How Menopause Is Treated
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Medically reviewed by Anita Sadaty, MD
Menopause is a normal part of a woman's life, not a disease that needs to be treated. Still, many women seek treatment to relieve symptoms that result from the significant hormonal changes that occur. Not only can these shifts significantly affect the quality of life, but they can also increase the risk of certain health concerns.
Read on to learn about the various medications, procedures, and lifestyle changes that can help relieve menopausal symptoms.
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Home Remedies and Lifestyle
Even if you are coping well with the hormonal changes of menopause, it is a good time to pause and take a look at your current lifestyle. Small adjustments can make the next decades healthy ones.
Exercise
Exercise is important regardless of your age, but it takes on added importance in menopause.
Strength training as well as aerobic-focused exercises can help counteract age-related muscle and bone loss, both of which accelerate after menopause begins. Regular moderate exercise also helps manage the mood disturbances that changing hormone levels can bring.
You may even want to consider joining a yoga class. Regular yoga practice has been shown to maintain flexibility, help with bone loss, and improve hot flashes.
Diet
Choosing the right food in menopause can help you stay healthy and may also help you manage symptoms caused by your changing hormone levels. The Academy of Nutrition and Dietetics recommends a diet based on vegetables, fruits, whole grains, lean protein (especially from beans and lentils), and low-fat dairy products.
In menopause, it is more of a challenge to maintain your muscle and bone mass. Ensuring that you get adequate protein and vitamin D in your diet can help you maintain and/or build muscle.
Maintaining a healthy weight can be more of a challenge after menopause. Watching your daily caloric intake is a worthy goal. Follow a balanced, reduced-calorie diet.
For symptoms of hot flashes, you may want to cut back on spicy foods and caffeine. Drinking too much caffeine, especially later in the day, might also lead to poor sleep, which is a common problem during menopause.
Limit Your Alcohol Intake
Alcohol can exacerbate some of the symptoms and complications of menopause, including poor sleep and mood problems. In some studies, alcohol has been shown to increase the frequency of hot flashes and night sweats.
Over-the-Counter (OTC) Therapies
Your healthcare provider may recommend vitamin D supplements and possibly calcium supplements to prevent bone loss and lower the risk of osteoporosis.
For vaginal dryness, there are a variety of vaginal moisturizers that you can use every two to three days. You can also use vaginal lubricants during sexual intercourse.
Always check with your practitioner before taking OTC products, supplements, and herbal remedies as they can interact with prescription medications or each other.
Prescriptions
While a lifestyle approach to menopausal symptoms is preferred, in some cases—particularly when OTC options haven't been effective, or you have significant symptoms that such treatments cannot help—your healthcare provider may recommend prescription therapy.
Hormone Replacement Therapy
The menopausal transition and, ultimately, menopause are the result of a gradual loss of ovarian activity. Lowered levels of ovarian hormones are directly responsible for the symptoms and changes that you experience.
Hormone replacement therapy (HRT) and estrogen replacement therapy (ERT) are very effective in treating the symptoms of menopause, especially vasomotor symptoms and vaginal atrophy. In fact, estrogen with or without progesterone is proven to be the most effective treatment of vasomotor symptoms associated with menopause, such as night sweats and hot flashes. Some women also take HRT to prevent bone loss in menopause, which can lead to osteoporosis.
There are many different formulations and concentrations available. Many hormone replacement options contain either a natural or a bioidentical form of estrogen and progesterone.
A bioidentical is chemically identical to the hormone your body produces, and it may be synthesized in a lab or processed from natural sources. This is true for most pharmaceutical HRT, not just for compounded formulations (those produced by compounding pharmacies in forms and dosages customized for you).
The American College of Obstetricians and Gynecologists (ACOG) recommends FDA-approved hormone therapy over compounded hormone therapy. Bioidentical hormones have not been shown to be safer than traditional hormone replacement therapy, and they carry the same risks.
In addition to the type and concentration of hormones, there are different forms of HRT for you to choose from, depending on your preferences, symptoms, and treatment goals. These include:
Oral (pills) include Bijuva (estradiol and progesterone), Activella (estradiol and norethindrone), FemHRT (ethinyl estradiol and norethindrone), Jintei (ethinyl estradiol and norethindrone), and Prempro (conjugated estrogens and medroxyprogesterone)
Transdermal patches such as Alora, Climara, Estraderm, and Vivelle-Dot are worn on the skin and replaced once or twice a week.
Topical creams or mists (Estrogel or Evamist) are applied to the skin to deliver estrogen treatment to the bloodstream.
Vaginal rings, suppositories, and creams are inserted into the vagina. Higher dosages may relieve systemic symptoms such as hot flashes. Lower dosages target vaginal dryness, which can result in discomfort or bleeding during sexual intercourse and may increase the risk of urinary symptoms. Imvexxy, for example, is a prescription medicine that contains an estrogen hormone in a vaginal insert. It is used after menopause to treat moderate to severe painful intercourse. The lower-dosage treatment for vaginal symptoms has been shown to have no increased risks for cardiovascular disease or cancer.
