In 2024, menopause hormone therapy (also known as MHT or HRT) is getting more attention in the press and on social media - but hormone therapy is not the only menopause solution available. Some women cannot or should not take hormones. Others may prefer not to take hormones. And for some women, hormones just don’t work for their symptoms.
If you’re curious about the world of menopause solutions outside of hormone therapy, this article is for you. Here, we will cover evidence-based hormone therapy alternatives that are backed by clinical studies and expert opinion. And if you’re interested in hormone therapy and how it works, we’ve got answers there as well.
Remember, as with any treatment you’re considering, it’s a good idea to consult a medical professional, like a board-certified doctor through Interlude.
Skip to what you need to know:
What is hormone therapy and what does it do?
When estrogen levels decline in perimenopause and menopause, hormone therapy can help relieve bothersome symptoms like hot flashes, night sweats, vaginal dryness, painful sex, frequent UTIs, and incontinence.
Hormone therapy is very effective. But what is it? There are two main types of hormone replacement therapy: systemic hormones and local hormones.
- Systemic hormones treat hot flashes, night sweats, and genitourinary symptoms. Systemic hormones are also used to prevent osteoporosis.
- Local hormones treat vaginal and urinary symptoms only.
Systemic hormones
Systemic hormones are prescribed as an oral estrogen pill or patch, plus progesterone to protect the uterine lining if needed. Systemic hormones travel through your whole body, hence the word “systemic”.
Local hormones
Vaginal estrogen is a local hormone therapy that’s prescribed as a cream, suppository, or ring. A progesterone is not needed. Vaginal estrogen is applied directly to the vaginal area, and is only absorbed locally in that area, hence the word “local”.
Does menopause hormone therapy cause cancer?
Systemic hormones are associated with rare but serious risks such as cancer or heart disease. However, women can take comfort that vaginal estrogen doses are significantly lower than systemic estrogens.(1-10)
Vaginal estrogen is not absorbed throughout the body.(11) Large clinical studies have concluded vaginal estrogen has not been shown to be associated with any serious risks.(12,13) Several organizations, including the American College of Obstetricians and Gynecologists, endorse the use of vaginal estrogen for women with breast cancer.
Vaginal estrogen and vaginal DHEA
If you’re looking for alternatives to hormone therapy, you might still consider vaginal estrogen or vaginal DHEA. Due to the lower risk profile, most women are good candidates even if they’re not candidates for systemic hormones.(14)
Vaginal estrogen
Helps with: vaginal dryness, frequent UTIs, overactive bladder, painful sex
Vaginal estradiol is a vaginal estrogen that’s highly effective at treating the vaginal and urinary symptoms of menopause. As mentioned before, vaginal estrogen can be safer than systemic hormones, and most women are a good candidate.
Multiple randomized controlled trials show that vaginal estrogen prevents vaginal dryness and painful sex.(15-28) There is also consistent evidence that vaginal estrogen prevents bacterial vaginosis, prevents recurrent UTIs, and reduces incontinence.(29-34)
At Interlude, a board-certified can prescribe estradiol vaginal cream or estradiol vaginal suppositories if appropriate. And we'll ship your medication straight to your door.
Keep reading: What We Know About Vaginal Estrogen
Vaginal DHEA
Helps with: genitourinary syndrome of menopause
Like vaginal estradiol, vaginal DHEA is also very effective. If you want to improve vaginal moisture, stop recurrent infections, or enjoy intimacy, then you might want to consider vaginal DHEA. Randomized controlled trials show that vaginal DHEA significantly improves vaginal pH, painful sex, and vaginal dryness.(7)
Vaginal DHEA is technically estrogen-free, but the body converts it into estrogen and testosterone. So if you’re uncomfortable with estrogen, then vaginal DHEA may not be for you.
Keep reading: 6 Things to Know About Intrarosa: A Vaginal DHEA Insert
Non-hormonal prescription solutions
If you’re skeptical about hormone-based menopause solutions of any kind, there are other prescription solutions out there that are proven to be effective but that don’t contain hormones.
