How To Treat Menopause

Menopause occurs when a person who previously menstruated has not had a period for at least 12 months. Menopause is not a disease or a health problem. Rather, this phase is a natural part of aging for all people who menstruate. For this reason, menopause does not necessarily require treatment.

However, menopause can cause symptoms that range from uncomfortable to debilitating. Many people seek treatment to relieve these symptoms during the time leading up to menopause (a phase known as perimenopause) and beyond. The goals of menopause treatment are to reduce symptoms such as hot flashes, sleep problems, and vaginal pain or dryness.

The most common and comprehensive treatment for menopause is hormone therapy. But this type of drug therapy carries some long-term health risks. So, some menopausal people opt for other types of medication or lifestyle habits that can ease their symptoms.

Medications

Several types of prescription medications can address the symptoms of perimenopause and menopause.

Hormone Replacement Therapy

As your body leads up to menopause and after menopause starts, the levels of hormones called estrogen and progesterone in your body fall dramatically. This decrease in female hormones is what causes many menopause symptoms.

Hormone replacement therapy (HRT) is made up of synthetic estrogen and/or progesterone—which means that these hormones are made in a lab. Taking HRT can help reduce menopause symptoms such as:

• Hot flashes (also known as vasomotor symptoms)
• Changes in mood such as irritability or depression
• Sleep problems
• Vaginal dryness

HRT is usually systemic, meaning the treatment helps the whole body and not just specific symptoms. You can take HRT in the form of oral pills, moisturizers, creams, patches, gels, sprays, or vaginal rings.

Keep in mind: HRt may have serious side effects such as an increased risk of blood clots, stroke, breast cancer, and gallbladder disease. To reduce these risks, experts recommend taking as low a dose of HRT as possible for the shortest time possible.

Low-Dose Topical HRT

Some people prefer not to take systemic HRT, or it may not be safe for them due to their health history. People with a personal or family history of blood clots, heart disease, breast cancer, or certain other health conditions may not be eligible for a systemic HRT prescription because of its risks. 

In this case, low-dose topical estrogen treatments may help with symptoms such as vaginal dryness. You can apply these treatments directly to your vagina in the form of creams, tablets, or rings. Side effects are not common, but they may include irritation and abnormal vaginal bleeding.

Birth Control Pills

During perimenopause, some people find low-dose birth control pills to be helpful in relieving their symptoms. This treatment may help lessen hot flashes, vaginal dryness, and mood swings. But it's worth noting that hormonal birth control can increase your risk for blood clots and high blood pressure (hypertension). This risk is much higher for people who smoke.

Non-Hormonal Medications

Other drug treatments may be helpful for people who cannot or do not want to take HRT. The U.S. Food and Drug Administration has approved the following medications to treat certain menopause symptoms:

• Veozah (fezolinetant): Treats hot flashes, but may also affect your liver enzyme levels
• Paxil (paroxetine): An antidepressant drug that can treat hot flashes, but may increase thoughts of self-harm and suicide
• Osphena (ospemifene): Improves vaginal pain and dryness, but may cause serious side effects including an increased risk of uterine cancer, strokes, and blood clots
• Intrarosa (prasterone): Helps treat vaginal pain during sex

Your healthcare provider may also prescribe other off-label medications for menopause symptoms. This means they are FDA-approved for different conditions but have been found to also help with menopause symptoms. These drugs include:

• Catapres (clonidine): A blood pressure medication that can help with hot flashes and night sweats
• Neurontin (gabapentin): An anti-seizure drug that can also improve hot flashes and night sweats
• Ditropan (oxybutynin): A urinary incontinence drug that may help with hot flashes

Keep in mind: all prescription drugs can cause some side effects. Your healthcare provider will monitor you closely after prescribing any of the drugs listed above.

Therapies

Studies have also shown that certain types of psychotherapy can help relieve menopause symptoms. You may choose to partake in therapy on your own or use therapy and medications in tandem.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) helps you identify and change habits or thoughts about your menopause symptoms. This therapy also helps reduce stress, which can trigger menopause symptoms or make symptoms worse. In some clinical trials, CBT for menopause helped reduce hot flashes and night sweats among people who reported their symptoms.

