Transitioning through the menopause journey can be challenging when living with symptoms like hot flashes, sleep disturbances, mood alterations, weight gain, and low libido. In addition to these symptoms, declining hormone levels can affect the bones, muscles, heart, and metabolism.
As a safe and effective method of easing symptoms, many women use menopause hormone therapy (MHT), while others prefer, or are recommended to use, non-hormonal alternatives.
In this article, we outline the most highly recommended non-hormonal treatment options to manage common menopause symptoms, boost overall health, and prevent the onset of more serious conditions postmenopause.
Why Use Non-Hormonal Alternatives to Ease Menopause Symptoms?
Between the age of 45-55, often earlier or later for some, production of the sex hormones estrogen and progesterone begins to decline. This stage is known as perimenopause and is a transition into menopause that typically lasts 7-12 years.
Although the sex hormones primarily support the reproductive system, estrogen, progesterone, and testosterone also help other body systems. This is why, in addition to irregular menstruation during perimenopause, other symptoms can also occur.
For example, throughout life, estrogen supports brain health, bone growth, cardiovascular health, and muscle mass, as well as healthy skin and vaginal health. Progesterone aids in stabilizing moods, inducing sleep, regenerating bones, and supporting the uterine lining. Testosterone, which begins to decline even before perimenopause helps to regulate the female sex drive, sleep, and energy levels.
Consequently, menopause symptoms can include brain fog, anxiety, depression, loss of bone density, heart palpitations, less muscle mass, joint pain, dry skin, and genitourinary symptoms. During the menopause transition, mood fluctuations, fragmented sleep, insomnia, fatigue, low sex drive, slowed metabolism and increased weight gain are also connected to the multifaceted roles of the sex hormones.
As hormone production gradually declines, it tends to happen haphazardly rather than uniformly, meaning perimenopause symptoms can ease off and worsen erratically.
To manage these fluctuations and ease symptoms; estrogen, progesterone, and sometimes testosterone are supplemented with MHT. That said, when MHT is not preferred or recommended due to a history of certain conditions or underlying risks, non-hormonal alternatives can also ease symptoms and make the menopause transition more comfortable.
How to Treat Menopause Symptoms Without MHRT
Whether women prefer a different route or have been advised to avoid MHT due to underlying risks based on their medical history, non-hormonal alternatives to MHT can help treat symptoms and manage other facets of the menopause transition.
In cases where MHT is not chosen or considered suitable, the following natural alternatives can be helpful. All treatments may not be required or relative for every individual, therefore guidance from a menopause expert is recommended to tailor a non-hormonal menopause plan to suit each person's needs and symptoms.
Nutritional Support
Making healthy dietary adjustments during the menopause transition is a powerful non-hormonal way of treating common menopause symptoms, reducing weight gain, and sustaining good health throughout postmenopause.
Consuming dairy products and foods that contain calcium, for example, can counteract the loss of bone density and reduce the risk of osteoporosis and vitamin D will help the body absorb and use calcium.
An adequate intake of vitamin B6 supports the regulation of hormones. And omega-3 fatty acids, also known as polyunsaturated fats, are natural anti-inflammatories that may help to lower blood pressure, boost the immune system, and decrease arterial plaque for improved cardiovascular health.
Magnesium helps to improve sleep and reduce fatigue, while foods high in dietary fiber assist digestion and prevent weight gain. Protein and fiber also fight muscle and bone density loss and support hormone production.
Soy products, flax seeds, and sesame seeds, all of which contain phytoestrogens, are known to mimic the effects of estrogen and for some may reduce hot flashes & night sweats, and boost moods, but the evidence is mixed.
In addition to treating menopausal symptoms, nutritional support can minimize menopausal weight gain. For instance, the metabolism (how the body converts food to energy) naturally slows down with age. Hormone imbalances, less physical activity, and the loss of muscle mass can further contribute too.
This means weight gain is more likely during menopause, particularly an accumulation of visceral fat around the abdomen. However, eating the right combination of nutritious foods can help stabilize the metabolism and reduce weight gain.
Whether you are taking MHT or not, it’s worth speaking with a menopause expert or nutritionist about creating a meal plan that suits your eating habits and can help reduce menopause symptoms especially for menopause trigger foods.
Helpful Supplements
Although the body absorbs nutrients and vitamins more easily through food, supplements can help when it’s not possible.
