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Non-hormonal treatments for menopausal symptoms

There are non-hormonal treatments that have been shown to be effective in the management of menopausal symptoms. 

Below is a list of the most common treatments and their side effects.

Venlafaxine and other similar antidepressants

There is now good evidence that selected antidepressants (at doses lower that those used to treat depression) can improve menopausal symptoms after breast cancer. The antidepressants that have been shown to lead to fewer and less severe hot flushes are venlafaxine, desvenlafaxine, paroxetine, and escitalopram. In addition, low doses of venlafaxine can also improve mood, and low doses of desvenlafaxine and paroxetine can also improve sleep.

Generally these antidepressants are used in low doses to treat menopausal symptoms, and side effects are less common than at higher doses. However, side effects can include nausea, decreased appetite, dry mouth, constipation, and decreased libido.

Some of these drugs, particularly paroxetine, may interfere with the way that your body breaks down tamoxifen and change its effectiveness. If you are taking tamoxifen, talk to your oncologist or general practitioner before starting treatment with antidepressants.

 Ask your doctor for more information about these drugs.


Zolpidem is a prescription medication used to treat insomnia. When added to venlafaxine (or other similar antidepressant drugs above) it may improve sleep and quality of life. Side effects of zolpidem can include sleep walking, sleep driving and other potentially dangerous sleep-related behaviours. Treatment with zolpidem may also interfere with your concentration in the morning, such as when driving.

Ask your oncologist for more information.


Gabapentin is a drug used to treat chronic pain and epileptic fits. Studies have shown that Gabapentin can lead to fewer and less severe hot flushes, improved sleep and improvements in anxiety and mental health for some women.

Many women find gabapentin acceptable to use. However, up to half of the women who use gabapentin experience side effects including sleepiness, light-headedness, and dizziness. These side effects may resolve with time or can be reduced by adjusting the dose.


Clonidine is a drug used to treat high blood pressure. It can be used to reduce menopause-associated hot flushes after breast cancer, but has been found to be less effective than other treatments such as venlafaxine. Side effects of clonidine include a dry mouth, constipation, dizziness, itching, blurred vision, and sleep disorders or restless sleep.

Cognitive behavioural therapy

Psychological therapies such as cognitive behavioural therapy (CBT) aim to help you change your thought patterns to be more helpful and healthy. Studies in women who have had breast cancer have shown that CBT may improve hot flushes, sleep and sexual function.