Hypnotherapy

Hypnotherapy, or hypnosis, is a form of therapy that involves leading people into a state of complete, focused relaxation so that their minds are more open. One government-funded study found that hypnotherapy reduced the frequency of hot flashes in people who had them often. It's worth noting that hypnotherapy should only be performed by a licensed professional.

Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) refers to treatments that some people may find helpful to use along with or instead of traditional medical treatments. In general, CAM for menopause falls into two categories: dietary supplements and mind-body practices.

Dietary Supplements

Most supplements for menopause relief have very little to no scientific evidence that proves their effectiveness. However, a few have shown minor possible benefits in some studies:

• Melatonin has been proven to help older adults sleep better and may help relieve insomnia in others
• Soy may have a small effect on improving hot flashes, although the studies on this are limited
• Black cohosh may help reduce hot flashes
• Red clover can help improve vaginal dryness

Keep in mind that supplements are not regulated by the FDA in the same way that other medicines are. Doses and ingredients may vary from what is listed on the label. Also, supplements can interact with other medicines you are taking. Always consult your healthcare provider before starting a new supplement.

Mind-Body Treatments

Certain complementary treatments that involve training the mind or body may also help reduce any menopause symptoms you're experiencing:

• Mindfulness: May reduce stress, insomnia, and fatigue
• Yoga: Can improve all types of menopause symptoms compared to no physical activity at all
• Acupuncture: Could helps relieve hot flashes, insomnia, mood swings, and overall quality of life for perimenopausal and menopausal people

Most mind-body treatments are safe for most people, but research on their effectiveness for menopause symptoms is mixed. If you want to try CAM therapies for yourself, first talk to your healthcare provider to make sure it is safe for you.

Lifestyle Changes

Making a few lifestyle changes also may help reduce, or improve your ability to cope with, certain menopause symptoms. In general, quitting smoking, managing stress, and maintaining a weight that is right for your body can improve your overall quality of life and reduce the negative effects of menopause.

To manage hot flashes, try these methods:

• Avoid alcohol, spicy food, and caffeine—all of which can trigger hot flashes
• Dress in layers and carry a portable fan with you
• Keep your bedroom cool during the night

To manage sleep disruptions, try these techniques:

• Stick to a regular sleep schedule and bedtime routine
• Try to avoid naps later in the day
• Do not use electronic devices in the bedroom or right before bedtime
• Minimize eating large meals, caffeine, and alcohol close to bedtime
• Get regular exercise, but not late at night

To help with vaginal dryness and pain during sex, try applying over-the-counter moisturizers or water-based lubricants.

Living With and Managing Menopause

Remember that menopause is a natural phase of life for half the population. Menopause is not something to hide or feel shame about. If symptoms are bothering you, talk to your healthcare provider. They may recommend or prescribe some of the treatment options listed above.

It's also important to know that having lower levels of estrogen and progesterone as you enter menopause may increase your risk for certain serious health problems. Ask your healthcare provider about how to manage your risk for heart disease, stroke, and osteoporosis. For example, getting regular exercise and supplementing calcium and vitamin D can help reduce your risk for osteoporosis—a condition that causes your bones to become weak and brittle.

A Quick Review

As people who menstruate reach their 40s and 50s, they enter a phase called perimenopause. This phase ends with menopause—which is a phase that occurs when you have not had a menstrual period for at least 12 months. During perimenopause and menopause, symptoms such as hot flashes, night sweats, trouble sleeping, mood swings, and vaginal dryness are common.

Some lifestyle changes may help you manage these symptoms until they pass. However, some symptoms can last for years and be quite disruptive. In these cases, treatments such as hormone replacement therapy or non-hormonal medications may help relieve symptoms. If menopause symptoms are affecting your quality of life, you may also consider asking your healthcare provider for a referral to see a mental health professional, such as a psychiatrist or psychologist.