Menopause Treatment

If your menopause symptoms bother you, talk to your doctor or nurse. Your doctor or nurse can suggest medicines to help with your symptoms. All medicines have risks, and your doctor can help you figure out which medicines are best for you.

• Low-dose hormonal birth control may help if you are in the years leading up to your final period. These may help stop or reduce hot flashes, vaginal dryness, and mood swings. They can also help with heavy or irregular periods. You should not use hormonal birth control if you smoke. Hormonal birth control, especially combination birth control pills and possibly other forms of combination hormonal birth control like the vaginal ring or skin patch, can raise your risk for blood clots and high blood pressure, and the risk is higher for women who smoke.
• Menopausal hormone therapy helps treat menopause symptoms after menopause, but it can raise your risk for blood clots, stroke, and some cancers. Learn more about menopausal hormone therapy. If you decide to take menopausal hormone therapy, use the lowest dose possible for the shortest amount of time that helps your symptoms.
• Two non-hormonal medicines approved by the Food and Drug Administration (FDA) may help treat certain menopause symptoms. One low-dose selective serotonin reuptake inhibitor (SSRI), a type of medicine usually used to treat depression, is approved to treat hot flashes in women who do not already have mood or anxiety problems. A medicine that acts like estrogen in the body is approved for the treatment of painful sex caused by menopause. You can also talk to your doctor about other medicines approved by the FDA for depression and anxiety that may also help with menopause symptoms.
• A hormonal medicine, with the generic name prasterone, is approved by the FDA to treat women who experience pain during sex caused by vaginal dryness after menopause. The medicine is applied in the vagina once a day.
• Over-the-counter (OTC) products can treat vaginal discomfort, dryness, or pain. A water-based vaginal lubricant can help make sex more comfortable. A vaginal moisturizer can help keep needed moisture in vaginal tissues and make sex more comfortable.
• Certain prescription medicines may help with vaginal discomfort, dryness, or pain if OTC products don’t work. These include estrogen creams, tablets, or rings that you put in your vagina (see information on topical hormone therapy). 
• Menopausal hormone therapy pill or patch may help if you have severe vaginal dryness. 

Menopausal hormone therapy is prescription medicine to help relieve your menopause symptoms, such as hot flashes and vaginal dryness, if they are severe enough to disrupt your daily life. Menopausal hormone therapy is sometimes called hormone therapy or hormone replacement therapy.

During menopause, your ovaries make very low levels of the hormones estrogen and progesterone. Menopausal hormone therapy replaces some of the hormones no longer made by your ovaries with artificial estrogen and progesterone.

Menopausal hormone therapy can help with hot flashes and other menopause symptoms. It is usually taken as a pill each day. You can also get estrogen or estrogen plus progesterone menopausal hormone therapy as a skin patch. Like all medicines, menopausal hormone therapy has risks. If you decide to take it, use the lowest dose for the shortest time needed. Other types of menopausal hormone therapy, called topical hormone therapy, do not treat hot flashes but can help with vaginal dryness.

There are many different brands of menopause hormone therapy. Read more about and find a list of FDA-approved hormone therapies.

Topical (TOP-ih-kuhl) hormone therapy is usually a low-dose estrogen cream applied directly to the vagina. It relieves vaginal dryness but does not help with other symptoms, such as hot flashes. It also is available as a vaginal ring, insert, and gel. The risks of topical hormone therapy are different from the risks of menopausal or hormone replacement therapy.

Menopausal hormone therapy, sometimes called hormone replacement therapy, is safe for some women, but it also has risks. That is why the FDA advises women who want to try menopausal hormone therapy to use the lowest dose that works for the shortest time needed.

