Jennifer Chandler
reviewed by Dr Michael Yapko
Friday, September 3, 2021
Jennifer Chandler
Friday, September 3, 2021

Menopause Treatment: Prescription vs Natural


There seem to be as many opinions about menopause treatment as there are stars in the sky. But it’s not really the opinion that matters, it’s the science. To help you navigate your way, let’s look at how effective the most common treatments really are.

Why do you need menopause treatment?

Menopause is a stage of life, not a condition or a disease⸺so why do you need treatment at all? Well, the short answer is; you may not. But for many women, the symptoms of menopause, even if temporary, can affect their quality of life.

Menopausal symptoms can include:

  • Hot flashes: Possibly the best known of the menopause symptoms, hot flashes affect 80% of women. Hot flashes can be embarrassing, uncomfortable and contribute to stress and anxiety.
  • Night sweats: These are the night time versions of a hot flash and can seriously disturb sleep. Women who experience night sweats often experience extreme fatigue and even depression.
  • Vaginal dryness: During menopause the vagina walls become thinner, drier, and less elastic. This can make sex and even day-to-day life uncomfortable.
  • Increased facial hair: A drop in estrogen means the balance between the male and female-dominant hormones changes, triggering more facial hair.
  • Brain fog: Although the exact mechanism behind ‘brain fog’ or ‘brain fades’ during menopause isn’t known, studies show cognitive function is definitely impacted by the hormone changes during menopause.
  • Depression: Around 20% of women experience depression during menopause, and a far higher number experience mood swings.
  • Weight gain: The slowing of our metabolism as we age, plus changes to our muscle mass, means that menopause can be a time of unwanted weight gain.

This stage of life can also see an increase in the risk of osteoporosis and heart disease.

So, while menopause in itself doesn’t require treatment, it’s easy to see why many women search out prescriptions and natural treatments to gain relief for their symptoms.

Prescription medications

Many menopause symptoms such as hot flashes, facial hair, and vaginal dryness are linked to changes in hormone levels, such as a drop in the level of estrogen your body produces. Many menopause treatments look to replace this reduction of estrogen, these are called hormone replacement therapies.

Other non-hormonal drugs for menopause include antidepressants and anti-seizure medications.

Hormone replacement menopause treatments

HRT can be delivered in the form of pills, patches, creams, vaginal rings, or even injections. There are two common types of HRT: Estrogen Therapy (ET), and combined Estrogen plus Progestin Therapy (EPT).

ET is most often prescribed for women with a hysterectomy. EPT is usually prescribed for women with an intact uterus as it can offer some protection against endometrial cancer.

What the research says:

HRT has been shown to reduce hot flashes by 70% to 80%. It can also help relieve menopause symptoms such as vaginal dryness, reduced sex drive, and mood swings. It’s also been shown to reduce the risk of osteoporosis.

However, a large series of clinical studies known as the Women’s Health Initiative (WHI) has shown that, for some women, HRT may be an unsafe menopause treatment and can increase their risk of cancer and heart disease.

If you’re considering HRT be sure to talk to your doctor. In some cases, the benefits may outweigh the risks, and vice versa.


Gabapentin is a medicine usually prescribed for controlling epilepsy and nerve pain, but has also been shown to help with hot flashes. Taken in tablet or capsule form, symptom relief is often achieved by two weeks, however the dose required to achieve this varies between women.

What the research says:

In one study, gabapentin was shown at higher doses to be as effective as estrogen in reducing the severity and frequency of hot flashes. However, participants noticed a far higher frequency of headaches, dizziness and disorientation. Common side effects of gabapentin include loss of concentration, forgetfulness, blurred vision, dryness of the mouth and fatigue.


Clonidine is a non-hormonal therapy that is usually used to treat high blood pressure and migraine headaches. It is also used to treat hot flashes in either tablet or patch form (although these aren’t available everywhere).

What the research says:

Clonidine has been shown to reduce hot flashes in menopausal women by 46% for the oral form and 80% for the patches. Many women reported not wanting to continue this treatment due to side effects such as drowsiness and vomiting. Long-term use may also increase blood pressure.


Certain types of antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), decrease the frequency of menopausal hot flashes.

