Can’t take hormone therapy for menopause? There are other options

A woman walks down a trail as fog looms at Montie Beach Park in Houston, on Monday, Oct. 17, 2011. (Cody Duty/Houston Chronicle via AP, File)

Shilpa Gajarawala struggled with hot flashes, night sweats, sleep problems and brain fog. But given her history of breast cancer, treating these menopausal symptoms with hormone therapy wasn’t an option.

“For two years, I tried to kind of power through,” said the 58-year-old physician assistant from Jacksonville, Florida.

But doctors say women like Gajarawala don’t need to suffer.

Though many women take hormone therapy medications to ease menopause symptoms, recently announced label changes may encourage even more to start. But others choose not to use these medications that circulate throughout the body. And doctors advise some to avoid them because they have medical problems such as severe liver disease or a history of heart attack, stroke, blood clots or a type of breast cancer that grows in response to hormones such as estrogen.

For those people, there are lifestyle changes, medications without hormones and other strategies that can help.

“The key here is that there’s something for everybody,” said Dr. Stephanie Faubion, medical director at the Menopause Society. “There’s always a solution. We have lots of other options available.”

Lifestyle changes

Boosting physical activity can make a difference. While exercise hasn’t been shown to alleviate menopausal symptoms directly, it can help to shed pounds, which is associated with reductions in hot flashes and night sweats.

Doctors suggest a mix of aerobic exercise, such as running or walking, and strength training, which slows the loss of bone density.

Along with exercise, doctors advise watching what you eat.

Emerging science shows that a “plant-forward diet,” rich in produce and soy and low in oil, may help with managing hot flashes in particular, said Faubion of the Mayo Clinic Center for Women’s Health. Experts aren’t sure why this is true, but some suggest it may be because it also helps with weight loss.

Another key, doctors said, is to avoid things in the diet that may trigger hot flashes, like caffeine or alcohol.

Eating well and exercising also help with other midlife health issues, like rising heart and diabetes risks.

During menopause, the body’s production of the hormones estrogen and progesterone declines greatly. The drop in estrogen levels can lead to higher blood pressure and cholesterol.

“It’s important that we focus on maintaining cardiovascular health” such as stopping smoking, getting enough sleep and watching stress levels, Faubion said.

Prescription drugs

Beyond lifestyle changes, some nonhormonal prescription medicines have been shown to ease menopausal symptoms.

Antidepressants can help with hot flashes and mood issues. Recent data suggest that a drug for an overactive bladder called oxybutynin may reduce hot flashes while also treating frequent urination that’s common during menopause.

And doctors pointed to a new drug on the market – Veozah, a brand name for fezolinetant — which works in the area of the brain that controls body temperature and blocks a source of hot flashes and night sweats. Another nonhormonal drug called elinzanetant — marketed as Lynkuet — was recently approved by the U.S. Food and Drug Administration. It works similarly, except it blocks two molecules in the nervous system instead of one.

One downside of such medications? Possible side effects.

Veozah’s label includes a federally required warning about the risk of a rare but serious liver injury. Lynkuet’s possible side effects include difficulty staying awake, fatigue and others. Some antidepressants can cause weight gain, although generally in doses higher than those used for menopause symptoms. And oxybutynin can cause dry mouth and, in some people, a condition in which they can’t completely empty the bladder.

“There’s no medication out there that’s entirely free of risk,” said Dr. JoAnn Manson at Harvard Medical School.

Other nonhormonal options

Over-the-counter products can also treat some menopausal symptoms. Lubricants available at drugstores can help women struggling with vaginal dryness.

Cognitive behavioral therapy, which focuses on changing unhealthy thought patterns and behaviors, has been shown to help women cope with hot flashes.

“It’s not like it’s going to make you not have a hot flash,” Faubion said. “But it makes them less significant for you and less burdensome.”

Manson said there’s “moderate evidence” that clinical hypnosis might also help, with some studies showing reductions in the frequency and severity of hot flashes.

“That seems a promising option,” she said. “But more research is needed.”

The bottom line is that women don’t have to simply “get through” menopause, said Dr. Juliana Kling, a women’s health expert at Mayo Clinic Alix School of Medicine in Arizona. “I would implore women to have that conversation ... about what treatment might be beneficial for them.”

Gajarawala did that. She now skips red wine, walks at least 10,000 steps a day, practices tai chi and takes an extended-release antidepressant to address her symptoms.

“It’s been a significant improvement,” she said.

Laura Ungar, The Associated Press