“Non-hormonal” therapies are appropriate for women where oestrogen therapy is contraindicated (see Table: Contraindications to HRT). A variety of selective serotonin reuptake inhibitors/ serotonin noradrenalin reuptake inhibitors, gabapentin and clonidine have been evaluated in regard to treatment of vasomotor symptoms, primarily in women with breast cancer. A meta- analysis of non-hormonal therapies indicated that paroxetine, venlafaxine, gabapentin and clonidine were effective in reducing vasomotor symptoms ( see Table: Non-hormonal therapies for vasomotor symptoms). However, these studies were of short duration (< 1 year) and long term efficacy and safety are unknown. In addition, there is a lack of efficacy data regarding direct comparison between different therapies and/ or oestrogen. As paroxetine and fluoxetine may interfere with tamoxifen metabolism, these medications should be avoided in women taking tamoxifen.

Table: Non-hormonal therapies for vasomotor symptoms

Non-hormonal therapy for urogenital atrophy consists of vaginal moisturisers, used chronically to improve symptoms, and lubricants, used prior to sexual intercourse. Use of a vaginal moisturiser decreases vaginal pH, improves vaginal elasticity and reverses vaginal atrophy, although, to a lesser extent than vaginal oestrogen cream.  

10.5 Sexual dysfunction

Content updated December 2010