Medications

On this page:
Antidepressants
Gabapentin
Clonidine
References

Exploring Non-Hormonal Options for Menopausal Symptom Relief

For women who cannot or choose not to use Hormone Replacement Therapy (HRT), medications can provide an effective alternative for managing menopausal symptoms. These medications are often selected based on individual health profiles, specific symptoms, and personal preferences. While they may not address the hormonal changes associated with menopause, they can offer relief from many of the disruptive symptoms women experience during this transitional phase.

The Menopause Society also recognises several of these non-hormonal methods, including antidepressants, gabapentin, and clonidine, as viable options for symptom relief when HRT is not suitable.

One of the primary classes of medications used as alternatives to HRT includes antidepressants. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs) are commonly prescribed to help manage mood swings, hot flushes, and anxiety by affecting neurotransmitters in the brain. Additionally, other medications like gabapentin, originally developed for epilepsy, and clonidine, typically used for high blood pressure, are prescribed off-label to alleviate symptoms such as hot flushes and night sweats.

While these medications can be effective in managing specific menopausal symptoms, they do not address all the effects of declining hormone levels, such as vaginal dryness or bone loss. Therefore, it’s essential to work closely with a healthcare provider to determine the most appropriate and safe treatment options, particularly for those with underlying health concerns or those who may be at risk for certain conditions.

Antidepressants

Antidepressants are sometimes considered as an alternative to Hormone replacement therapy (HRT) for managing menopausal symptoms, particularly when HRT is not suitable or preferred due to medical reasons or personal preferences. While HRT directly replaces declining hormones like estrogen and progesterone, antidepressants work by affecting neurotransmitters in the brain, such as serotonin and norepinephrine, which can help alleviate certain menopausal symptoms.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most commonly prescribed classes of antidepressants for menopausal symptoms. They can be effective in managing symptoms such as hot flashes, mood swings, anxiety, and sleep disturbances.

However, it’s essential to note that while antidepressants can help relieve specific menopausal symptoms, they do not address the underlying hormonal changes associated with menopause. Therefore, they may not be as effective as HRT for managing certain symptoms like vaginal dryness or bone loss.

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs)

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs) are commonly prescribed classes of medications used to treat depression, anxiety disorders, and other mental health conditions. SSRIs work by blocking the reuptake of serotonin, while SNRIs block the reuptake of both serotonin and norepinephrine, two neurotransmitters crucial for mood regulation. By increasing the levels of these neurotransmitters in the brain, SSRIs and SNRIs can effectively alleviate symptoms of depression, such as persistent sadness, loss of interest in activities, changes in appetite or sleep, and feelings of worthlessness or guilt. These medications may also be used to manage conditions like obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder (PTSD).

Evidence shows that SSRIs and SNRIs can significantly reduce vasomotor symptoms (VMS) such as hot flashes, with reductions ranging from 25% to 69%, and they have also shown improvements in mood and sleep.
NAMS Position Statement (2023) Non Hormone Therapy, p. 577.

In the context of menopause, SSRIs and SNRIs can be beneficial in alleviating symptoms such as hot flushes, mood swings, and irritability. Their influence on serotonin and norepinephrine pathways not only helps stabilise mood but also reduces the intensity and frequency of menopausal symptoms, offering relief to many women during this transitional period. Additionally, SNRIs may be prescribed for managing certain types of chronic pain, such as neuropathic pain and fibromyalgia, further contributing to their versatility in treatment.

Caution must be taken when prescribing to patients with uncontrolled seizures, bipolar disorder, kidney or liver issues, untreated low sodium, or poorly managed high blood pressure.

SSRI/SNRI Therapy Options

There are various SSRI/SNRI options in New Zealand and all are fully funded. They include the following medications:

Paroxetine (SSRI)
Citalopram (SSRI)
Escitalopram (SSRI)
Enlafax XR or Venlafaxine (SNRI)

Dose: The dosage of SSRIs and SNRIs for managing postmenopausal symptoms can vary depending on the specific medication and individual needs.

Side Effects: Common side effects include nausea, weight gain, sexual dysfunction, dry mouth, constipation, and drowsiness. Some people may also experience increased anxiety or agitation.

