Intended for healthcare professionals

Practice Clinical updates

Non-hormonal treatments for menopausal symptoms

BMJ 2017; 359 doi: (Published 23 November 2017) Cite this as: BMJ 2017;359:j5101
  1. Martha Hickey, professor of obstetrics and gynaecology, NHMRC practitioner fellow1,
  2. Rebecca A Szabo, senior lecturer in obstetrics and gynaecology and medical education1 2,
  3. Myra S Hunter, emeritus professor of clinical health psychology3
  1. 1Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia and the Royal Women’s Hospital, Victoria, Australia
  2. 2Department of Medical Education, University of Melbourne, Parkville, Australia
  3. 3Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
  4. Correspondence to: M Hickey:

What you need to know

  • Menopause is a normal event, but around 25% of women have problematic vasomotor symptoms (hot flushes and night sweats) that impair quality of life and might require treatment

  • Systemic hormone replacement therapy (HRT) is currently the most effective treatment for vasomotor symptoms and may also improve vaginal dryness, sleep, and quality of life

  • For those wishing to avoid HRT, there are non-pharmacological and non-hormonal pharmacological treatments for vasomotor symptoms

  • Most non-hormonal treatments act quickly, so if there is no improvement after 2-4 weeks consider a different approach

  • Management of menopausal symptoms should be individualised and address patient aims and preferences for treatment. Therapies should target the symptoms that most affect function and quality of life

Menopause is a normal event, and most women do not seek medical intervention. Of those who do, some will require only information and advice, but around 25% have problematic symptoms that may need treatment. Vasomotor symptoms are the main reason that women seek treatment. Hormone replacement therapy is effective for vasomotor symptoms, but for some it is unsuitable (due to preference or contraindications) and non-hormonal treatments can be considered.

This update provides an overview of the evidence supporting non-hormonal treatments for vasomotor and vaginal symptoms, and translates this into practical guidance on managing these symptoms in clinical practice.

What are menopausal symptoms?

The menopause is the final menstrual period. The “perimenopause” or “menopause transition” is the time from the onset of menstrual cycle changes until one year after the final menstrual period.1

Changes in vaginal bleeding patterns and vasomotor symptoms characterise the menopause transition, but the overall experience is highly variable and may be influenced by psychological, social, and cultural factors.2 Common symptoms include hot flushes and night sweats (vasomotor symptoms) and genital symptoms (vaginal dryness, dyspareunia), which may be accompanied by mood and sleep disturbance.3 …

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