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Non-Hormonal Medications

Non-hormonal therapies for menopausal vasomotor symptoms (VMS) include a number of medications which are used “off-label” and are indicated for patients who cannot or do not wish to take menopausal hormone therapy (MHT). Each option will provide some relief from vasomotor symptoms but also provides benefits to other menopause related symptoms such as mood, sleep or urinary symptoms. 

The answers to the MQ6 assessment tool can inform as to which of these options may be preferred given the patient’s individual symptom profile. The chart below indicates options available in Canada as of January 2023. 

The “+” indicates relative impact for the symptom listed based on consensus/low-level evidence.

Non-Hormonal Treatment Options**

Gabapentin*

Antidepressants*

ie. SSRI, SNRI

Clonidine

Oxybutinin*

Vasomotor Symptoms

++(1)

++

+

++

GSM

+(2)

Sleep

+++(1)

+/-

Mood

+/-(3)

++/+++

  1. Gabapentin can be sedating at higher doses and has shown particular benefit for night sweats
  2. Oxybutynin is indicated (on-label) for symptoms of overactive bladder (OAB)
  3. There is some evidence for benefits of gabapentinoids on mood/anxiety

*indicates off-label use for vasomotor symptoms
**based on low-level evidence/consensus opinion

Type

Doses

Antidepressants: SNRI*

Venlafaxine XR

37.5-75 mg once daily

Desvenlafaxine

100 mg once daily

Antidepressants: SSRI*

Paroxetine

10-20 mg once daily

Citalopram

10-20 mg once daily

Escitalopram

10-20 mg once daily

Gabapentinoids*

Gabapentin

up to 900 mg per day in divided doses

Other

Clonidine (on-label)

0.05 mg twice daily

Oxybutinin*

2.5-5 mg twice daily

*NB all the above are off-label uses of these medications

For a full listing of hormonal products and non-hormonal medication options click here.

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