Women who can’t take hormone therapy today still have safe menopause treatment options. AP
Shilpa Gajarawala lived through two difficult years of hot flashes, sleepless nights, brain fog and heavy fatigue. Her history of breast cancer meant she could not use hormone therapy, a common treatment for menopause symptoms. She tried to manage without help, but the symptoms affected her daily life.
Doctors say many women share her struggle, yet they don’t need to suffer in silence. Hormone therapy helps many people, but not everyone can use it safely. Some avoid it by choice, while others face medical conditions that make hormone-based treatments unsafe. These include past heart attacks, blood clots, certain cancers, and serious liver problems.
Specialists stress that every woman has options.
“There’s always a solution. We have lots of other options available,” said Dr. Stephanie Faubion, medical director at the Menopause Society.
Lifestyle Adjustments
Doctors encourage simple lifestyle changes to ease symptoms. Exercise plays a big role, even though it does not directly stop hot flashes. Regular movement can help with weight control, which links to fewer hot flashes and night sweats. Experts recommend a mix of walking or running along with strength training to protect bones.
Diet also matters. Studies show that a plant-forward approach, rich in vegetables and soy, may lower the intensity of hot flashes. Some researchers believe this benefit comes from weight loss, while others suggest plant compounds may help the body regulate temperature.
Doctors also advise avoiding triggers like caffeine and alcohol. These can spark hot flashes and worsen sleep.
Heart health becomes important during menopause, too. Lower estrogen levels can raise cholesterol and blood pressure. Doctors suggest quitting smoking, sleeping well, and lowering stress levels to protect long-term health.
Prescription Medications Without Hormones
When lifestyle steps are not enough, nonhormonal prescription drugs may help. Some antidepressants reduce hot flashes and improve mood. Another drug, oxybutynin, often used for bladder issues, has shown positive results for both hot flashes and frequent urination.
A newer drug, Veozah — the brand name for fezolinetant — targets the brain area involved in temperature control. It blocks one of the triggers that cause hot flashes. Another recent option, elinzanetant, sold as Lynkuet, blocks two similar molecules.
All drugs come with potential side effects. Veozah carries a warning about rare but serious liver issues. Lynkuet may cause tiredness. Some antidepressants cause weight gain at higher doses. Oxybutynin can lead to dry mouth or trouble fully emptying the bladder.
“There’s no medication out there that’s entirely free of risk,” said Dr. JoAnn Manson of Harvard Medical School.
Additional Nonhormonal Tools
Drugstore products also help. Over-the-counter lubricants ease vaginal dryness, a common concern during menopause. Cognitive behavioural therapy helps many women cope better with hot flashes by improving how they respond to them.
“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.”
Some studies show clinical hypnosis may reduce how often hot flashes occur, though doctors say more research is needed.
Finding the Right Approach
Doctors encourage women to speak openly about their symptoms. “I would implore women to have that conversation ... about what treatment might be beneficial for them,” said Dr. Juliana Kling of Mayo Clinic.
Gajarawala took that advice. She changed her daily habits, added tai chi, walked 10,000 steps each day, skipped red wine, and used an extended-release antidepressant. Her symptoms eased.
“It’s been a significant improvement,” she said.