Adequate amounts of vitamin D, which is mostly absorbed from sunshine, can be difficult to absorb during the winter months in colder climates. However, it is essential to aid the body in using calcium for healthy bones during menopause. Therefore, many women take vitamin D as a daily supplement.
Other helpful supplements for easing menopause symptoms include omega-3s, calcium, magnesium, vitamin B6, and probiotics to protect the gut microbiome and the estrobolome.
Physical Activity
Physical activity is an essential element of wellness throughout life and it is no different during the menopause transition and postmenopause.
Studies into the links between physical activity and women’s health during the menopausal transition highlight that regular physical activity can help lower the severity of several menopause symptoms when compared to non-exercise control groups.
For best results in easing a wide range of menopause symptoms, a regular combination of aerobic exercise, flexibility & balance, strength training, and pelvic floor exercises is recommended.
Aerobic Exercise
Regular aerobic exercise such as brisk walking, swimming, or cycling during the menopause transition can help improve moods by encouraging the release of serotonin. It is also known to improve sleep, stamina, and cardiovascular, as well as respiratory health. Because exercise helps to regulate body temperature by improving blood circulation, it may also minimize hot flashes.
Flexibility & Balance
Yoga or pilates are recommended to improve flexibility and balance, encouraging bone and muscle growth. Yoga and Pilates can also help restore elasticity in the tendons and ligaments to reduce joint pain and improve the range of motion.
When practiced with conscious breathing, yoga & pilates can help to reduce anxiety and stress, boosting mental health and psychological well-being in menopausal women.
Another benefit of yoga or pilates is better posture. The core and back muscles can weaken with age and provide less postural support, leading to back pain and muscle imbalances. Regular flexibility and balance training can also help muscles stay strong & supple to prevent slouching.
Strength Training
Targeting the muscles with strength training is recommended to improve muscle tone and bone growth in menopausal women. In addition to Yoga or Pilates, this type of exercise can lower the risk of osteoporosis and provide improved agility and independence in later life.
Building muscle tone also helps improve the resting metabolic rate (RMR), which is the rate at which the body burns fat (uses calories) while resting. Building and maintaining muscle requires more energy than fat so having more muscle speeds up the metabolism and reduces weight gain.
Pelvic Floor Exercise
Pelvic health is important throughout life, but even more pertinent during menopause. Forming a protective sling beneath the pelvis, the pelvic floor muscles support pelvic organs like the bladder and bowel, in addition to enhancing sexual pleasure.
Hormone changes, particularly decreased estrogen, can affect the elasticity and strength of the pelvic floor muscles. When weakened, the decreased support from the pelvic floor muscles can result in urinary incontinence, less bowel control, pelvic organ prolapse, and reduced sexual sensitivity, or pain during sex.
To prevent or treat these common menopause symptoms, daily Kegel exercises are recommended to strengthen and tone the pelvic floor muscles during the menopause transition. Guidance from a pelvic floor physical therapist is advised to learn how to do Kegels correctly and a consistent practice is recommended. Just like other muscles, the benefits will diminish if not exercised regularly.
If you have pelvic pain, it’s important to see a pelvic floor physical therapist for further evaluation.
Non-Hormonal Medications
Antidepressants such as Paroxetine (Paxil) and Desvenlafaxine (Pristiq) have been proven to treat hot flashes and night sweats in addition to the depression and anxiety associated with menopause. With the reduction of night sweats, sleep interruptions are also typically minimized.
When sleep interruptions or insomnia are prevalent symptoms during menopause, medications such as Melatonin, Valerian Root, Trazodone, Remeron, and Amitriptyline are recommended.
For women suffering from urinary incontinence during menopause, Oxybutynin, which is an antispasmodic, helps to reduce muscle spasms in the bladder. By decreasing bladder muscle spasms, bladder control improves, the frequent urge to urinate is eased, and urine leaks are prevented. Oxybutynin is also known to relieve hot flashes and night sweats.
If menopausal weight gain contributes to additional health factors, Wellbutrin or GLP-1 agonists can be prescribed to aid in weight loss. (Wellbutrin is also known to help treat fatigue). And if libido is low during menopause, Flibanserin and Bremelanotine can help improve the female sex drive.
Emotional Support
In addition to the physical and physiological changes, the menopause transition can bring about emotional and psychological fluctuations too. To lower the impact of these changes on their quality of life, many women find that emotional support from a counselor or wellness coach can help.
