A new social media trend is resonating with women navigating menopause. It claims that taking a combination of an antihistamine together with a stomach acid reducer, like Pepcid, can ease perimenopause and menopause symptoms, including hot flashes, sleep disturbances, and mood changes. Is this the cure-all women have been searching for? We asked a board-certified OB-GYN, who specializes in menopause, to weigh in.

Menopause 101

The menopause life transition has three stages: perimenopause, menopause, and post-menopause. Menopause is defined as the final menstrual period, which can be confirmed after 12 consecutive months without a period. It is the day that marks the permanent conclusion of a woman’s reproductive capabilities. Once you hit that first day of menopause, you move to postmenopause, which lasts for the remainder of your life.

However, a lot goes on before and after that day. Before you reach menopause, a woman goes through perimenopause. This can begin as early as your late 30s. The most common symptoms include hot flashes with or without night sweats, weight gain, body composition changes, brain fog, mood changes (like anxiety and depression), poor quality of sleep, and sexual problems (like low libido and vaginal dryness). These symptoms affect every woman differently. The average time that a woman goes through perimenopause is seven years.

There’s a reason these changes occur. "The symptoms of perimenopause and menopause happen as a result of the decline and fluctuation of estrogen due to loss of ovarian function," says Sadaf Lodhi, DO, FACOOG, FACOG, MSCP, IF, a board-certified OB-GYN, CEO and Founder of Femme Vie Health, and the host of The Muslim Sex Podcast. Lodhi explains that hot flashes and night sweats happen due to changes in the thermoregulatory zone in the hypothalamus, which controls whether you feel hot or cold. As such, even small increases in body temperature can cause sweating and flushing. Fatigue, another common symptom, "is often due to sleep disruption from night sweats, and increased anxiety or depression and from hormonal changes," explains Lodhi.

As for skin itching and sensitivity, Lodhi says that "Estrogen receptors are present from our head to our toes. The decline in estrogen decreases collagen, skin thickness, moisture, and blood flow." Additionally, Lodhi explains that vaginal and vulvar itching are some of the most common symptoms of the genitourinary syndrome of menopause (GSM), which is also present in the menopause transition along with generalized skin dryness and itching. Digging into the science, this is because "Estrogen activates mast cells, which release histamine, tryptase, prostaglandins, and cytokines," says Lodhi. As such, the fluctuating spikes of estrogen in perimenopause may lead to women noticing worsening allergies, sensitivities, and inflammatory symptoms. 

Does the Menopause Trend Actually Work?

To find relief, women are turning to a new viral social media trend, which involves taking a combination of an antihistamine like fexofenadine and cetirizine (commonly known by their brand names Allegra and Zyrtec, respectively) and famotidine (commonly known as Pepcid). As a result, women have reported improvements in symptoms like hot flashes, flushes, skin itching, low energy, and brain fog.

According to Lodhi, "This combination can treat some of the symptoms of menopause like itching, but there are not any published clinical trials or guidelines that support the use of fexofenadine (which is an H1 antihistamine) and famotidine (an H2 antihistamine) for hot flashes and night sweats." In addition, Lodhi explains that this combination is not mentioned in any position statement from The Menopause Society (formerly NAMS), the ACOG, the AAFP, or any systematic review of nonhormonal menopause therapies.

Further, while histamine may contribute to flushing and the dual H1/H2 blockade could reduce this, Lodhi explains that the mechanism behind menopausal hot flashes centers on different pathways — not histamine. In addition, "Fexofenadine and famotidine are generally safe OTC medications, but using them in place of evidence-based treatments risks leaving significant symptoms undertreated and will not give protection from osteoporosis," says Lodhi. 

What Is Recommended Instead?

The most effective, evidence-based treatment for vasomotor symptoms, including hot flashes with or without sweats, is hormone therapy (HT). According to Lodhi it can reduce "vasomotor symptom frequency by approximately 75%." She adds "For women under age 60 or within 10 years of menopause onset, without contraindications, the benefits of hormones generally outweigh the risks."

For those who cannot or prefer not to use hormone therapy, there are other nonhormonal options, including several medications that have evidence of efficacy and are recommended by The Menopause Society. To find the best fit for treatment, it’s important to find a Menopause Society Certified Practitioner (MSCP). "The most frequently reported barrier to adequate menopause care is lack of provider training — 62% of providers across specialties cite this as the primary barrier," says Lodhi.

To find a qualified MSCP, go to The Menopause Society (TMS) Certified Practitioner Directory, the most reliable resource. The Menopause Society offers a certification program (MSCP — Menopause Society Certified Practitioner) that ensures providers have demonstrated competency in menopause management. Clinics affiliated with an MSCP are significantly more likely to suggest FDA approved medication and therapies. Unfortunately, according to Lodhi, "There are roughly 4,100 Menopause Society Certified Practitioners (MSCPs) for approximately 64 million women aged 50 and older in the U.S. This translates roughly to 1 certified practitioner for every 15,000–30,000+ menopausal women, with some studies suggesting an average of 1 MSCP per 29,537 menopausal females."

Food and Menopause

If you’re looking for other options to help with hot flashes, there are several additional things you can do with your diet:

Eat Soy Foods

Soy foods contain compounds called isoflavones, which are sometimes called "phytoestrogens" because they can behave similarly to estrogen. According to Matthew Nagra, ND, a neuropathic doctor: "Since many menopausal symptoms are largely driven by a drop in estrogen levels, these isoflavones may help ease symptoms like hot flashes. However, unlike estrogen itself, isoflavones don't appear to carry the risks people sometimes worry about, like promoting breast cancer. In fact, the best available research suggests soy consumption may actually help lower breast cancer risk."

Nagra further explains that with regards to menopausal symptoms, many of the available studies have looked at isoflavone supplements rather than soy foods directly, but the findings are promising, and the doses of isoflavones that have a demonstrated benefit can be reasonably achieved by consuming soy foods. "The research points to a target of around 50 to 60 milligrams of isoflavones per day, including at least 20 milligrams of a specific type called genistein," he adds. As such, it’s recommended to have about 2 servings of soy foods daily. This can include tofu, edamame, soy milk, tempeh, and/or soy yogurt. Even better, soy provides high-quality protein, essential fatty acids, calcium, iron, and other important nutrients to help support women during menopause.

Minimize Caffeine

Caffeinated beverages, like coffee and tea, can trigger hot flashes, so enjoy it in the morning and stop around 12 to 2 p.m. to give your body time to metabolize it. Caffeine also interrupts quality sleep, so in some cases, it provides a double whammy for women. You can also keep a diary to see if the timing of when you take in caffeine triggers your hot flashes.

Minimize Alcohol

Alcohol is another trigger for hot flashes. If you find you’re getting night flashes after an evening of drinking alcohol, minimize how much you drink or skip it altogether.

Bottom Line: The viral trend isn’t the answer to your menopause symptoms. Your best bet is to find a qualified Menopause Society Certified Practitioner, who can help you use the latest and most updated recommended treatments.

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