Menopause Treatment

Menopause, a natural phase in a woman’s life, brings its own set of physical and emotional challenges. As hormone levels fluctuate and decline, symptoms such as hot flashes, mood swings, and bone loss can emerge.

In this section, we cover various treatment options, including Hormone Replacement Therapy (HRT), prescription and over-the-counter (OTC) medications, procedures, and surgeries, and a blend of conventional and alternative therapies.

Also, the role of dietary supplements and specific products and devices in symptom management is covered. While some of these treatments can effectively manage symptoms and improve wellbeing and quality-of-life, any underlying conditions may still require resolution.

To learn more about treatments for specific symptoms, visit the Symptoms of Menopause page.

Hormone Replacement Therapy (HRT) (also called Hormone Therapy (HT), Menopause Hormone Therapy (MHT), Estrogen Replacement Therapy (ERT), and Postmenopausal Hormone Therapy (PHT)) is a commonly prescribed medication treatment used to relieve symptoms of menopause.

HRT works by replacing hormones, primarily estrogen or estradiol, and progesterone or progestin for women with a uterus, that the body produces less of postmenopause.

Estradiol is the second and major form of estrogen (E2 or 17 beta-estradiol) in addition to estrone (E1) and estriol (E3). The body produces less estradiol during menopause, and more estrone which is considered pro-inflammatory. Estrone is linked to increased health risks such as inflammation, obesity, hormone-sensitive breast cancer, and tumor growth.

The hormones typically used for HRT, include bioidentical (chemically identical to hormones naturally produced by the body) or synthetic hormones such as conjugated estrogen (CE) (synthesized in a laboratory), and a related type called conjugated equine estrogen (CEE) (derived from pregnant horse urine) like Premarin.

Regulated bioidentical hormones (also called bioidentical hormone replacement therapy (BHRT) or body identical hormones) are recommended over compounded, due to safety and efficacy.

The different applications of HRT used during and after menopause include estrogen-only, primarily as estradiol, progestin only, and combined estrogen and Bazedoxifene, a selective estrogen receptor modulator (SERM).

Estradiol comes in oral pill, patch, gel, spray and injection form, as well as vaginal cream, tablet, insert, and ring form. An example of estradiol is Estrace.

Progestin comes in oral pill form like Provera (medroxyprogesterone acetate).

Combined estrogen and progestin comes in oral pill and patch form like Climara Pro (estradiol with levonorgestrel).

Combined estrogen and Bazedoxifene, comes in oral pill form like Duavee (bazedoxifene).

High-dose estrogen therapy (HDE) may be prescribed to women with osteopenia and osteoporosis, endometriosis, premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and estrogen receptor-positive breast cancer.

HDE is also called pseudopregnancy as when it is given in combination with a high dose of progestogen, hormone levels mimic those during pregnancy.

The two primary types of HRT are systemic hormone therapy and low-dose vaginal products with estrogen or local estrogen.

The first type of HRT, systemic hormone therapy. typically contains a higher dose of estrogen, which circulates throughout the entire body. It can be delivered through various forms, including oral pills, patches, gels, sprays, or injections.

This form of therapy is primarily used to treat common systemic symptoms of menopause, such as vasomotor symptoms, mood changes, and bone loss.

It is often prescribed as a combination of estrogen and progesterone or progestin. This combination reduces the risk of endometrial cancer by counteracting the unbalanced growth of the uterine lining caused by estrogen. However, for those who have had a hysterectomy and no longer have a uterus, progestin may not be necessary.

While systemic HRT may be effective for overall symptom relief and in preventing osteoporosis, it can interfere with existing medications, and is associated with certain risks, including an increased risk of cardiovascular disease, blood clots, stroke, and certain types of cancers like breast.

The specific risks and benefits depend on a woman’s health status, the type, and dose of hormones used, and the duration of the therapy.

The second type of HRT, low-dose vaginal products, are localized treatments that involve administering a low dose of estrogen directly to the affected area.

These are available as vaginal creams, tablets, inserts, or rings and are specifically aimed at treating genitourinary syndrome of menopause (GSM) symptoms, including vaginal dryness, painful sexual intercourse (dyspareunia), and urinary problems.

Since these products deliver estrogen directly to the affected area, they have minimal systemic absorption because of reduced circulating blood levels in the body. This lowers the risk of systemic side effects reducing exposure to breast and endometrial tissues.

These products are beneficial for women who cannot take systemic HRT because of certain health risks. However, they are not recommended for treating other menopause symptoms like vasomotor symptoms.

The HRT type, dosage, timing, and method of delivery should be personalized to optimize benefits and minimize risks. It is crucial if you are considering HRT to discuss your options with a healthcare professional to determine the most suitable form of therapy for your needs.

