What are the nonhormonal alternatives to estrogen therapy for menopausal symptoms?

Updated: Oct 16, 2018
  • Author: Janice L Bacon, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Therapeutic options for women who request treatment for VMS but for whom estrogen is not safe or not desired include:

Prescription options that are non-hormonal include:

Serotonin- norepinephrine reuptake inhibitors

Selective serotonin reuptake inhibitors (SERMS)

Gabapentin or Pregabalin

Clonidine (for patients failing gabapentin or pregabalin)

A study by Freeman et al found that the use of escitalopram (10-20mg/day), a selective serotonin reuptake inhibitor (SSRI), can be a useful alternative to estrogen/progesterone; escitalopram reduces and alleviates more severe hot flashes. [31]

New approaches under consideration and study include:

Stellate ganglion block

Guided relaxation


Cognitive behavior modification

NK3 receptor antagonists [114, 115]

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