Antidepressants may also be prescribed to help reduce mood changes and depression experienced during menopause.

What the research says:

Antidepressants can reduce hot flashes by about 40% at best. This is a far lower efficacy than both HRT, and hypnotherapy⸺a therapy we’ll discuss later.

The long-term effects of using antidepressants as a menopause treatment is not yet known.

Table of prescription v natural remedies for hot flashes

Natural menopause treatments

Some women find the list of side effects from prescribed menopause treatments to be daunting and prefer to search out more natural therapies such as herbal supplements or exercise. However, before simply selecting a ‘natural’ pill from your local pharmacy, it’s a good idea to look into the effectiveness and side effects of each.  

Herbal Supplements

A variety of natural supplements are marketed for relieving symptoms of menopause. These include:

  • Black cohosh
  • St.-John’s-wort
  • Vitamin E
  • Vitamin D
  • Calcium

What the research says:

Although some studies suggest black cohosh may reduce hot flashes, the evidence is mixed. There are also concerns about the safety of this supplement given the lack of research.

St-John’s-wort has been shown to be useful in treating anxiety and depression, but the jury is still out on its effectiveness in treating other menopausal symptoms such as hot flashes.  

Studies show that vitamin D and calcium supplements can play an important role in bone health. One study showed that vitamin D slowed bone density loss, while calcium improved bone density.

While there has been some preliminary research into the efficacy of vitamin E, the results were minimal and may not be better than the placebo. There are also potentially serious health complications for women with heart disease, diabetes, or hypertension.

Calm your IBS in just 6 weeks with Nerva

Start Now
Self-guided gut hypnotherapy
Developed by doctors
89% of users report improved gut symptoms

Take control of how you think, feel & act with Mindset

Try for free
Self-guided hypnosis app
Developed by world-experts
Courses on anxiety, negative thinking, achieving goals & more

Self-manage menopause & hot flashes naturally

Learn more
Evidence-based hypnotherapy
Menopause education
Symptom tracking & more!

Plant estrogens (phytoestrogens)

You may have heard that eating more soy is an ideal way to ease menopause symptoms. That’s because soy contains plant estrogens, known as phytoestrogens, which are thought to help to balance hormones in the body.

What the research says:

Several studies have linked phytoestrogens to reduced severity of hot flashes. Other studies believe the data is ‘weak at best’ and larger scale research needs to be done.  

It’s worth noting that phytoestrogens have been linked in research to both an increase and reduction in the risk of breast cancer.  Other research suggests they may increase the risk of other cancers. Overall, more research needs to be done to understand the full effects and potential risks of phytoestrogens on the body.


Whether it’s running, walking, yoga or resistance training, much has been said about the benefits of exercise during menopause and for your overall well-being.

What the research says:

Resistance training has been shown to increase muscle mass and strengthen bones, reducing the risk of osteoporosis and improving metabolism to slow weight gain.

Yoga has also been shown to improve coordination and help prevent falls, and may be a countermeasure to bone density loss.

Less is known about how or if exercise can improve hot flashes. More research needs to be done.


During hypnotherapy you are guided through a deep, hypnotic relaxation and given suggestions of coolness designed to help control or manage symptoms of hot flashes. Hypnotherapy can be conducted in person with a qualified therapist, or at home through a hypnotherapy app.

What the research says:

Hypnotherapy has been shown to reduce the severity of hot flashes in menopausal women by up to 80%. In addition, hypnotherapy has been shown to help manage mild symptoms of anxiety and depression sometimes present during menopause.

Staying sexually active

While 55% of women report a decrease in sexual desire during menopause, sex may in fact be a useful menopause treatment. Plus, as this time in your life can be marked by more freedoms (such as a reduced risk of pregnancy in post-menopause!) why not spend a little time connecting with your partner!

What the research says:

Staying sexually active during menopause may help decrease vaginal discomfort by stimulating blood flow to the vagina. Sex during menopause may also keep the vagina muscles toned, and maintain the vagina’s stretchiness. If dryness is an issue, there are lubricants and moisturizers available made specifically to assist with vaginal dryness during menopause.

