How To Manage Menopause Without Hormone Therapy

Hot flashes and vaginal dryness and brain fog, oh, my. If menopause symptoms start to impact your quality of life, a variety of treatment options and lifestyle changes can help.

Oftentimes, that includes starting hormone replacement therapy (HRT), which replaces the hormones your body no longer makes enough of. But taking hormones isn’t an option for everyone. If that’s the case for you, how can you find relief?

Can I go through menopause without hormone replacement?

You may very well go through menopause without needing any type of treatment. If your symptoms don’t trouble you, there’s no need for medication.

But what about if your symptoms do interfere with your quality of life? Though not everyone is a candidate for HRT, there are still ways you can find relief, from tweaking your diet and changing your bedtime routine to asking your healthcare provider about nonhormonal medications.

“There are quite a few nonhormonal options that can be helpful, mostly for addressing vasomotor symptoms, like hot flashes and night sweats, as well as for mood changes,” says menopause specialist Sobia Khan, MD.

Who isn’t a candidate for hormone therapy?

Dr. Khan outlines medical conditions that may rule out HRT.

• Certain types of cancer: Estrogen therapy can negatively affect some active cancers, like hormone receptor-positive (HR+) breast cancer and some ovarian cancers. But having a history of these cancers doesn’t necessarily rule out hormone therapy. “If you’ve been treated and don’t currently have any disease, you could still be a candidate,” Dr. Khan says.
• Undiagnosed uterine bleeding: Abnormal bleeding could be a sign of uterine (endometrial) cancer.
• Blood clots: Estrogen can raise the risk of blood clots, so your provider may recommend against hormones if you’re at high risk for them.
• Cardiovascular disease: If you’ve had a heart attack or stroke, or are at risk for them, your provider may not recommend hormone therapy. “A cardiac risk calculator helps us figure out each patient’s risk,” Dr. Khan says.
• Gallbladder disease: Estrogen can bring an increased risk of gallbladder problems, so hormone therapy may not be recommended if you already have a condition like gallstones.
• Liver disease: Your liver breaks down estrogen and removes it from your body. But when your liver isn’t working as it should, the hormone can build up.

Nonhormonal ways to manage menopause

Starting in perimenopause (aka the lead-up to menopause), your estrogen levels drop, which can bring symptoms like hot flashes, irregular periods and more. If HRT isn’t in the cards for you, these tips may help you find relief.

1. Identify (and try to avoid) your hot flash triggers

“Hot flash triggers are different for everyone,” Dr. Khan notes, “so you really have to learn yourself and your body to figure out what yours are.”

It may help to keep track of your hot flashes, like in a journal, so that you can better identify what triggers them. Common triggers include:

• Stress and anxiety
• Certain foods and drinks, like alcohol, caffeine, sugar and spicy foods
• Tight and/or synthetic clothing
• Cigarette smoking
• Warm weather

2. Find a lube to help with vaginal dryness

A decrease in estrogen can, frankly, wreak havoc on your natural vaginal lubrication. That decline can make you feel itchy and dry. Vaginal dryness can also make sex uncomfortable or even painful — but lubricants can help.

“Water-based lubricants are a great place to start,” Dr. Khan recommends. “Silicone-based lubricants also have a really nice slipperiness and feel.”

In general, she doesn’t recommend using food oils, like coconut oil or olive oil, because they can cause irritation and allergies. (“They’re also really messy, and they’ll destroy your bedsheets!”)

But if you feel like you need more help than lubricants can provide, talk to your healthcare provider about longer-term vaginal moisturization.

“Vaginal estrogen cream doesn’t bring the same concerns associated with systemic hormone therapy,” Dr. Khan adds. “There are also options like hyaluronic acid suppositories and internal and external moisturizers, which can bring a lot of relief.”

3. Keep your bedroom cool

If you experience night sweats — the overnight version of hot flashes — making changes to your bedroom could bring relief.

“Try to control your sleep environment as much as possible,” Dr. Khan advises. “Sometimes, people tell me they argue about room temperature with significant others who aren’t going through menopause — but I would say that the one of you who’s going through menopause should win!”

Data shows that temperatures as cool as 65 degrees Fahrenheit (18.33 degrees Celsius) are best for sleep. You can also turn on a fan for ambient cooling throughout the night or crack open the windows for some fresh air and breeze.