Women who cannot or choose not to use HRT can find value in prescription and over-the-counter (OTC) medications.

Prescription medications include antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), to manage mood and psychological symptoms and vasomotor symptoms such as hot flashes.

Blood pressure medications, like clonidine and anti-seizure medications such as gabapentin, typically used for seizure control, can be effective in reducing the frequency and intensity of hot flashes.

Prescription dehydroepiandrosterone (DHEA) may be used to treat GSM symptoms. DHEA is a substance that is naturally made in the body, where it is converted into estrogen and testosterone.

Additionally, Selective Estrogen Receptor Modulators (SERMs) can mimic or block estrogen in different tissues and can also treat GSM symptoms.

Attention-Deficit/Hyperactivity Disorder (ADHD) medication may be prescribed to women without ADHD to address cognitive and thinking symptoms during menopause. Symptoms may include focus difficulty, multi-tasking difficulty, postmenopausal brain fog, and memory and recall impairment.

Medical marijuana (or cannabis) may be prescribed for severe and chronic pain.

OTC medications to manage pain include Ibuprofen, Acetaminophen, and Naproxen, antihistamines can help with allergies and skin irritation, and various nasal sprays and decongestants treat nasal related symptoms such as rhinitis and sinusitis.

Vaginal moisturizers and lubricants, including those containing low-dose estrogen, help treat vaginal dryness and discomfort.

These products come in various formulations, including those containing low-dose estrogen, and non-hormonal options such as water-based, silicone-based, or oil-based lubricants.

Vaginal moisturizers are designed for regular use to maintain vaginal moisture and elasticity, while lubricants are typically applied as needed to reduce discomfort during sexual activity.

Regular use of vaginal moisturizers can help ease dryness and support overall vaginal health by maintaining tissue integrity and pH balance. When selecting a lubricant, it’s important to consider compatibility with condoms, particularly as some oil-based lubricants can degrade latex.

The selection of prescription and OTC medications should consider your specific needs and health profile. Consultation with a healthcare professional will help determine if medications have any interactions with existing medications and health conditions.

Several medical procedure and surgeries provide effective solutions for alleviating symptoms associated with menopause, offering significant improvements in the quality of life for women. A selection of these is covered below.

Women experiencing heavy menstrual bleeding, painful cramps, and other menstrual symptoms that interfere with daily functioning may undergo surgical procedures like endometrial ablation, uterine artery embolization, and a hysterectomy.

Endometrial ablation removes a layer of the uterine lining, uterine artery embolization removes uterine fibroids and obstructs blood supply to the uterus, and a hysterectomy removes the uterus.

These procedures are not suitable if you wish to have children as they may interfere with your ability to conceive.

For moderate to severe vasomotor symptoms, such as hot flashes, a nerve block procedure known as stellate ganglian block may be performed. This procedure is used for pain management and involves the injection of a local anesthetic into a collection of nerves in the neck called stellate ganglion.

Typically, a series of injections for example every 1-2 weeks is required for continued pain relief.

The stellate ganglian block procedure may have a modulatory role in thermoregulatory areas of the brain involved in vasomotor symptoms. Thermoregulation is the body’s ability to maintain its core body temperature by balancing heat generation with heat loss.

Laser therapy for vaginal rejuvenation is a non-invasive technique that can help induce collagen remodeling and synthesis, and elastin formation to treat vaginal atrophy.

Vaginal rejuvenation may result in improved vaginal elasticity and the restoration of premenopausal epithelial function, alleviating symptoms such as vaginal dryness, burning, and dyspareunia.

For urinary incontinence, a number of procedures are available including bulking material injections, OnabotulinumtoxinA (Botox) injections, nerve stimulators, and electrical stimulation.

Bulking material injections are injected into the tissue surrounding the urethra, and Botox injections into the bladder. Nerve stimulators stimulate the sacral nerves involved in bladder control, and electrical stimulation is targeted at the pelvic floor muscles involved in urination.

Surgical procedures like sling procedures, bladder neck suspension, and an artificial urinary sphincter may be performed where other interventions are not resulting in satisfactory improvement.

The decision to proceed with any procedure should be made in consultation with a healthcare professional. Many of these procedures are only considered once less invasive, and high-risk strategies have proved ineffective.

Various conventional and traditional therapies offer additional ways to treat menopause symptoms.

Therapies related to menopause include talk therapy (also known as talking therapy or psychotherapy), physical therapy, occupational therapy, speech therapy, and nutritional therapy.