The Wrap Up

Menopause comes with many symptoms that may range from annoying to severely disruptive. Several medication treatments and natural remedies are available, but it can be hard to tell fact from fiction when it comes to understanding their efficacy. HRT is still the most commonly used menopause treatment but isn’t appropriate for everyone. Hypnotherapy has been proven to effectively manage hot flash symptoms, without side effects. Other menopause treatments such as antidepressants and herbal supplements should be taken only on the advice of your doctor.

Self-hypnosis app for sleep, anxiety & depression

Try the Mindset app
Self-guided hypnosis app
Developed by world-experts
Courses on anxiety, negative thinking, achieving goals & more

Calm your IBS in just 6 weeks with Nerva

Start Now
Self-guided gut hypnotherapy
Developed by doctors
89% of users report improved gut symptoms

Manage hot flashes naturally, at home

Learn more
Evidence-based hypnotherapy
Menopause education
Symptom tracking & more!

Our Sources

Mindset Health only uses high-quality sources, including peer-reviewed research, to support our articles. We work with experts to ensure our content is helpful, accurate and trustworthy.

  1. Avis NE, Crawford SL, Greendale G, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015;175(4):531–539. doi:10.1001/jamainternmed.2014.8063
  2. Archer, D.F., Pickar, J.H., Bottiglioni, F. and Menopause Study Group, 1994. Bleeding patterns in postmenopausal women taking continuous combined or sequential regimens of conjugated estrogens with medroxyprogesterone acetate. Obstetrics & Gynecology, 83(5), pp.686-692.
  3. Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015;57(Suppl 2):S222-S232. doi:10.4103/0019-5545.161483
  4. Hadjidakis, D.J., Kokkinakis, E.P., Sfakianakis, M.E. and Raptis, S.A., 2003. Bone density patterns after normal and premature menopause. Maturitas, 44(4), pp.279-286.
  5. Harinarayan, C.V., 2005. Prevalence of vitamin D insufficiency in postmenopausal south Indian women. Osteoporosis International, 16(4), pp.397-402.
  6. Laufer, L.R., Erlik, Y., Meldrum, D.R. and Judd, H.L., 1982. Effect of clonidine on hot flashes in postmenopausal women. Obstetrics and gynecology, 60(5), pp.583-586.
  7. Loprinzi, C.L., Levitt, R., Barton, D., Sloan, J.A., Dakhil, S.R., Nikcevich, D.A., Bearden III, J.D., Mailliard, J.A., Tschetter, L.K., Fitch, T.R. and Kugler, J.W., 2006. Phase III comparison of depomedroxyprogesterone acetate to venlafaxine for managing hot flashes: North Central Cancer Treatment Group Trial N99C7. Journal of clinical oncology, 24(9), pp.1409-1414.
  8. MacLennan, A.H., Broadbent, J.L., Lester, S. and Moore, V., 2004. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane database of systematic reviews, (4).
  9. Messina, M.J. and Wood, C.E., 2008. Soy isoflavones, estrogen therapy, and breast cancer risk: analysis and commentary. Nutrition journal, 7(1), pp.1-11.
  10. Mohammed, K., Abu Dabrh, A.M., Benkhadra, K., Al Nofal, A., Carranza Leon, B.G., Prokop, L.J., Montori, V.M., Faubion, S.S. and Murad, M.H., 2015. Oral vs transdermal estrogen therapy and vascular events: a systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism, 100(11), pp.4012-4020.
  11. Quintero, G.C., 2017. Review about gabapentin misuse, interactions, contraindications and side effects. Journal of experimental pharmacology, 9, p.13.
  12. Reddy, S.Y., Warner, H., Guttuso Jr, T., Messing, S., DiGrazio, W., Thornburg, L. and Guzick, D.S., 2006. Gabapentin, estrogen, and placebo for treating hot flushes: a randomized controlled trial. Obstetrics & Gynecology, 108(1), pp.41-48.