Research shows that:

• Menopausal hormone therapy may be an option for women up to age 59, but usually only within 10 years of menopause. Younger women and those closer to their final menstrual period are less likely to have the harmful side effects from menopausal hormone therapy.
• Menopausal hormone therapy reduces menopause symptoms, such as hot flashes, sleep problems, mood changes, and vaginal dryness.
• Hot flashes usually require higher doses of estrogen therapy that affect the whole body.
• Women with vaginal dryness or discomfort during sex may find relief with low doses of topical vaginal estrogen.
• Estrogen alone and estrogen plus progesterone raise the risk of stroke and blood clots in the legs and lungs. The risks are rare in women between 50 and 59.

Menopausal hormone therapy may not be safe for some women. You should discuss your risks with your doctor if you have:

• A history of heart disease or risk factors, such as high cholesterol
• A family or personal history of breast cancer
• High levels of triglycerides, a type of fat in your blood
• A family history of gallbladder disease
• Liver disease
• A history of stroke or blood clots

The FDA recommends that women take estrogen-only or estrogen plus progesterone menopausal hormone therapy at the lowest dose that works for the shortest time needed.

Talk to your doctor to weigh the risk and benefits of menopausal hormone therapy based on your symptoms, age, and risk factors.

Companies that make bioidentical hormone therapy use the term “bioidentical” to suggest that their products are exactly the same as natural hormones. Many of these companies also claim that their products are safer than menopausal hormone therapy. However, the FDA does not recognize this term or regulate these products. No studies have been done to evaluate how safe or effective these products are.

Talk to your doctor or nurse before trying any bioidentical hormone therapy.

Some women report relief for hot flashes and other menopause symptoms with complementary or alternative therapies. Talk to your doctor or nurse before taking any herbal or vitamin supplement. The Food and Drug Administration (FDA) does not regulate supplements in the same way they regulate medicines. Many supplements can interfere with medicines and make them work incorrectly or not at all.

Some research studies show relief from premenstrual syndrome (PMS) symptoms with these herbal supplements, but other studies do not. Many herbal supplements should not be used with other medicines. Some herbal supplements women use for menopause symptoms are:

• Black cohosh: The underground stems and root of black cohosh are used fresh or dried to make tea, capsules, pills, or liquid extracts. Black cohosh is used to help treat menopausal symptoms, such as hot flashes.
• Red clover: Red clover has phytoestrogens (fayh-toh-ES-truh-juhnz), which are similar to estrogen. Phytoestrogens are also found in some cereals, vegetables, legumes (peas, beans, soy). You can take red clover in tea or as a pill. Red clover may not be safe for women who should not take menopausal hormone therapy with estrogen.
• Soy: Soy is a plant in the pea family. The seeds of soy are soybeans. Soybeans make isoflavones, a type of phytoestrogen. Soy can be found in dietary supplements or added to foods such as cheese and pasta. Soybeans can be cooked and eaten or used to make foods such as tofu and soy milk. Soy may not be safe for women who should not take menopausal hormone therapy with estrogen.
• Mind and body practices: Yoga, tai chi, and acupuncture may help reduce menopause symptoms, including sleep and mood problems, stress, and muscle and joint pain. One study also found that hypnosis (a trance-like state during which your mind is relaxed) helped decrease hot flashes by 74%.

Research continues on these and other alternative ways of relieving menopause. Talk to your doctor or nurse before trying natural remedies.

References

1. North American Menopause Society. (2014). The Experts Do Agree About Hormone Therapy.
2. Sood, R., Faubion, S.S., Kuhle, C.L., Thielen, J.M., Shuster, L.T. (2014). Prescribing menopausal hormone therapy: an evidence-based approach. International Journal of Women’s Health; 6: 47-57.
3. National Center for Complementary and Integrative Health. (2016). Menopausal Symptoms: In Depth. 
4. Elkins, G.R., Fisher, W.I., Johnson, A.K., Carpenter, J.S., Keith, T.Z. (2013). Clinical hypnosis in the treatment of postmenopausal hot flashes: A randomized controlled trial. Menopause; 20: 291–298.

Source

The Office on Women's Health in the U.S. Department of Health and Human Services

Content last updated May 23, 2019