Thriving in Menopause: Hormonal and Non-Hormonal Options
Menopause is a natural phase of life. With education, proactive management, and the right support, you can thrive during this transition.
Hormone Replacement Therapy (HRT)
HRT remains the gold standard for managing vasomotor symptoms (hot flashes and night sweats) which contribute to disrupted nighttime sleep and preventing osteoporosis. Recent evidence suggests that HRT is safe and effective when initiated within 10 years of menopause or before the age of 60.
Candidates for HRT should work closely with their healthcare provider to weigh risks and benefits, particularly if they have contraindications such as:
History of breast cancer
Blood clots
Active coronary artery disease
Non-Hormonal Alternatives
For women who prefer not to or cannot use hormone replacement therapy (HRT), there is a newly approved (at the time of this writing of this post) medication called fezolinetant, which is a neurokinin B receptor antagonist that works by targeting the brain’s thermoregulatory center—essentially, the part of the brain that helps regulate body temperature. This innovative approach has been shown to significantly reduce the frequency and intensity of hot flashes.
Hot flashes can be particularly disruptive to nighttime sleep, often leaving women feeling exhausted and frustrated. Fezolinetants may help alleviate this key contributor to sleep disruption. However, it's important to note that while fezolinetant addresses hot flashes, it is not specifically approved for treating insomnia related to menopause.
As with any newer medication, the long-term safety profile of fezolinetant is still being studied, but its development offers hope for women seeking effective, non-hormonal solutions to improve their quality of life during menopause. Always consult with a healthcare provider to determine the best treatment options for your individual needs.
Cognitive-Behavioral Therapy for Insomnia (CBT-I)
CBT-I is the first-line treatment for chronic insomnia, offering long-term benefits over medications.
CBT-I effectively reduces insomnia symptoms in peri- and postmenopausal women, with sustained improvements up to six months post-treatment.
Other non-pharmacological approaches, like yoga nidra, acupuncture, and nutritional supplements (I encourage you to read the article for a list of supplements that have at least 1 study showing benefit, albeit small studies), may be beneficial for sleep in menopause.
Lifestyle Modifications
Behavioral and lifestyle changes can significantly improve menopause symptoms and overall health:
Regular Exercise: Weight-bearing activities support bone health, while aerobic exercise reduces cardiovascular risks.
Mindfulness and Stress Management: Practices like meditation have been shown to alleviate hot flashes and improve sleep quality.
Healthy Diet: A balanced diet rich in calcium and vitamin D supports bone health and metabolic stability.
Sleep Hygiene: Prioritizing consistent sleep schedules, limiting screen time, and creating a cool, dark bedroom environment can promote better sleep.
The Importance of Shared Decision-Making
Navigating menopause is deeply personal, and no two journeys are the same. The cornerstone of effective management is shared decision-making—an open dialogue between you and your healthcare provider to tailor treatments to your unique needs and preferences. If you’re experiencing menopause symptoms, don’t hesitate to seek guidance. Your health and quality of life matter.
Menopause is a natural phase of life. With education, proactive management, and the right support, you can thrive during this transition. For a deeper dive into this topic, tune in to S5Ep4 and S5Ep7 to learn more of the Sleep Is My Waking Passion podcast, where I explore these issues and more in detail.
Stay informed, take charge, and prioritize your health. You deserve it.
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