Menopause is the permanent end of menstruation and fertility, defined as occurring twelve months after the last menstrual period. It is a natural biological process, however, many women seek relief from uncomfortable symptoms that affect day to day life. Common symptoms of menopause are:
- irregular periods
- decreased fertility
- mood swings
- increased abdominal fat
- vaginal dryness
- sleep disturbances
- decreased libido
- vasomotor symptoms of hot flashes and night sweats
As women age, their hormone levels decrease over time, specifically estrogen, progesterone, and testosterone. Hormones may begin to decline around ages 35-45, though there is significant variance.
Hormonal Changes in Menopause
The hormonal changes include:
- a steep decrease of progesterone
- a slower, more steady decline of testosterone
- decreasing fluctuating levels of estrogen that may be causal in hot flashes and mood swings
Post-menopause, all these hormones are lower in comparison to younger years. Estrogen, progesterone, and testosterone, along with other hormones and neurotransmitters, form an intricate symphony of signals that can often become “out of tune,” especially in the menopausal person.
Side Effects of Treating Menopause with SSRIs
Pharmaceutical drugs such as SSRIs are often prescribed to treat menopause symptoms. While these are effective for some, many women seek alternative methods for various reasons, mainly to avoid adverse side effects such as:
- decreased libido
- diminished sexual responsiveness
- decreased salience 
Furthermore, pharmaceuticals often do not fix the problem; they may cover up symptoms without addressing the root cause. This can lead to neurotransmitter and hormone depletion or loss of function, further deteriorating health.
Alternative Methods to Treat Menopause
Current research shows efficacy for alternative methods to treat a variety of menopausal symptoms.
Yoga has been shown in some studies to improve the quality of life in menopausal women, reduce insomnia, and reduce hot flashes. [1, 7, 8]
Omega-3 Fatty Acids
Omega-3 fatty acids, essential for brain health, have been successful in reducing the number and interference of hot flashes. 
St. John’s Wort
St. John’s Wort is a flowering plant with antidepressant and anti-inflammatory properties. It is also useful in improving quality of life and sleep disturbances in menopausal women. 
Acupuncture, in combination with other treatment methods, can relieve hot flashes and other menopause symptoms. 
Ginseng has been shown to improve sexual dysfunction, overall health status, physical well-being, and depression. 
Hops may be effective for menopausal people experiencing hot flashes, sweating, palpitations, and insomnia. 
Black cohosh is a plant used historically by Native Americans for dysmenorrhea, menopause symptoms, sore throats, and depression. This plant’s action is mediated by dopamine receptors, and blocks the reabsorption of serotonin.  Today, research supports the use of black cohosh for reducing vasomotor symptoms, improving sleep, reducing emotional disturbances, and improving sexual symptoms. [4, 6, 9]
Isoflavones are a type of phytochemical, many of which act as phytoestrogens. Soy, red clover, and magnolia bark extract are isoflavones that have been shown to alleviate menopause symptoms such as hot flashes, poor sleep, pain, mood swings, and cognitive symptoms. [4, 10]
Addressing Key Nutrient Deficiencies in Menopause
Additionally, it is essential to address key nutrient deficiencies in order to properly balance hormones in menopause.
For example, magnesium is needed for phosphorylation, essential fatty acids, sleep, and is a cofactor for many amino acids, and calcium is necessary for vitamin D and bone health. Many women have nutrient deficiencies, including low calcium, folate, vitamin E, iron, and magnesium.
These deficiencies can be improved through eating whole foods and using supplementation. Some other key nutrients include iodine for thyroid function, zinc, vitamin B6, methyl donors, cobalt, chromium, and boron. Using a nutraceutical composed of plant extracts, vitamins, and minerals may improve the quality of life for menopausal women. 
The best treatment is suited to the individual’s needs and specific imbalances. These imbalances can be identified through testing sex hormones and neurotransmitters.
Practitioners should also include therapeutic lifestyle changes such as stress management and dietary habits, including ensuring adequate micronutrients. When seeking to avoid or reduce the use of SSRIs for managing menopause, many people may benefit from alternative therapies to alleviate symptoms as a part of a holistic treatment.
- Avis, N. E., Legault, C., Russell, G., Weaver, K., & Danhauer, S. C. (2014). A Pilot Study of Integral Yoga for Menopausal Hot Flashes.Menopause (New York, NY),21(8), 846.
- Comhaire, F. H., & Depypere, H. T. (2015). Hormones, herbal preparations and nutriceuticals for a better life after the menopause: part II.Climacteric,18(3), 364-371.
- Freeman, M. P., Hibbeln, J. R., Silver, M., Hirschberg, A. M., Wang, B., Yule, A. M., … & Cohen, L. S. (2011). Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial.Menopause (New York, NY),18(3), 279.
- Kim, M. Y., Choi, S. D., & Ryu, A. (2015). Is complementary and alternative therapy effective for women in the climacteric period?.Journal of menopausal medicine,21(1), 28-35.
- Kugaya, A., Seneca, N. M., Snyder, P. J., Williams, S. A., Malison, R. T., Baldwin, R. M., … & Innis, R. B. (2003). Changes in human in vivo serotonin and dopamine transporter availabilities during chronic antidepressant administration.Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology,28(2), 413-420.
- Mohammad-Alizadeh-Charandabi, S., Shahnazi, M., Nahaee, J., & Bayatipayan, S. (2013). Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial.Chinese medicine,8(1), 1.
- Newton, K. M., Reed, S. D., Guthrie, K. A., Sherman, K. J., Booth-LaForce, C., Caan, B., … & Cohen, L. S. (2014). Efficacy of yoga for vasomotor symptoms: a randomized controlled trial.Menopause (New York, NY),21(4), 339.
- Reed, S. D., Guthrie, K. A., Newton, K. M., Anderson, G. L., Booth-LaForce, C., Caan, B., … & Freeman, E. W. (2014). Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements.American journal of obstetrics and gynecology,210(3), 244-e1.
- Shahnazi, M., Nahaee, J., Mohammad-Alizadeh-Charandabi, S., & Bayatipayan, S. (2013). Effect of black cohosh (cimicifuga racemosa) on vasomotor symptoms in postmenopausal women: a randomized clinical trial.Journal of caring sciences,2(2), 105.
- Thomas, A. J., Ismail, R., Taylor-Swanson, L., Cray, L., Schnall, J. G., Mitchell, E. S., & Woods, N. F. (2014). Effects of isoflavones and amino acid therapies for hot flashes and co-occurring symptoms during the menopausal transition and early postmenopause: A systematic review.Maturitas,78(4), 263-276.