If you still have your uterus, you will need to take progesterone in addition to estrogen to protect the lining of your uterus from developing endometrial hyperplasia. In certain situations, your healthcare provider may suggest testosterone replacement as well.
Depending on your history and your symptoms, your practitioner may also suggest that you try another type of hormonal medication, called a selective estrogen receptor modulator (SERM).
There are certain clinical situations when using hormones is not appropriate. These include a personal history of breast cancer, a blood clotting disorder, or if your healthcare provider has told you hormones are contraindicated. The risks of HRT include coronary heart disease, stroke, venous thromboembolism (clots), and dementia. These risks rise for those over age 60 or who begin HRT more than 10 or 20 years after the onset of menopause. Taking HRT for longer durations and at higher dosages also may increase health risks.
HRT used to be standard care for menopausal symptoms, but concerns about the risks have made it a less-common option. The treatment can now be better tailored to treat your symptoms while minimizing risks. A conversation with your healthcare provider can determine if the benefits outweigh the risks for you.
Related: Hormone Replacement Therapy for Menopause
Paxil
Paxil (paroxetine) belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). Research has shown that these drugs, which are used to treat depression, also help relieve the vasomotor symptoms associated with low estrogen levels in non-depressed menopausal women.
Since the hormone changes of menopause can also cause depression, an SSRI may also be an appropriate choice in some women. But these benefits need to be balanced with the side effects of most SSRIs, which include weight gain and decreased sex drive—two issues already common in menopausal women.
Veozah
(Veozah) (fezolinetant) belongs to a class of drugs known as neurokinin 3 (NK3) receptor antagonists. Veozah is the first NK3 receptor antagonist approved by the Food and Drug Administration (FDA) to treat hot flashes caused by menopause.
Clonidine
Unlike Paxil, which has approval from the FDA for the treatment of vasomotor symptoms, Clonidine is used off-label to treat these issues. Some evidence supports the benefits of this blood pressure medication to reduce hot flashes.
Gabapentin
Like clonidine, gabapentin is not FDA approved for the treatment of hot flashes. It is a medicine used to prevent seizures, but has also been shown to reduce vasomotor symptoms. It is not as effective as estrogen, but is a good option for women who cannot use hormone replacement therapy.
Complementary Alternative Medicine (CAM)
Complementary and alternative medicine (CAM) offers options outside of traditional Western or allopathic medicine. Many of these options are based on centuries-old healing practices like Chinese-medicine, Ayurveda, and herbal medicine. You may choose to seek an integrative approach combining allopathic with naturopathic, homeopathic, or Eastern medicine.
While there is some clinical evidence to support the benefits and safety of some of these options, generally, scientific evidence is mixed. According to one scientific review, there is no consistent evidence to support the safety or benefit of many CAM therapies.
Naturopathy & Homeopathy
Naturopathic medicine, or naturopathy, is based on the principle that disease is caused by a breakdown in the way the body normally heals itself. Naturopathic doctors use a variety of healing practices to help your body heal itself, including:
Clinical nutrition
Herbal medicine
Acupuncture
Light therapy
Some common homeopathic or herbal remedies recommended to treat menopausal symptoms include:
Black cohosh
Red clover
Ginseng
St. John's wort
Gingko biloba
The evidence is limited to support benefit from these herbal remedies. Most of these herbs have estrogen-like activity, and there is concern that they may have some of the same risks as taking estrogen. They may interact with many different prescription drugs. Further, specific risks of liver damage have been noted for black cohosh and kava.
It is important to let all your healthcare providers know about any herbal remedies you're taking for menopause.
Chinese Medicine
Chinese medicine is an over 3,000-year-old healing practice based on a complex concept of energy balance in the universe and ultimately in the individual. Simply put, when this energy is out of balance disease occurs. Traditional Chinese medicine uses varying healing techniques, including:
Diet
Herbs
Acupuncture
Exercise
Energy healing
Although a definite benefit is not yet supported by significant scientific evidence, there are reports showing that traditional Chinese medicine helps to relieve the menopause symptoms of:
Sleep problems
Hot flashes
Mood disturbances
Aches and pains
Memory and concentration problems
Decreased sex drive
Some experts suggest that traditional Chinese medicine is an important part of treatment options for menopausal symptoms especially as part of an integrated approach.
Ayurveda
Ayurveda, like Chinese medicine, is an ancient healing practice that is over 3,000 years old. Ayurvedic practitioners use several different healing techniques, including:
Nutrition
Detoxification
Purification
Yoga
Breathing
Massage therapy
Ayurveda is a well-recognized complementary and alternative medicine option. Unfortunately, it is difficult to apply Western research study design to this healing philosophy, so very limited evidence is available to comment on its effectiveness. But that doesn't mean it is not effective in helping to treat menopausal symptoms.
Related: Natural Treatments for the Symptoms of Menopause
A Word From Verywell
Menopause causes many changes in your body. It is a normal process and not a disease. However, the hormonal changes of menopause can cause unpleasant symptoms and long-term health issues that affect your quality of life. Making simple lifestyle changes and integrating different therapeutic approaches can help you live very well through menopause and beyond.
