The value of over-the-counter products/services in the management of mild-to-moderate menopausal symptoms

For women with mild-to-moderate menopausal symptoms, lifestyle changes and over-the-counter products and services can be beneficial for symptom management, especially for those who are contraindicated or averse to using menopausal hormone therapy (MHT). Lifestyle changes, such as increased exercise and improvements in diet, enhance overall health and are suggested by some low-level evidence - largely from observational studies - to alleviate menopausal symptoms. Over-the-counter dietary and herbal supplements are a popular alternative to MHT. While evidence is mainly low-level, some of these products have shown efficacy and tolerability in menopausal symptom management through meta-analyses, systematic reviews and randomized controlled trials (RCTs). However, mixed evidence and inconsistencies in product dosage, components and quality remain an issue. In addition, caution is advised for women on other medications or with conditions such as breast cancer that could interact with or be impacted by these products. There is high-level evidence from RCTs supporting the efficacy of behavioral therapies, in particular cognitive behavioral therapy, in menopausal symptom management, and clinicians should consider their implementation. Education on menopause and its management is essential. The authors recommend a three-step approach for treating women with self-reported mild-to-moderate menopausal symptoms who prefer to avoid prescription medications even after being informed about their benefit-risk profiles: 1) lifestyle changes; 2) non-prescription options and over-the-counter products; and 3) prescription therapies, if still necessary and with patient agreement. This approach broadens access to menopausal symptom management, providing relief to a wide range of women.