Hormonal and Non-Hormonal Approaches

Hormonal Options for Menopause Symptoms

During perimenopause and menopause, three key hormones—estrogen, progesterone, and testosterone—begin to fluctuate and ultimately decline. These natural hormones influence various aspects of health, including sleep, energy, bone density, and cognitive function. When levels drop significantly, women may experience a wide range of disruptive symptoms.

This is where menopausal hormone therapy (MHT) can play a powerful role.

Estrogen Therapy

Estrogen is the most commonly used hormone for treating menopause symptoms. It is available in several forms:

• Oral tablets
• Transdermal patches
• Gels or sprays
• Vaginal inserts for localized symptoms (e.g., dryness, discomfort)

You may hear the term ‘bioidentical estrogen’—this refers to formulations that are chemically identical to the estrogen your body naturally produces.

Progesterone Therapy

If you still have a uterus, progesterone is typically recommended alongside estrogen to protect the uterine lining. Progesterone comes in:

• Oral capsules (including bioidentical options)
• Intrauterine devices (IUDs)
• Vaginal preparations (occasionally used off-label)

Testosterone Therapy

While testosterone is not FDA-approved for general use in women, it is frequently used off-label to address low libido, fatigue, and mood changes in menopause. Options include:

• Transdermal products (originally developed for men, used in modified doses)
• Compounded creams or gels made by specialty pharmacies

Combination Therapies

Some products combine estrogen and progesterone in a single pill or patch. Others, such as tissue-selective estrogen complexes (TSECs), combine estrogen with a selective estrogen receptor modulator (SERM) to provide symptom relief while protecting breast and uterine tissue.

Note: I’ll cover combination therapies and TSECs more in an upcoming blog post.

 

Non-Hormonal Options for Menopause Symptoms

Not all women are candidates for hormone therapy. Fortunately, several non-hormonal treatments have been shown to reduce vasomotor symptoms like hot flashes and night sweats:

FDA-Approved or Evidence-Based Non-Hormonal Medications

• SSRIs and SNRIs (low-dose antidepressants like paroxetine)
• Gabapentin (a nerve-related medication that can reduce hot flashes, especially at night)
• Fezolinetant (a new non-hormonal option that targets brain pathways involved in body temperature regulation)

While these medications don’t offer the protective benefits of hormone therapy (like reducing risks of osteoporosis or cardiovascular disease), they can provide meaningful symptom relief.

Supplements and Natural Remedies

There’s no shortage of over-the-counter products claiming to ease menopause symptoms. However, many menopause supplements lack strong clinical evidence. That doesn’t mean they can’t be helpful—some women do find relief—but they’re typically not first-line treatments.

If you’re considering a supplement, always consult your healthcare provider to ensure it’s safe and won’t interact with any medications or underlying health conditions.

 

A Final Word: You Deserve Expert Menopause Care

Navigating menopause can be overwhelming, but you don’t have to go it alone. There are safe and effective options available, and the best plan is one that’s individualized for your body, symptoms, and goals.

Look for a provider with specialized training in menopause care who can guide you through an evidence-based discussion about what’s best for you, whether that includes hormone therapy, non-hormonal options, or both.

Your symptoms are real. Your health matters. And you deserve care that helps you feel your best in this powerful chapter of life.