  13. Schairer, C., Lubin, J., Troisi, R., Sturgeon, S., Brinton, L. and Hoover, R., 2000. Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk. Jama, 283(4), pp.485-491.
  14. Stubbs, C., Mattingly, L., Crawford, S.A., Wickersham, E.A., Brockhaus, J.L. and McCarthy, L.H., 2017. Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women. The Journal of the Oklahoma State Medical Association, 110(5), p.272.
  15. Hamdy, R.C., Baim, S., Broy, S.B., Lewiecki, E.M., Morgan, S.L., Tanner, S.B. and Williamson, H.F., 2010. Algorithm for the management of osteoporosis. Southern medical journal, 103(10), pp.1009-15.
  16. King, A.C., Oman, R.F., Brassington, G.S., Bliwise, D.L. and Haskell, W.L., 1997. Moderate-intensity exercise and self-rated quality of sleep in older adults: a randomized controlled trial. Jama, 277(1), pp.32-37.
  17. Villaverde‐Gutiérrez, C., Araujo, E., Cruz, F., Roa, J.M., Barbosa, W. and Ruíz‐Villaverde, G., 2006. Quality of life of rural menopausal women in response to a customized exercise programme. Journal of advanced nursing, 54(1), pp.11-19.
  18. Kroenke, C.H., Caan, B.J., Stefanick, M.L., Anderson, G., Brzyski, R., Johnson, K.C., LeBlanc, E., Lee, C., La Croix, A.Z., Park, H.L. and Sims, S.T., 2012. Effects of a dietary intervention and weight change on vasomotor symptoms in the Women’s Health Initiative. Menopause (New York, NY), 19(9), p.980.
  19. Washburn, S., Burke, G.L., Morgan, T. and Anthony, M., 1999. Effect of soy protein supplementation on serum lipoproteins, blood pressure, and menopausal symptoms in perimenopausal women. Menopause (New York, NY), 6(1), pp.7-13.
  20. Patisaul, H.B. and Jefferson, W., 2010. The pros and cons of phytoestrogens. Frontiers in neuroendocrinology, 31(4), pp.400-419.
  21. Carpenter, C.L., Ross, R.K., Paganini‐Hill, A. and Bernstein, L., 2003. Effect of family history, obesity and exercise on breast cancer risk among postmenopausal women. International journal of cancer, 106(1), pp.96-102.
  22. Gava G, Orsili I, Alvisi S, Mancini I, Seracchioli R, Meriggiola MC. Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina (Kaunas). 2019 Oct 1;55(10):668. doi: 10.3390/medicina55100668. PMID: 31581598; PMCID: PMC6843314.
  23. Hardcastle, A.C., Aucott, L., Fraser, W.D., Reid, D.M. and Macdonald, H.M., 2011. Dietary patterns, bone resorption and bone mineral density in early post-menopausal Scottish women. European journal of clinical nutrition, 65(3), pp.378-385.
  24. Hormones, B., 2006. A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks. Altern Med Rev, 11(3), pp.208-223.
  25. Fishman, J.R., Flatt, M.A. and Settersten Jr, R.A., 2015. Bioidentical hormones, menopausal women, and the lure of the “natural” in US anti-aging medicine. Social science & medicine, 132, pp.79-87.
  26. David, S.M., Salzillo, S., Bowe, P., Scuncio, S., Malit, B., Raker, C., Gass, J.S., Granai, C.O. and Dizon, D.S., 2013. Randomised controlled trial comparing hypnotherapy versus gabapentin for the treatment of hot flashes in breast cancer survivors: a pilot study. BMJ open, 3(9), p.e003138.
  27. Geer, J.H., Morokoff, P. and Greenwood, P., 1974. Sexual arousal in women: The development of a measurement device for vaginal blood volume. Archives of Sexual Behavior, 3(6), pp.559-564.
  28. Burleson, M.H., Trevathan, W.R. and Todd, M., 2007. In the mood for love or vice versa? Exploring the relations among sexual activity, physical affection, affect, and stress in the daily lives of mid-aged women. Archives of sexual behavior, 36(3), pp.357-368.
