhormonal Menopause Treatments

3 minute read

By: Sharon D. Malone, MD|Last updated: October 21, 2022

So, you’ve exercised, eaten a healthy diet, meditated, and prayed on it, and you’re still bothered by hot flashes, mood swings, sleeplessness and vaginal dryness. And due to a personal history of breast cancer, endometrial cancer, or a history of blood clots, estrogen is not right for you. What can you do about it?  

Hot flashes are best addressed by identifying triggers such as spicy foods, alcohol (looking at you, red wine) and stress, then trying to minimize them. If that doesn’t work, you have more options. We have an FDA-approved, nonhormonal option for the treatment of hot flashes: low-dose Paroxetine. Since hot flashes at night are frequent disruptors of sleep, treating them often improves not only the quality and duration of sleep but it also improves the downstream effects that flow from lack of sleep. Trust me, as someone who has spent a considerable part of my life prior to menopause with disordered sleep due to being on call at night, it wreaks havoc on your mood. 

Worried about taking an SSRI? Paroxetine at the dose needed to treat hot flashes is much lower than the doses needed to treat depression. One thing to note: Since paroxetine is an SSRI, you should always make sure that you are not already taking medication in this class. 

Treating vaginal dryness and urinary symptoms of menopause for those who are not candidates for systemic estrogen (pills or patches) is vitally important. Painful sex, frequent UTIs, urinary urgency and frequency significantly affect your quality of life. The initial recommendation is a trial of nonhormonal moisturizers and/or lubricants. However, if that is insufficient, topical estrogen can very often be used safely. Technically, topical estrogen cream is a hormonal treatment, but the amount of estrogen in the cream is extremely low and does not significantly affect the levels of estrogen in your bloodstream. 

Estradiol Vaginal Cream (photo of a woman's finger trying Estradiol Vaginal Cream)

It is recommended that you inform your oncologist or your gynecologist if you choose to use topical vaginal cream. And since there is no increased risk of blood clots or worsening of cardiovascular risks with the use of vaginal estrogen, it can be used without concern. So, topical vaginal estrogen to treat the symptoms of vaginal dryness, painful sex and urinary symptoms is safe and effective for almost everyone–despite the warning on the box.

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