Non-hormone based medications for early menopause

Some women with early menopause (EM) may not be able to take Hormone Replacement Therapy (HRT or MHT), either because of having experienced oestrogen sensitive cancer or difficulty with side-effects from HRT (see Taking hormone-based medications for early menopause). Other women may prefer not to take HRT.

Alternative pharmacological medications that have been proven to be effective for relief of hot flushes in clinical trials include clonidine, some antidepressants, gabapentin, and pre-gabalin. These medications can help reduce hot flushes and night sweats, and antidepressants may also help with low mood. Some women who have experienced hormone sensitive cancer may under particular circumstances be able to use vaginal oestrogen if they have not found non-hormone based vaginal moisturisers or lubricants helpful for vaginal dryness. Only clonidine is authorised for use by the TGA and available via the PBS for hot flushes. Use of the other medications is considered “off-label”.

Among the women we spoke to who could not take HRT for EM, a few were taking non-hormone based medications to try to reduce menopausal symptoms, others had tried these medications then stopped taking them, and a few had not tried them at all.

Non-hormone based pharmacological therapies: What women knew

Women who had experienced hormone sensitive cancer were aware that they could not take oestrogen-based forms of HRT. As Maree, who had experienced hormone sensitive breast cancer and carried the BRCA 1 gene mutation, explained: ‘I can’t take HRT or anything of that nature. I need to prohibit oestrogen production.’

Most women said their health practitioners (GPs, oncologists, surgeons, or endocrinologists at menopause clinics) had informed them about the need to avoid oestrogen and therefore HRT, and advised them about other medications they might try.

Kate described her experience at a menopause clinic where she was told about different ‘ideas’ about managing EM after cancer, including different medications.

However, not all women received information about alternative medications for symptoms of medically-induced EM. Alex, who had experienced ovarian cancer, said: ‘I can’t take HRT, so after we sort of discussed that, they mainly just focused on what I can do, which is exercise.’

Eden, who was having hormone (adjuvant endocrine) therapy to reduce the risk of her hormone sensitive breast cancer recurring, did not remember receiving advice about other medications for alleviating menopausal symptoms.

Taking non-hormone therapies for EM: Women’s experiences

The main non-hormone pharmacological therapies that women mentioned taking for menopausal symptoms included antidepressant medication and gabapentin. A couple of women mentioned taking medications that they could not recall the name of, and Jacqueline said she had taken sleeping pills ‘at one stage, just to try and get a decent night’s sleep every week or so’. Reasons for taking these medications included to help reduce hot flushes, nerve pain, joint aches, and low mood (see Experiences of symptoms of early menopause – Part 1 and Women’s experiences of symptoms of early menopause – Part 2).

Some women found non-hormone-based medications helpful for hot flushes.

Maree found gabapentin reduced her hot flushes, particularly at night.

Nancy found antidepressants helpful for hot flushes, and recounted her oncologist telling her they could also help with ‘depression’ following cancer. 

Women who were taking antidepressants were doing so for different reasons. Some said they took them for physical symptoms of EM such as nerve pain, joint aches or hot flushes, while others took them for mood, particularly in relation to cancer. Yen-Yi had begun taking a SNRI antidepressant after ‘hitting rock bottom’ emotionally during hormone therapy for breast cancer (see Women’s experiences of symptoms of early menopause – Part 1, Women’s experiences of symptoms of early menopause – Part 2 and Psychological therapies for early menopause). When asked if she felt the medication had helped her hot flushes, she said: ‘I think for me it was just around my mood. I didn’t – to be honest I wonder what other menopausal symptoms could it help with.’

A few women noted antidepressants could have multiple benefits, for both physical symptoms of EM and mood.

Fiona described how her reasons for taking antidepressants changed over time.

For some women, non-hormone based medications for EM were not effective, caused side-effects, or interacted negatively with other medications, prompting them to stop taking them.

Sylvia, who was not able to take HRT following uterine cancer, described her experience taking an antidepressant medication for EM symptoms.

Natalie, who experienced EM following a hysterectomy for endometriosis, could not tolerate HRT or non-hormonal medications for EM.

However, some women described trying several different medications in the hope of finding one that would work for them.

Kate had mixed experiences with non-hormone based medications for EM, but her desire for a ‘normal life’ meant she was determined to keep looking for a medication that worked.

Further information:

Talking Points (Women)

Talking Points (Health Practitioners)

Other resources