Research also reveals that attending group classes or menopause workshops with like-minded, similar-aged women can provide a sense of community and a shared experience for those going through the menopause transition.
Meditation & Mindfulness
Discovering mindfulness through meditation can improve an individual’s overall quality of life by helping them to stay present in each moment. For women transitioning through menopause, an increased awareness can help manage mood swings, stress, and anxiety, as well as help with the mild to moderate depression that sometimes arises during menopause.
Meditation and mindfulness can also help women of menopausal age to accept a more positive perception of themselves. It’s also helpful to recognize that menopause symptoms will not last forever and create a mindset of acceptance as opposed to a sense of loss.
Vaginal Lubricants, Moisturizers & Dilators
Genitourinary symptoms of menopause can include vaginal dryness, urinary incontinence, and vaginal or vulvar irritation. Vaginal dryness and irritation can often cause pain during sex (dyspareunia) and daily discomfort, while urinary incontinence can lower menopausal women’s quality of life.
Non-hormonal remedies for vaginal dryness, irritation, and dyspareunia include vaginal lubricants and moisturizers. To avoid any vaginal pH imbalances that cause further irritation, it’s wise to use a water-based personal lubricant and organically-produced vaginal moisturizers.
Vaginal dilators are recommended to relieve dyspareunia and urinary incontinence by gently stretching and toning the vaginal tissues and pelvic floor muscles. Although initial guidance is recommended from a pelvic physical therapist or gynecologist, vaginal dilators are designed for use in the comfort of your own home.
Herbal Remedies
Botanical medicine (herbal remedies) has been used for centuries to help women through the menopause transition.
St. John’s Wort, for instance, helps to release serotonin and improve low moods, as well as mild to moderate depression. It is also linked to reduced night sweats, improved sleep, and less fatigue. Although successful for many, it can react with certain medications, so women taking medication for another condition are advised to check with their healthcare provider before taking St. John’s Wort.
What to Avoid During Menopause to Ease Symptoms?
Alcohol, caffeine, spicy foods, and smoking are known to trigger hot flashes during menopause. Avoiding them, or largely reducing their intake, can help lower the frequency of hot flashes and night sweats.
Female health experts also advise against eating processed foods during the menopause transition. Aside from providing little nutrients for the body, processed foods are generally high in saturated fats, which increase inflammation and the severity of hot flashes, and contribute to a myriad of other health issues.
Conclusion
The non-hormonal approach to treating menopause symptoms is largely based on boosting physical, physiological, and mental health.
By supporting the body’s physical and physiological health with a combination of physical activity, nutrients, vitamins, and supplements, the symptoms experienced due to low hormone levels can be addressed in an alternative, but still effective way.
Practicing mindfulness and feeling emotionally supported can help reduce the anxiety, negativity, and sense of loss often associated with menopause. Furthermore, feeling positive instead of fearful about the changes occurring during this stage of life can lead to a sense of acceptance and enlightenment.
When considering a non-hormonal approach to menopause, working with a qualified menopause expert, nutritionist, or naturopathic doctor is essential for developing a comprehensive plan that works for you and your symptoms.
References
British Nutrition Foundation – Managing Menopause with Diet - https://www.nutrition.org.uk/nutrition-for/women/menopause/managing-menopause-symptoms-with-nutrition-and-diet/
Taylor and Francis Online Medical Journals – Understanding Weight Gain During Menopause - https://www.tandfonline.com/doi/full/10.3109/13697137.2012.707385
National Library of Medicine - Physical Activity and Health During the Menopausal Transition - https://pmc.ncbi.nlm.nih.gov/articles/PMC3270074/
Balance Menopause – Get Stronger During the Menopause - https://www.balance-menopause.com/menopause-library/get-stronger-during-the-menopause/
Cleveland Clinic - Oxybutynin - https://my.clevelandclinic.org/health/drugs/18705-oxybutynin-tablets
The New England Journal of Medicine - FDA Approval of Paroxetine for Menopausal Hot Flushes - https://www.nejm.org/doi/full/10.1056/NEJMp1402080
National Library of Medicine - Reducing Menopausal Symptoms With Mindfulness-Based Meditation - https://pubmed.ncbi.nlm.nih.gov/38363970/
National Library of Medicine - St. John's Wort extract: efficacy for menopausal symptoms of psychological origin - https://pubmed.ncbi.nlm.nih.gov/10623319/