Fezolinetant
Helps with: hot flashes, night sweats
Fezolinetant is a pill that’s taken daily to help the brain reduce hot flashes. Marketed under the brand name Veozah, fezolinetant is a hormone-free medication that works with your brain to help reduce hot flashes and night sweats.
Veozah is a great option for women who do not want or cannot take hormone therapy. Clinical studies have shown that Veozah can reduce hot flashes by more than 50%.(35)
Keep reading: 5 Things to Know About Veozah: A New Drug for Hot Flashes
Bladder medications
Helps with: overactive bladder, hot flashes, night sweats
Oxybutynin is an oral medication that’s used for overactive bladder. There’s also research to show that oxybutynin can significantly improve hot flashes and night sweats. However, oxybutynin is associated with some uncomfortable side effects, so about 71% of people who try oxybutynin will stop using it.(36)
If you’re looking to reduce urinary frequency or urgency and don’t want the side effects from oxybutynin, then vaginal estrogen might be the way to go. Recent research shows that vaginal estrogen is just as effective as oxybutynin at reducing overactive bladder.(34)
Keep reading: Are Your Bladder Issues Due to Hormonal Changes?
Anti-depressants
Helps with: hot flashes, night sweats
Medications that treat depression can also be prescribed in lower doses to help treat hot flashes and night sweats. These lower doses are meant to treat perimenopause and menopause symptoms, and not depression.
Large randomized controlled trials have shown that medications like paroxetine, escitalopram, citalopram, venlafaxine, and desvenlafaxine can significantly reduce hot flashes and night sweats.(37-42)
Lifestyle changes
Weight loss
Proven to help with: hot flashes
Studies have found that weight loss is associated with a decrease in hot flashes and night sweats.(43,44) This is encouraging for women who are obese, since obesity is associated with increased hot flashes and night sweats.
Remember, when it comes to managing perimenopause and menopause symptoms, it’s always a good idea to cultivate habits that promote your overall health and well-being. Focus on improving your sleep, eating a healthy diet, minimizing alcohol, and regular cardiovascular exercise.
Cognitive behavioral therapy
Helps with: hot flashes, night sweats
Clinical studies show that perimenopausal and postmenopausal women can benefit from cognitive behavioral therapy.
In one study, for example, cognitive behavioral therapy reduced the bother and interference of symptoms like hot flashes in a work setting.(45)
Other mind-body techniques like yoga, relaxation, paced breathing, and mindfulness might be helpful, but more research is needed if these techniques can consistently improve perimenopause and menopause symptoms.
Herbs, botanicals, moisturizers, and lubricants
Many over-the-counter solutions can help relieve perimenopause and menopause symptoms.
Herbs and botanicals
Might help with: hot flashes
When it comes to the safety or efficacy of herbal treatments for perimenopause and menopause symptoms, research is lacking.
Black cohosh is an herbal supplement that's commonly used to treat menopause symptoms. And there may be good evidence for it. Emerging research shows that black cohosh may be helpful for symptoms like hot flashes.(46)
Read more: The Impact of Black Cohosh on Menopause Symptoms
Lubricants and moisturizers
Helps with: vaginal dryness, pain with sex
If you’re looking to ease vaginal dryness or pain with sex, then the first thing to try is vaginal moisturizers and lubricants. A good vaginal moisturizer can be used daily to help restore moisture to the vaginal and vulvar skin. And a good lubricant can help make sex more comfortable. It's key to look for products that will not irritate or dry out the delicate vaginal skin.
Many women will find that moisturizers and lubricants alone are not adequate, and if so, vaginal estrogen would be the next logical solution.
Read more: Our Picks for the Best Vaginal Moisturizers, Best Lubricants for Vaginal Dryness
Next steps
Need a little help deciding what’s right for you? There’s no one-size-fits-all treatment for perimenopause and menopause symptoms. But Interlude is here to help. Not only can a board-certified doctor prescribe vaginal estrogen if it’s appropriate for you, you can ask them any questions you may have. When you sign up for a prescription for vaginal estrogen, a board-certified doctor will review your health profile within hours. And, if prescribed, we'll ship your treatment straight to your door.
