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/ Pregabalin* | Antidepressants* ie. SSRI, SNRI | Clonidine | Oxybutinin* | |
Vasomotor Symptoms | ++(1) | ++ | + | ++ |
GSM | +(2) | |||
Sleep | +++(1) | +/- | ||
Mood | +/-(3) | ++/+++ |
- Gabapentin can be sedating at higher doses and has shown particular benefit for night sweats
- Oxybutynin is indicated (on-label) for symptoms of overactive bladder (OAB)
- 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.