Talk therapy involves talking to a therapist about emotional, cognitive, and psychological challenges. The main aim is to identify, understand, and address the underlying issues causing distress, leading to improved day-to-day functioning and overall quality of life.

The five broad categories of talk therapy include psychoanalysis and psychodynamic therapy, behavioral therapy, cognitive-behavioral therapy (CBT), humanistic therapy, and holistic or integrative therapy.

Examples of each category include Freudian therapy (psychoanalysis and psychodynamic therapy, hypnotherapy (behavioral therapy), mindfulness-based cognitive therapy (MBCT), Gestalt therapy (humanistic therapy), and counseling, couple therapy, and sex therapy (holistic or integrative therapy, which often includes a blend of different approaches based on individual needs).

CBT is also a variation of behavioral therapy, and is often recommended and used to treat a range of menopause symptoms.

CBT can provide women with coping strategies and techniques to handle symptoms, and change negative and dysfunctional emotions and thought patterns, thereby changing how they feel and their behaviors.

Physical therapy is primarily concerned with pain relief, healing, and restoring function and movement related to physical injuries or conditions.

Physical therapy involves exercises, manual therapy, and modalities like heat and cold therapy to treat musculoskeletal conditions, such as muscle pain (myalgia). Types of physical therapies include physiotherapy, sports therapy, and orthopedic therapy.

Additionally, pelvic floor physical therapy is used to treat GSM symptoms focusing on the pelvic floor muscles, ligaments, and connective tissues that support the pelvic organs, including the bladder, rectum, uterus, and vagina.

Occupational Therapy (OT) helps individuals develop, recover, or maintain daily living and work skills. It is focused on improving life skills and adaptability, including cognitive, physical, sensory, and motor skills.

OT is often used for rehabilitation after injuries; however, it also helps with developmental disorders, chronic illnesses, and mental health issues experienced during menopause.

Speech therapy may be recommended for women experiencing vocal changes because of hormonal fluctuations. This type of therapy focuses on improving communication skills, including speech, language, voice, fluency, and swallowing disorders.

Nutritional therapy may be performed by dietitians or nutritionists as part of medical treatment, or preventive health care.

In this therapy, they specialize in using diet and nutrition to improve health and treat various conditions such as heart diseases, diabetes, obesity, gastrointestinal disorders, bone health, autoimmune disorders, and skin conditions such as Psoriasis.

Conventional and traditional therapies may be used in combination with other treatment strategies, including complementary and alternative therapies. For example, CBT may be used with biofeedback, which is covered in the next section.

Complementary and alternative medicine (CAM) encompasses a variety of adjuvant therapies that offer diverse and holistic approaches to health and wellness.

These therapies are used alongside, or as an alternative to, conventional medical treatments to treat menopause symptoms. Some of these therapies are included below.

Traditional alternative medicine includes acupuncture, a fundamental aspect of Traditional Chinese Medicine (TCM), Ayurvedic medicine (including herbal medicine), homeopathy, and naturopathy. Acupuncture will be explored in more detail.

Acupuncture involves the insertion of fine needles into specific points on the body, and is known for its benefits in managing menopause symptoms. With minimal side effects, it can effectively treat common issues like hot flashes, disrupted sleep, and mood swings by balancing hormones, regulating the internal thermostat, and restoring energy flow.

Acupuncture promotes relaxation, improves sleep quality by influencing neurotransmitters, reduces stress, and boosts mood by increasing serotonin levels.

Additionally, acupuncture can enhance circulation and stimulate the body’s natural painkillers, providing relief from menopause-related discomforts. This natural therapy also supports cognitive function and emotional regulation, making it a valuable and holistic approach for women navigating the complex changes of menopause.

Other categories of therapies include external energy therapies, body-based practices, body movement therapies, mind-body exercises, and mind and mindfulness practices.

External energy therapies such as electromagnetic therapy, reiki, and Qigong involve the use of external energy sources to promote healing and hormonal balance.

Body-based practices involve therapies that focus on body manipulation and movement such as chiropractic and osteopathic medicine, and massage therapy.

Massage therapy manipulates the body’s soft tissues to promote relaxation, pain relief, increased muscle and joint mobility and flexibility, improved circulation, improved skin tone, and stimulation of the lymphatic system. Types of massage therapy include deep tissue, reflexology, myofascial release, and lymphatic massage.

Body movement therapies and mind-body exercises include yoga and Tai Chi, which combine physical postures, breathing exercises, and meditation to enhance physical and mental well-being.

Mind and mindfulness practices include meditation, biofeedback, and hypnosis.

Meditation involves various techniques to promote relaxation and mental clarity.

