When Shilpa Gajarawala began experiencing intense hot flashes, sleepless nights and brain fog, hormone therapy wasn’t an option. The 58-year-old physician assistant from Jacksonville, Florida, had survived breast cancer — and that history put standard hormone treatments off the table.
“For two years, I tried to kind of power through,” she said.
But specialists say women like Gajarawala don’t need to endure these symptoms. Although many rely on hormone therapy to ease menopause, new federal label changes may lead more women to consider it. Still, a large number avoid the treatment, and doctors advise others to steer clear due to conditions such as severe liver disease, or histories of heart attack, stroke, blood clots or hormone-sensitive breast cancer.
For them, experts say a wide range of lifestyle changes, nonhormonal medications and other strategies can offer relief.
“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.”
Lifestyle changes
Doctors say exercise doesn’t directly eliminate menopausal symptoms, but it can contribute to weight loss — and even modest reductions in weight have been linked to fewer hot flashes and night sweats. They recommend a mix of aerobic exercise such as walking or running, along with strength training to slow bone loss.
Diet also plays a role. Emerging research shows a “plant-forward” diet rich in vegetables and soy and low in oil may reduce hot flashes, Faubion said. While the reasons are not fully understood, some experts believe the benefit may be tied to weight management.
Physicians also suggest avoiding common triggers, including caffeine and alcohol. Eating well and staying active help curb rising midlife health risks, such as heart disease and diabetes, which are influenced by the sharp decline in estrogen during menopause.
“It’s important that we focus on maintaining cardiovascular health,” said Faubion, noting the need for adequate sleep, stress management and smoking cessation.
Prescription medications
Several nonhormonal prescription drugs have shown promise.
Certain antidepressants can ease hot flashes and mood disturbances. Oxybutynin, a drug commonly used for overactive bladder, may also reduce hot flashes while helping with frequent urination — another common menopausal complaint.
A newer entrant, Veozah (fezolinetant), works by targeting the part of the brain that regulates body temperature and blocking the source of hot flashes. Another nonhormonal drug, elinzanetant — sold as Lynkuet — was recently cleared by the U.S. Food and Drug Administration and works similarly, blocking two nerve-system molecules instead of one.
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However, the medications carry risks. Veozah includes a warning about rare but serious liver injury. Lynkuet can cause fatigue and trouble staying awake. Oxybutynin may lead to dry mouth or incomplete bladder emptying. Some antidepressants can cause weight gain, although generally at higher doses than those used for menopause.
“There’s no medication out there that’s entirely free of risk,” said Dr. JoAnn Manson of Harvard Medical School.
Other approaches
Nonhormonal over-the-counter options — such as lubricants — can help with vaginal dryness. Cognitive behavioral therapy has proved useful in helping women cope with hot flashes by reducing their psychological impact.
Clinical hypnosis may also help, with moderate evidence suggesting fewer and less severe hot flashes, Manson said, though more research is needed.
Dr. Juliana Kling of the Mayo Clinic Alix School of Medicine said women should not feel they must simply endure menopause. “I would implore women to have that conversation ... about what treatment might be beneficial for them,” she said.
Gajarawala has since changed her routine: she avoids red wine, walks 10,000 steps daily, practices tai chi and uses an extended-release antidepressant.
“It’s been a significant improvement,” she said.
Source: AP