Non-hormonal options for managing menopause symptoms: a narrative review

Objective. An increasing number of menopausal womenexperience significant symptoms but are either contraindicated or choose electively to avoid Hormone Replacement Therapy (HRT). Therefore, there is an increasing and urgent need for rigorous research and validate alternative therapeutic options to mitigate menopausal symptoms and prevent potential long-term disturbances in this population. The aim of this review was to summarize the most recent non-hormonal options for the management of early symptoms and the prevention of potential long-term complaints of menopause. Materials and Methods. Relevant publications were identified through systematic searches of PubMed, Scopus, Medline, Cochrane Library, ClinicalTrials.gov, and Embase. The search was complemented by cross-referencing the bibliographies of the retrieved articles. Results. In menopause, lifestyle and nutritional improvements are crucial for maintaining and promoting overall well-being alongside any treatments. While botanicals, supplements, vitamins, acupuncture, hypnosis, and behavioral therapies may alleviate early symptoms, their effectiveness remains insufficiently proven. Particular caution is needed with phytoestrogens due to their significant estrogenic and anti-estrogenic properties. Additionally, antidepressants like SSRIs and SNRIs show promise for managing symptoms. Conclusions. It is important to recognize that non-hormonal therapies should be recommended based on their primary mechanisms of action. For instance, gabapentin may be the preferred option for patients experiencing hot flashes and restless legs syndrome. However, due to the uncertainties surrounding the neuroendocrine causes of menopausal symptoms, the development of targeted therapies is still in progress.