Biofeedback helps individuals learn to control bodily processes that are typically involuntary, and is often used to improve muscle control for urinary symptoms.

While hypnotherapy is a type of behavioral therapy, hypnosis is more of a state of consciousness that can help focus attention, guide relaxation, and allow modification of behavior by suggestion.

Sensory-based therapies include art, dance, music therapy, and visualization or guided imagery, which engage the senses to promote healing and emotional well-being. These therapies often help in expressing feelings that might be hard to verbalize and can be effective in treating emotional and psychological symptoms around the menopausal transition.

CAM also includes dietary supplements, herbal medicine, and diet and nutrition.

Dietary supplements are covered in the next section, herbal medicine is part of Ayurvedic medicine, and diet is covered on the Menopause Management page. The covered CAM therapies offer unique holistic benefits, can be useful as part of a stand-alone or integrated approach, and can be tailored to your unique preferences and needs.

Dietary supplements typically contain natural ingredients that may support overall health and help treat symptoms associated with menopause. They can be used alone, or they can complement other treatment and management approaches, including diet and nutrition.

Supplements can be categorized as plant estrogens (phytoestrogens) including isoflavones, vitamins and minerals, lipids and omegas, intestinal health support, urinary health support, anti-inflammatory support, hormonal support, weight loss support, antioxidants, superfoods, adaptogens, cognitive support, and sleep aids.

Plant estrogens, or phytoestrogens, are used for their estrogen-like effects, helping to alleviate common menopausal symptoms such as vasomotor symptoms and bone density loss, and balance the hormonal fluctuations experienced during menopause.

Some phytoestrogens include coumestan, found in red clover (Trifolium pratense), isoflavones, found in soy, lignans, found in flaxseed (Linum usitatissimum), and stilbenes, found in the skin of grapes, commonly produced as resveratrol.

While prescription DHEA may treat GSM symptoms, the supplement form is used for a range of health conditions and for aging skin, and to increase sex drive (libido) and muscle strength. Creatine, particularly combined with strength training, can help improve exercise performance, reduce bone resorption, inflammation, and oxidative stress, increase bone formation, and counterbalance bone, muscle, and strength loss.

Vitamins and minerals provide the essential nutrients the body needs to function optimally and stay healthy during the menopausal transition. Notable vitamins include the B vitamins, C, and A, D (ergocalciferol (D2) and cholecalciferol (D3)), E, and K, the four fat-soluble vitamins.

Minerals include macrominerals or electrolytes and microminerals or trace minerals. Some macrominerals include sodium, phosphate, potassium, magnesium, and calcium, and some microminerals include boron, iron, zinc, copper, iodine, selenium, and manganese.

A multivitamin typically contains both vitamins and minerals.

Lipids and omegas such as Omega-3 fatty acids (containing eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA)) are beneficial for heart health, cognitive function, and reducing inflammation, which is crucial as the risk of heart disease can increase post-menopause.

Intestinal health is another key focus, with supplements like prebiotics and probiotics, especially lactobacillus and bifidobacterium strains, help support the immune and digestive systems, and gut microbiome by balancing unfriendly gut bacteria.

Probiotics also support urinary health as well as cranberry (Vaccinium macrocarpon). saw palmetto extract (Serenoa repens), vitamin D, and lycopene.

Cinnamon (Cinnamomum verum or Cinnamomum cassia), curcumin (Curcuma longa or turmeric), Boswellia serrata extract, also known as Indian frankincense, containing acetyl-11-keto-β-boswellic acid (AKBA), saffron (Crocus sativus), stinging nettle (Urtica dioica), and Gingko biloba have anti-inflammatory properties.

Dietary supplements that provide hormonal support for many menopausal symptoms such as hot flashes, include dong quai (Angelica sinensis), pumpkin seed extract (Cucurbita pepo), saw palmetto extract (Serenoa repens), and beta-sitosterol (β-sitosterol), as well as supplements listed under adaptogens below.

Weight loss is supported by green tea extract (Camellia sinensis) containing epigallocatechin gallate (EGCG), green coffee bean extract (Coffea arabica or Coffea canephora), L-carnitine, cinnamon, and iodine in the case of thyroid dysfunction. Many of these supplements are available in food form as included on the Menopause Management page.

Antioxidants protect against cell damage caused by free radicals and reactive oxygen species (ROS), both of which contribute to oxidative stress. This can lead to cell damage, and play a role in the development of various conditions, including Alzheimer’s disease, cardiovascular disease, and cancer. Some antioxidants include vitamins A, C, and E, beta-carotene, lycopene, lutein, and zeaxanthin.

Phytoestrogens, catechins, flavones, flavonoids, and polyphenols are antioxidants.