  29. Mukherjee, A., Mukherjee, P. and Rude, R.R., 2010. Bikram yoga as a countermeasure of bone loss in women. Chinese Medicine, 1(1), p.1.
  30. Kronenberg, F. and Fugh-Berman, A., 2002. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Annals of internal medicine, 137(10), pp.805-813.
  31. Leach, M.J. and Moore, V., 2012. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews, (9).
  32. Barton DL, Loprinzi CL, Quella SK, Sloan JA, Veeder MH, Egner JR, Fidler P, Stella PJ, Swan DK, Vaught NL, Novotny P. Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol. 1998 Feb;16(2):495-500. doi: 10.1200/JCO.1998.16.2.495. PMID: 9469333.
  33. Lee AW, Wu AH, Wiensch A, Mukherjee B, Terry KL, Harris HR, Carney ME, Jensen A, Cramer DW, Berchuck A, Doherty JA, Modugno F, Goodman MT, Alimujiang A, Rossing MA, Cushing-Haugen KL, Bandera EV, Thompson PJ, Kjaer SK, Hogdall E, Webb PM, Huntsman DG, Moysich KB, Lurie G, Ness RB, Stram DO, Roman L, Pike Loprinzi CL, Sloan J, Stearns V, Slack R, Iyengar M, Diekmann B, Kimmick G, Lovato J, Gordon P, Pandya K, Guttuso T Jr, Barton D, Novotny P. Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. J Clin Oncol. 2009 Jun 10;27(17):2831-7. doi: 10.1200/JCO.2008.19.6253. Epub 2009 Mar 30. PMID: 19332723; PMCID: PMC2698018.
  34. MC, Pearce CL; Ovarian Cancer Association Consortium. Estrogen Plus Progestin Hormone Therapy and Ovarian Cancer: A Complicated Relationship Explored. Epidemiology. 2020 May;31(3):402-408. doi: 10.1097/EDE.0000000000001175. PMID: 32028322; PMCID: PMC7584395.
  35. Maclennan AH, Broadbent JL, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004 Oct 18;2004(4):CD002978. doi: 10.1002/14651858.CD002978.pub2. PMID: 15495039; PMCID: PMC7004247.
  36. Pandya KJ, Morrow GR, Roscoe JA, et al. Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9488):818-824. doi:10.1016/S0140-6736(05)67215-7
  37. Gambacciani M, Levancini M. Hormone replacement therapy and the prevention of postmenopausal osteoporosis. Prz Menopauzalny. 2014;13(4):213-220. doi:10.5114/pm.2014.44996
  38. Golmakani N, Parnan Emamverdikhan A, Zarifian A, Sajadi Tabassi SA, Hassanzadeh M. Vitamin E as alternative local treatment in genitourinary syndrome of menopause: a randomized controlled trial. Int Urogynecol J. 2019 May;30(5):831-837. doi: 10.1007/s00192-018-3698-z. Epub 2018 Jul 3. PMID: 29971469.
  39. Patisaul HB, Jefferson W. The pros and cons of phytoestrogens. Front Neuroendocrinol. 2010;31(4):400-419. doi:10.1016/j.yfrne.2010.03.003
  40. Reid IR, Bolland MJ. Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?. Nutrients. 2020;12(4):1011. Published 2020 Apr 7. doi:10.3390/nu12041011
  41. Saremi, Adonis MS; Arora, Rohit MD, FACC* Vitamin E and Cardiovascular Disease, American Journal of Therapeutics: May 2010 - Volume 17 - Issue 3 - p e56-e65 doi: 10.1097/MJT.0b013e31819cdc9a
  42. Scavello I, Maseroli E, Di Stasi V, Vignozzi L. Sexual Health in Menopause. Medicina (Kaunas). 2019 Sep 2;55(9):559. doi: 10.3390/medicina55090559. PMID: 31480774; PMCID: PMC6780739
  43. Srivastava M, Deal C. Osteoporosis in elderly: prevention and treatment. Clin Geriatr Med. 2002 Aug;18(3):529-55. doi: 10.1016/s0749-0690(02)00022-8. PMID: 12424871
  44. Non-hormonal treatments for menopause. Updated August 2016. Accessed August 31 2021.

Similar Articles

What is Mindset?

We’re glad you asked! Mindset is a hypnotherapy app for mental health & positive thinking.

Personalized to you

Learn coping skills


Created by experts

Available 24/7

Loved by thousands

Take our free IBS quiz
Start now