From the Guidelines
When hormone replacement therapy (HRT) is contraindicated for menopause symptoms, the most effective alternative treatment options include non-hormonal prescription medications such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as lifestyle modifications. These alternatives can help mitigate vasomotor symptoms of menopause, as recommended by the American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline 1. Some key options include:
- Low-dose SSRIs like paroxetine or escitalopram
- SNRIs like venlafaxine, which has been found to be safe and effective in reducing hot flashes 1
- Gabapentin, an anticonvulsant that has also been shown to be effective in reducing hot flashes 1
- Lifestyle modifications, such as dressing in layers, avoiding triggers like spicy foods, caffeine, and alcohol, maintaining a cool sleeping environment, and practicing paced breathing 1 It's also important to note that for women with breast cancer, certain SSRIs like paroxetine and fluoxetine should not be offered to those taking tamoxifen, due to concerns about reducing the conversion of tamoxifen to active metabolites 1. Overall, these alternative treatment options can help improve the quality of life for women experiencing menopause symptoms when HRT is contraindicated, by addressing neurotransmitter imbalances and directly improving comfort without affecting hormone levels.
From the Research
Treatment Options for Menopause Symptoms when HRT is Contraindicated
When Hormone Replacement Therapy (HRT) is contraindicated, there are alternative treatment options available for menopause symptoms. These options include:
- Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Studies have shown that SSRIs and SNRIs can reduce the frequency and severity of hot flashes in menopausal women 2, 3. Paroxetine, citalopram, and escitalopram are effective SSRIs, while venlafaxine is a commonly used SNRI.
- Self-Help Measures and Alternative Therapies: For women who are unable or unwilling to take HRT, self-help measures and alternative therapies can be recommended 4. These may include lifestyle changes, such as diet and exercise, as well as complementary therapies like acupuncture and herbal supplements.
- Low-Dose Local Estrogen Therapy: For women with only vaginal symptoms, low-dose local estrogen therapy may be preferred 5.
- Non-Hormonal Prescriptions: Other non-hormonal prescription options, such as gabapentin and pregabalin, may also be considered for the treatment of hot flashes and other menopause symptoms.
Important Considerations
When considering alternative treatment options, it is essential to take into account the individual woman's medical history, needs, and preferences 5. The treatment choice should be patient-specific, and the lowest effective dose should be used for the shortest duration necessary. Women with a history of breast cancer or taking tamoxifen should avoid SSRIs, which can interfere with tamoxifen metabolism 2. SNRIs may be a safer option for this population.