Superfoods like pomegranate extract (Punica granatum) provide a concentrated source of essential nutrients.

Adaptogens, such as ashwagandha (Withania somnifera), black cohosh (Actaea racemosa), Panax ginseng (red ginseng or Korean ginseng), and St. John’s wort (Hypericum perforatum), are known for their properties in helping the body manage stress.

Adaptogens also help manage menopause symptoms such as vasomotor symptoms, like hot flashes and night sweats, heart palpitations, irritability, and mood swings.

Cognitive support includes Omega-3 fatty acids, found in fish oil supplements, resveratrol, and ginkgo biloba for optimal brain function. Acetyl-L-carnitine (ALCAR), green tea extract (Camellia sinensis) containing epigallocatechin gallate (EGCG), ashwagandha, and Gotu kola (Centella asiatica) support increased attention and focus.

Sleep aids are useful in addressing disrupted sleep, common for women experiencing night sweats. Sleep aids include chamomile extract (Matricaria chamomilla), Gamma-Aminobutyric Acid (GABA), 5-Hydroxytryptophan (5-HTP) (Griffonia simplicifolia), magnesium, and melatonin, which can help regulate sleep patterns and improve sleep quality, contributing to overall health and wellness. Prioritizing sleep and recovery are also essential, as covered on the Menopause Management page.

Incorporating dietary supplements with menopause treatment can offer a holistic approach to managing symptoms. It is essential, however, to use them under the guidance of a healthcare professional as they can interact with other supplements, medications and health conditions.

In the treatment of menopause, a variety of products and devices help manage symptoms. These range from vaginal moisturizers and lubricants to more specialized devices, such as pelvic weights and wands.

Vaginal moisturizers can help alleviate vaginal dryness, a common menopause symptom. These products, including those formulated with hyaluronic acid and vitamin E, can be found in various forms, like suppositories and topical applications. They provide hydration and can relieve dryness and itchiness. Similarly, lubricants, including warming varieties, play a crucial role in decreasing discomfort and enhancing pleasure during sexual activities.

The importance of using products free from harmful ingredients like sulfates, parabens, and synthetic fragrances cannot be overstated, as these can exacerbate dryness and irritation.

For more targeted relief, vaginal dilators can be beneficial. These devices relax tight vaginal muscles, helping to widen and lengthen the vaginal opening. This not only improves the production of natural lubrication but can also re-strengthen weak pelvic floor muscles, enhancing both comfort and sexual experiences. Sex toys and vibrators can also help increase sexual pleasure.

To learn more, visit the Sexual and Libido Changes page and the Guide to Sex Around Menopause.

Pelvic health is further supported by the use of pelvic weights and wands. These tools are effective in accessing hard-to-reach pelvic floor muscles, facilitating exercises that strengthen this crucial area. Regular use can lead to improved control over urinary functions and enhanced sexual sensation. They can also help ease pelvic pain and discomfort.

Pelvic floor or Kegel exercises are also beneficial and included on the Menopause Management page.

For women experiencing urinary incontinence, medical devices such as a urethral insert can help prevent leakage during strenuous activities, and a pessary can help support the urethra to prevent urine leakage. A pessary can also help hold a sagging organ in place when experiencing a pelvic organ prolapse (POP).

Products like urinary leakage briefs and absorbent pads can be used where other interventions are unsuccessful. These can be worn discreetly under everyday clothing, providing security and confidence. It is important to change these products regularly to prevent leaks, odors, infections, and skin irritation.

Essential oils may provide some relief for symptoms, such as hot flashes, disrupted sleep, and mood swings. Oils like chamomile, lavender, and ylang ylang hold calming and soothing properties. They can help promote relaxation, reduce stress, and improve sleep quality.

Some essential oils like clary sage, fennel, and thyme contain phytoestrogens, which may play a role in balancing hormones. Methods of using these oils include diffusion, direct skin or topical application with proper dilution using a carrier oil like almond or jojoba for example, and as part of massage therapy.

The products and devices provide women with practical and effective solutions to manage symptoms. As with any health intervention, healthcare professionals should be consulted regarding the most appropriate, safe and effective solutions for you.

Finishing our exploration of menopause treatments, it is clear that navigating this phase is a deeply personal journey. The information provided helps you make informed and holistic healthcare choices.

From HRT and various medications to surgical options, and a spectrum of conventional, traditional, and alternative therapies, each woman has access to a range of treatments tailored to her unique symptoms and health profile.

Additionally, dietary supplements, products, and devices offer practical, everyday solutions for symptom management. However, it is essential to approach these treatments under the guidance of healthcare professionals to ensure their safety and effectiveness.