4. Embrace natural fibers

To avoid triggering hot flashes and night sweats, consider going natural where you can — in terms of both your clothing and your bedding.

During the day, avoid synthetic fibers, like nylon and polyester, which can trap heat and contribute to hot flashes. Though natural fibers, wool and silk can do the same, so you may be best avoiding them as well.

The same is true of what goes on your bed.

“Covers and pajamas that are made of natural fibers can help,” Dr. Khan says. “If you have a memory foam pad on the bed that’s trapping heat, consider switching to a cooling mattress topper instead.”

5. Up your sleep hygiene game

Night sweats can cause you to wake up throughout the night, which can seriously mess with the quality and quantity of your sleep. So, study up on sleep hygiene, which refers to the habits and behaviors that can help you get a good night’s sleep — like allotting enough time for sleep, keeping a consistent sleep/wake schedule and powering down electronics before bed.

“Anything that calms your brain and promotes better sleep can also help symptoms of menopause,” Dr. Khan notes. You might:

• Wind down before bedtime with aromatherapy.
• Darken your room with blackout curtains.
• Turn on a white noise machine at night.
• Try a sleep meditation to help you drift off.

“If you continue to struggle with sleep, I recommend seeing a sleep specialist,” Dr. Khan says. “You could actually be dealing with some sort of sleep disorder like sleep apnea.”

6. Adapt your diet

There’s no specific “menopause diet,” but what you eat (and avoid) may influence menopause symptoms. As we’ve already discussed, things like caffeine, alcohol and spicy foods could trigger hot flashes, so you may want to cut back or cut them out entirely. But incorporating soy-based foods into your diet may be beneficial, too.

Some studies show that soy products may help ease menopausal symptoms. Why? Because soy is a source of phytoestrogens, a type of phytonutrient that has estrogen-like effects in the body.

“Soy milk doesn’t have a ton of phytoestrogens because there’s actually a very small amount of soy in there,” Dr. Khan explains. “But foods like soybeans, soy flour and tofu have a decent amount and can be easily worked into your diet.”

7. Address your stress and anxiety

Easier said than done, we know. But managing stress and treating your anxiety won’t just improve your quality of life — it may also help reduce hot flashes.

The relationship between stress, anxiety and menopause is a complex one. Preexisting anxiety may be a predictor of hot flashes. And an older study showed that premenopausal women who struggled with anxiety were up to five times more likely to have hot flashes than their counterparts who learned to manage their anxiety.

“Hot flashes are modulated in the brain, so anything you do to calm your brain and find a sense of peace — like deep breathing — may be helpful,” Dr. Khan says. “It may not decrease the number of hot flashes you have, but it can decrease the distress they make you feel.”

8. Ask about nonhormonal medications

There are some medications that don’t contain hormones that can help with specific symptoms of menopause.

“Nonhormonal medications can’t replace estrogen that you’ve lost,” Dr. Khan clarifies. “But they can help mediate the neurological changes that are happening in your body as a response to that lack of estrogen.”

She shares some of the options:

• Fezolinetant (Veozah™): This medication is specifically designed to treat moderate to severe hot flashes. “It targets a brand-new pathway in the brain that is specific to vasomotor symptoms,” Dr. Khan says.
• SSRIs (selective serotonin reuptake inhibitors): Antidepressants like venlafaxine and paroxetine can help with vasomotor symptoms. When they’re prescribed for menopause, they’re given at a lower dose than for depression.
• Gabapentin: “This antiseizure medication is typically used for nerve pain, so it makes sense that it can also help with neurologic disruption of estrogen withdrawal,” Dr. Khan points out. But it can bring drowsiness, so it’s not a fit for everyone.
• Clonidine: This blood pressure medication isn’t often prescribed for hot flashes, but it is considered safe and may help. But it can cause a drop in blood pressure, which can lead to dizziness.

Do nonhormonal menopause treatments work?

Everyone is different — and different treatments work for different people. What worked well for your mom or your best friend or your neighbor might not necessarily be the right thing for you, and vice versa. As is so often the case, it depends on your symptoms.

But if you’ve tried making lifestyle changes and they don’t seem to be helping, it’s important to talk to a healthcare provider.

“Menopause can hit you by surprise with all the different symptoms you can experience,” says Dr. Khan. “But there are a lot of ways your provider can work with you to alleviate those symptoms and help you feel better.”