Can't take hormone therapy for menopause? There are other options
[November 17, 2025]
By LAURA UNGAR
Shilpa Gajarawala struggled with hot flashes, night sweats, sleep
problems and brain fog. But given her history of breast cancer, treating
these menopausal symptoms with hormone therapy wasn’t an option.
“For two years, I tried to kind of power through,” said the 58-year-old
physician assistant from Jacksonville, Florida.
But doctors say women like Gajarawala don’t need to suffer.
Though many women take hormone therapy medications to ease menopause
symptoms, recently announced label changes may encourage even more to
start. But others choose not to use these medications that circulate
throughout the body. And doctors advise some to avoid them because they
have medical problems such as severe liver disease or a history of heart
attack, stroke, blood clots or a type of breast cancer that grows in
response to hormones such as estrogen.
For those people, there are lifestyle changes, medications without
hormones and other strategies that can help.
“The key here is that there’s something for everybody,” said Dr.
Stephanie Faubion, medical director at the Menopause Society. “There’s
always a solution. We have lots of other options available.”
Lifestyle changes
Boosting physical activity can make a difference. While exercise hasn’t
been shown to alleviate menopausal symptoms directly, it can help to
shed pounds, which is associated with reductions in hot flashes and
night sweats.
Doctors suggest a mix of aerobic exercise, such as running or walking,
and strength training, which slows the loss of bone density.
Along with exercise, doctors advise watching what you eat.
Emerging science shows that a “plant-forward diet,” rich in produce and
soy and low in oil, may help with managing hot flashes in particular,
said Faubion of the Mayo Clinic Center for Women’s Health. Experts
aren't sure why this is true, but some suggest it may be because it also
helps with weight loss.
Another key, doctors said, is to avoid things in the diet that may
trigger hot flashes, like caffeine or alcohol.
Eating well and exercising also help with other midlife health issues,
like rising heart and diabetes risks.
During menopause, the body’s production of the hormones estrogen and
progesterone declines greatly. The drop in estrogen levels can lead to
higher blood pressure and cholesterol.
"It's important that we focus on maintaining cardiovascular health” such
as stopping smoking, getting enough sleep and watching stress levels,
Faubion said.
Prescription drugs
Beyond lifestyle changes, some nonhormonal prescription medicines have
been shown to ease menopausal symptoms.
Antidepressants can help with hot flashes and mood issues. Recent data
suggest that a drug for an overactive bladder called oxybutynin may
reduce hot flashes while also treating frequent urination that's common
during menopause.
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A woman walks down a trail as fog looms at Montie Beach Park in
Houston, on Monday, Oct. 17, 2011. (Cody Duty/Houston Chronicle via
AP, File)
 And doctors pointed to a new drug on
the market – Veozah, a brand name for fezolinetant — which works in
the area of the brain that controls body temperature and blocks a
source of hot flashes and night sweats. Another nonhormonal drug
called elinzanetant — marketed as Lynkuet — was recently approved by
the U.S. Food and Drug Administration. It works similarly, except it
blocks two molecules in the nervous system instead of one.
One downside of such medications? Possible side effects.
Veozah’s label includes a federally required warning about the risk
of a rare but serious liver injury. Lynkuet's possible side effects
include difficulty staying awake, fatigue and others. Some
antidepressants can cause weight gain, although generally in doses
higher than those used for menopause symptoms. And oxybutynin can
cause dry mouth and, in some people, a condition in which they can't
completely empty the bladder.
“There’s no medication out there that’s entirely free of risk,” said
Dr. JoAnn Manson at Harvard Medical School.
Other nonhormonal options
Over-the-counter products can also treat some menopausal symptoms.
Lubricants available at drugstores can help women struggling with
vaginal dryness.
Cognitive behavioral therapy, which focuses on changing unhealthy
thought patterns and behaviors, has been shown to help women cope
with hot flashes.
“It’s not like it’s going to make you not have a hot flash,” Faubion
said. “But it makes them less significant for you and less
burdensome.”
Manson said there’s “moderate evidence” that clinical hypnosis might
also help, with some studies showing reductions in the frequency and
severity of hot flashes.
“That seems a promising option,” she said. “But more research is
needed.”
The bottom line is that women don’t have to simply “get through”
menopause, said Dr. Juliana Kling, a women’s health expert at Mayo
Clinic Alix School of Medicine in Arizona. “I would implore women to
have that conversation ... about what treatment might be beneficial
for them."
Gajarawala did that. She now skips red wine, walks at least 10,000
steps a day, practices tai chi and takes an extended-release
antidepressant to address her symptoms.
“It’s been a significant improvement,” she said.
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