Interactions: SSRIs and SNRIs can interact with other medications, including blood thinners and certain pain relievers, increasing the risk of adverse effects.

Discontinuation Syndrome: Stopping these medications abruptly can lead to withdrawal symptoms such as dizziness, nausea, and flu-like symptoms.

Suicidal Thoughts: Particularly in younger individuals, there may be an increased risk of suicidal thoughts or behaviours. Regular monitoring is essential.

Gabapentin

Gabapentin is a medication originally developed to treat epilepsy, but it’s also commonly prescribed for managing various types of nerve pain (neuropathic pain) and migraines. Additionally, it’s sometimes used off-label to help relieve hot flushes and other symptoms associated with menopause.

After 6 weeks of treatment, pregabalin at a dose of 75 mg twice a day or 150 mg twice a day decreased VMS frequency by 59% and 61%, respectively, whereas placebo decreased symptoms by 35%
NAMS Position Statement (2023) Non Hormone Therapy, p. 578.

The exact mechanism of how gabapentin works to alleviate menopausal symptoms is not fully understood. However, it’s believed to modulate the activity of certain neurotransmitters in the brain, which can help regulate body temperature and reduce the frequency and severity of hot flushes. When used for menopausal symptoms, gabapentin is typically prescribed at lower doses than those used to treat epilepsy or nerve pain.

Gabapentin Therapy Option

The gabapentin options are fully funded in New Zealand, they include the following medications:

Neurontin
Nupentin

Dose: The dosage of gabapentin for postmenopausal symptoms can differ based on the individual and the specific treatment plan.

Side Effects: Common side effects include dizziness, drowsiness, weight gain, and swelling. Some people may also experience mood changes or impaired coordination.

Interactions: Gabapentin can interact with other medications like antidepressants and antipsychotic medicines.

Withdrawal: Abrupt discontinuation can lead to withdrawal symptoms, including increased anxiety and seizures in some cases.

Cognitive Effects: Long-term use may impact cognitive function, leading to difficulties with memory and concentration.

Clonidine

Clonidine is a medication primarily used to treat high blood pressure (hypertension). However, it’s also prescribed off-label for a variety of other conditions, including menopausal symptoms such as hot flushes and night sweats.

[Clonidine] has been shown to be modestly more beneficial than placebo but less beneficial than SSRIs, SNRIs, and gabapentin in reducing VMS.
NAMS Position Statement (2023) Non Hormone Therapy, p. 578.

Clonidine works by stimulating certain receptors in the brain that help regulate blood pressure and body temperature. When used for menopausal symptoms, it can help reduce the frequency and severity of hot flashes by modulating the body’s response to temperature changes.

Clonidine Therapy Options

In New Zealand, Clonidine is fully funded and available in both:

Tablet form
Transdermal patch

Dose: The starting dose for the tablet form is typically 25 mcg twice a day. It’s then gradually increased up to 75 mcg twice a day. For the patch form of clonidine, the typical starting dose is a patch that delivers 0.1 mg per day, applied once weekly. The dose can be adjusted based on individual response, with patches available in higher doses, such as 0.2 mg or 0.3 mg per day.

Side Effects: Potential side effects include sleep disturbances and dry mouth.

References

Australasian Menopause Society, Non Hormonal Treatments for Menopausal Symptoms [Updated: Sept 2018].

The Menopause Society, formerly known as the North American Menopause Society (NAMS), Position Statement (2023) Non Hormone Therapy, Menopause: The Journal of The North American Menopause Society Vol. 30, No. 6, pp. 573-590.

British Menopause Society (BMS), Prescribable Alternatives to HRT, [Updated: July 2020].

Healthify, Menopausal Non-Hormone Therapy, [Updated: 8 Dec 2022].

Healthify, Gabapentin, [Updated: 17 Apr 2024].

Healthify, Paroxetine, [Updated: 28 Mar 2024].

Healthify, Citalopram, [Updated: 5 Dec 2022].

Healthify, Escitalopram, [Updated: 7 Mar 2024].

Healthify, Velafaxine, [Updated: 28 Mar 2024].

Healthify, Clonidine Tablets, [Updated: 28 Mar 2024].

Healthify, Clonidine Patch, [Updated: 28 Mar 2024].

[Updated: 18 July 2025]