Non-hormonal prescribed treatments for menopause
These are treatments which do not affect hormone levels and are suitable for women who are unable to take HRT
Antidepressants – Selective serotonin re-uptake Inhibitors (SSRIs) and serotonin and noradrenaline re-uptake Inhibitors (SNRIs)
What are they?
SSRIs and SNRIs are antidepressants commonly used to treat depression and anxiety. Examples include:
- SSRIs: Fluoxetine, paroxetine, citalopram, escitalopram, sertraline
- SNRIs: Venlafaxine
How can they help with menopause symptoms?
These medications can help reduce hot flushes and night sweats in some women, leading to better sleep, less fatigue, and overall improved well-being. They are often prescribed in low doses for women who cannot take HRT.
Special considerations
- Venlafaxine is preferred for women taking tamoxifen for breast cancer, as it does not interfere with the effectiveness of tamoxifen. Paroxetine and fluoxetine can reduce the effectiveness of tamoxifen.
- Antidepressants can reduce libido in some women, which might lead to discontinuation.
Side effects include:
- Upset stomach
- Nausea
- Diarrhoea or constipation
- Dizziness
- Blurred vision
- Dry mouth
- Anxiety
- Reduced libido (sex drive) and/or arousal
These side effects usually lessen over time, but some women may experience a persistent decrease in libido.
Important note
Antidepressants should not be the first choice for treating low mood associated with menopause, as there is no evidence to support their use for this purpose.
Clonidine
What is clonidine?
Clonidine is a medication primarily used to lower blood pressure and prevent migraines. It has been shown to reduce the severity and frequency of hot flushes in some women. Clonidine and Veoza are the only non-hormonal medications licensed for the treatment of menopausal hot flushes and night sweats in the UK.
Side effects include:
- Constipation
- Depression
- Dizziness
- Dry mouth
- Headache
- Nausea
Clonidine may not be suitable for women with low blood pressure and must be withdrawn gradually to prevent rebound high blood pressure. It can cause significant sleep disturbances in 50% of women.
Gabapentin and pregabalin
What are they?
Gabapentin and pregabalin are usually used for neuropathic pain and also as anticonvulsants. They may also reduce hot flushes for some women.
Side effects include:
- Drowsiness
- Dizziness
- Fatigue
- Weight gain
- Dry mouth
Both gabapentin and pregabalin are controlled drugs and are used unlicensed for the treatment of hot flushes in the UK.
Oxybutynin
What Is Oxybutynin?
Oxybutynin is a medication usually used to treat an overactive bladder. Studies have shown that oxybutynin can reduce the incidence of hot flushes and it is being used off-license by some menopause specialists for this purpose.
Side effects include:
- Stomach pain
- Diarrhoea
- Nausea
- Headaches
- Dry mouth
- Dry eyes
Fezolinetant (Veoza) for menopause symptom relief
What is fezolinetant (Veoza)?
Fezolinetant, marketed under the brand name Veoza, is a new non-hormonal medication approved to treat hot flushes and night sweats during menopause.
How does fezolinetant work?
Fezolinetant targets the brain’s temperature control centre, blocking specific receptors in the brain called neurokinin 3 (NK3) receptors. These receptors are found on nerve cells known as KNDy neurons, which play a key role in the brain’s thermoregulatory centre. By blocking these receptors, fezolinetant helps to regulate the body’s cooling signals, reducing the frequency and severity of hot flushes and night sweats.
Benefits of fezolinetant
- Non-hormonal: Ideal for some women who cannot take HRT due to medical reasons e.g. a history of a specific cancers or an active blood clot.
- Targeted relief: Specifically designed to address hot flushes and night sweats, providing effective relief.
- Improved quality of life: Helps reduce discomfort and sleep disturbances caused by menopausal symptoms, leading to better overall well-being.
Limitations
- Targeted relief: Unlike HRT, it does not address menopausal symptoms such as brain fog, tiredness, or joint pain.
- Limited use: It is not licensed for women with a history of breast cancer.
Side effects include:
- Headache
- Nausea
- Fatigue
Availability: Veoza is currently available by private prescription. It is not yet approved for NHS use; however, a NICE review is currently in progress.
Consult your menopause specialist
HRT remains the most effective treatment for menopause symptoms those who can take it. Veoza provides an alternative for managing hot flushes and night sweats for some women who cannot use HRT. As additional information from ongoing trials becomes available, the role of Veoza in menopause care will be better understood.
Discussing fezolinetant with your menopause specialist is essential to determine if it is the right treatment for you. They will consider your medical history, current medications, and individual health factors to make the best recommendation.
Contact us
If you are experiencing menopausal symptoms and want to explore fezolinetant as a treatment option, contact our clinic to schedule a consultation with one of our specialists. We are dedicated to providing personalised care and effective solutions for managing menopause.
