What to know about a viral menopause trend, according to a doctor

Online influencers claim a combination of over-the-counter drugs can relieve some symptoms of perimenopause and menopause. (PeopleImages/iStockphoto/Getty Images via CNN Newsource)

A viral trend claims that a combination of common over-the-counter medications, specifically an allergy drug and an acid reducer, can ease symptoms of perimenopause and menopause.

Perimenopause is the transitional time leading up to menopause, and it can begin several years before the final menstrual period, often in a woman’s early to mid-40s, though sometimes earlier. Menopause occurs when a woman has gone 12 consecutive months without a menstrual period, and the average age in the United States is around 52.

But back to the internet: Does this viral women’s health recommendation work — and is it safe?

I wanted to know what the science shows and what women with menopausal symptoms should do to manage them, so I reached out to CNN wellness expert Dr. Leana Wen, an emergency physician and adjunct associate professor at George Washington University. She previously served as Baltimore’s health commissioner.

CNN: What is this viral trend, and where did it come from?

Dr. Leana Wen: The trend you’re referring to involves taking a combination of an antihistamine, often something like fexofenadine and cetirizine (commonly known by their brand names Allegra and Zyrtec, respectively), along with famotidine (commonly known by brand name Pepcid). This idea has spread widely on social media platforms, where some women have reported improvements in menopausal symptoms such as hot flashes, flushing, skin itching and even low energy and brain fog.

It’s important to note that the origin appears to come from anecdotal reports and online communities, not from scientific journals and clinical trials. These medications are not approved by the U.S. Food and Drug Administration to treat menopausal symptoms.

CNN: Is there any scientific basis for using these medications to treat symptoms of perimenopause or menopause?

Wen: There is a theoretical mechanism that some online influencers point to, which involves histamine, a chemical from the body’s immune system that acts through different receptors, including H1 and H2 receptors. Antihistamines block H1 receptors, and famotidine blocks H2 receptors. Histamine can affect blood vessels and may contribute to flushing and itching in some conditions, such as allergic reactions and mast cell activation syndrome, a condition that causes intense episodes of swelling, hives and other symptoms.

However, menopause symptoms are primarily driven by changes in estrogen levels and how those changes affect the brain’s temperature regulation system. This process involves complex interactions in the hypothalamus, not simply histamine pathways. I am not aware of any high-quality scientific evidence in the form of clinical trials showing that antihistamines or famotidine are effective treatments for menopause symptoms.

So, while the idea is biologically interesting, it remains unproven. Anecdotal reports should not be confused with rigorous scientific evidence, and more research is needed to study how effective these treatments are for menopause symptoms.

CNN: What symptoms are women hoping to relieve with this combination?

Wen: The symptoms most commonly mentioned are hot flashes, night sweats and flushing. Some people also report improvements in itching or skin sensitivity, which can occur around perimenopause and menopause.

Hot flashes are quite characteristic of this life transition. They often involve a sudden sensation of heat, usually starting in the chest or face and spreading outward, sometimes accompanied by profuse sweating, palpitations and anxiety. They can last from seconds to several minutes and may occur multiple times a day or night. They could interrupt sleep, and the woman may wake up with the sheets soaked from sweating.

These symptoms can be quite disruptive, which is why many women are seeking relief and may be drawn to over-the-counter options that seem accessible and easy to try.

CNN: What are the potential risks of taking these medications for this purpose?

Wen: Both allergy medicines and antacids are generally safe when used as directed for their intended purposes. However, using them regularly and potentially over long periods for an unproven indication is different.

Antihistamines can cause side effects such as drowsiness, dizziness, dry mouth and, in some cases, effects on concentration. While newer antihistamines are less sedating than older antihistamines like diphenhydramine (commonly sold as Benadryl), they are not completely free of these side effects. Famotidine also can have side effects, including headache and gastrointestinal symptoms. Both drugs could interact with other prescription and over-the-counter medications, and I advise patients who wish to try them to check with their primary care clinician in advance to make sure it is safe to do so.

Which brings me to my other concern, which is women trying these unproven treatments may delay seeking appropriate medical care. If someone relies on a viral trend instead of consulting with a clinician, they may miss out on FDA-approved treatments that are known to be effective.

CNN: How should women think about perimenopause and menopause more generally?

Wen: As noted, perimenopause is the transitional step preceding menopause, which could be multiple years, while menopause refers to the specific time when a woman has gone 12 consecutive months without menstruating.

Symptoms for the two can vary widely. In addition to the symptoms we discussed before, women may experience irregular periods, mood changes, difficulty concentrating, vaginal dryness and changes in libido. Some also report joint pain, fatigue and changes in skin and hair.

These symptoms are driven by fluctuating hormone levels, especially declines in estrogen. Understanding that these physiologic changes are normal can help guide treatment that addresses the underlying cause.

CNN: What are evidence-based treatments for menopause symptoms that women should consider?

Wen: The most effective treatment for moderate to severe menopausal symptoms, particularly hot flashes, is hormone therapy using estrogen (also sometimes called hormone replacement therapy), with or without progesterone depending on whether a woman has a uterus. This therapy has been extensively studied and can significantly reduce symptoms. Multiple delivery methods are available, including pills, patches, gels and sprays.

For those women who cannot or prefer not to use hormone therapy, there are nonhormonal options. Certain antidepressants have been shown to reduce hot flashes. Other medications, including gabapentin and clonidine, may also be helpful in some cases. The FDA has also recently approved some new medications, namely elinzanetant and fezolinetant, specifically for treating hot flashes.

Lifestyle measures also can help. They include maintaining a cool environment, dressing in layers, reducing triggers such as alcohol and prioritizing good sleep hygiene.

CNN: When should someone seek medical advice for menopause symptoms, and what should they ask their clinician?

Wen: Women should seek medical advice if their symptoms are affecting their quality of life, interfering with sleep or daily functioning or if they have questions or concerns about changes in their menstrual cycle or overall health. They should go to their primary care provider; if needed, they can also seek specialist advice through a practitioner certified by the Menopause Society who has specific expertise in treating menopause and perimenopause.

It’s helpful to come prepared with a clear description of symptoms, including when they started, how often they occur and how they interfere with daily function. Patients should also discuss their individual health history, including risk factors for conditions such as cardiovascular disease or breast cancer, which can influence treatment decisions. If they have tried over-the-counter remedies, they should be sure to mention them.

Patients should ask to discuss the full range of treatment options, including hormone therapy and nonhormonal alternatives. The goal is to have a personalized plan that is based on evidence and tailored to their specific needs.

By Katia Hetter, CNN