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Alternatives to HRT



Some women cannot safely take HRT, or simply don't wish to for various reasons. When symptoms are milder, these can sometimes be managed adequately with dietary and lifestyle modifications such as cutting out caffeine and alcohol, eating well, regular exercise, good sleep hygiene and supplements. Cognitive behavioural therapy and complementary therapies such as acupuncture can also be helpful.

 

For women who are still struggling, there are a number of prescribable alternatives to HRT that your doctor may consider. Most of these are aimed at suppressing only hot flushes and sweats, but an improvement in these symptoms can lead to better sleep, energy levels and mood and all the indirect benefits of these. The most commonly used of these alternative drugs are the SSRI group of antidepressants, such as Paroxetine or Citalopram, or a different type of antidepressant called Venlafaxine. As well as improving hot flushes and sweats they can also help with low mood and anxiety. Clonidine is a different type of medication which acts on the blood vessels to reduce flushing but it can cause a drop in blood pressure and side effects can include sleep disturbance. Both Gabapentin and Pregabalin, which are used for epilepsy, can also reduce hot flushes in about 50% of women.

 

The latest addition to the group of drugs for menopausal flushes is Veoza, and this works in a novel way on receptors in the brain. It is currently only available in the UK on a private prescription, but hopefully will be approved by the NHS in due course. Clinical trials have been very encouraging and the frequency of hot flushes and sweats are reduced by around 60% within the first three months. It is advised that liver function is monitored whilst the drug is being used, but any changes are transient and reversible. Veoza should not be used alongside HRT, and hasn't been studied in women over 65 or those who have had breast cancer. Whilst the manufacturer advises that Veoza should be avoided in women after a hormone sensitive cancer, it is not known to significantly affect hormone levels, and may be a suitable option following a discussion with your doctor or menopause specialist.


Dr Helen Kennedy, Women's Health Doctor & BMS Accredited Menopause Specialist

The Maxwell Practice, private GP clinic, Henley-on-Thames

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