How Menopause Is Treated

Menopause itself is not a disease. But it does signal that significant hormone changes have occurred in your body. These hormone changes, especially the low estrogen levels, put you at risk for certain illnesses and may cause significant symptoms that affect your quality of life. Treatment options for menopause are either for symptom relief, prevention, or both. The two most common symptoms of menopause that women seek treatment for are vasomotor symptoms and vaginal atrophy.

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 good look at your current lifestyle. Yes, your body is aging whether you like it or not. But it doesn't mean you have to throw in the towel (aside from the proverbial menstrual one that is). By making some small adjustments you can make the next decades your healthiest yet. The older you get the more likely you are to appreciate the saying, "Health is Wealth."

Exercise

Exercise is important regardless of your age, but it takes on added importance in menopause. Your focus needs to shift from fitting intoy our skinny jeans to maintaining function in your aging body. In menopause. you need to focus on strength training as well as aerobic-focused exercises to counteract age-related muscle loss (which starts at age 40) and the age-related bone loss that starts with menopause. 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 your flexibility and help with bone loss as well as improve hot flashes.

Diet

It is important to take a look at your diet and eating habits. Following a healthy diet is crucial to your overall health and wellness. A well-balanced diet will give you all the vitamins and nutrients you need to keep your body healthy. In menopause, weight management is an issue so watching your daily caloric intake is important. But it is just as important that you get adequate protein in your diet so that you can maintain and/or build muscle. Choosing the right food in menopause can help you stay healthy and may also help you manage the symptoms caused by your changing hormone levels.

Limit Your Alcohol Intake

Consuming too much alcohol and is not good for you. For many women, it becomes the go-to solution for a stressful day. Unfortunately, the way it works with alcohol is the more you drink the more you need to drink it. Some women are more susceptible to alcohol dependence than others. Consuming too much alcohol can lead to multiple medical problems, including weight gain, malnutrition, depression, and dementia, and it has been linked to an increased risk of breast cancer. Alcohol has also been shown to make your hot flashes and night sweats more intense. Try having a hot cup of herbal tea or going for a walk on some days after work instead of automatically raising your glass.

If you think you have developed a dependence on alcohol you should discuss this with your doctor. It is too important for your health to ignore.

Over-the-Counter (OTC) Therapies

Your doctor 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.

A variety of OTC herbal and natural products are marketed for relief of menopausal symptoms such as hot flashes. These include phytoestrogens, black cohosh, DHEA, dong quai, evening primrose oil, ginseng, kava, melatonin, and wild yam. However, either research is lacking or the research so far doesn't show these to be consistently effective, according to the National Center for Complementary and Integrative Health. In addition, kava supplements have been linked to a risk of severe liver disease. Always check with your doctor before taking OTC products as they can interact with prescription medications or each other.

Prescriptions

While a lifestyle approach to menopausal symptoms is preferred, in some cases your doctor may recommend prescription therapy.

Hormone Replacement Therapy

The symptoms of the menopausal transition and ultimately menopause are caused by a gradual loss of ovarian activity. The resulting low levels of your ovarian hormones are directly responsible for the symptoms and changes of menopause. Replacing those hormones makes a lot of sense, especially for women who are very symptomatic. As with any medication, there are risks associated with its use, but often the benefits of the medication outweigh the risks. Your doctor can help you decide if hormone replacement therapy (HRT) is right for you.

Hormone replacement therapy is 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 the vasomotor symptoms, including night sweats and hot flashes associated with menopause.

Replacing your ovarian hormones is effective in treating many of the symptoms of menopause in addition to vasomotor symptoms and vaginal atrophy. It also helps to slow some of the inevitable changes in your aging body. Taking HRT to prevent bone loss which can lead to osteoporosis is considered preventative.

Health care has come a long way from the one-size-fits-all approach to HRT of the past. There are many different formulations and concentrations available. Many hormone replacement options contain a more natural or bioidentical form of estrogen and progesterone. This is true for most pharmaceutical HRT, not just for compounded formulations. In addition to the type and concentration of hormones, there are different forms of HRT for you to choose from, including:

  • Oral
  • Transdermal
  • Topical
  • Vaginal

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 doctor may suggest testosterone replacement as well. Depending on your history and your symptoms, your doctor may also suggest that you try another type of hormonal medication, called a SERM or selective estrogen receptor modulator.

HRT can now be better tailored to treat your symptoms while minimizing your risks.

There are certain clinical situations when using hormones is not appropriate. Perhaps you have a personal history of breast cancer or a blood clotting disorder and your doctor has told you hormones are contraindicated. If you are having severe vasomotor symptoms you may want to consider nonhormonal medications.

Paxil

Paxil (paroxetine) belongs to a class of drugs known as SSRI or serotonin reuptake inhibitors. Research has shown that SSRIs and which are used to treat depression also help relieve the vasomotor symptoms associated with low estrogen levels in nondepressed menopausal women. Since the hormone changes of menopause can also cause depression An SSRI may 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 problems already common in menopausal women.

Clonidine

Unlike Paxil, which has FDA approval for the treatment of vasomotor symptoms, Clonidine is used off-label to treat vasomotor symptoms. Some evidence has supported 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 it has also been shown to reduce vasomotor symptoms. It is not as effective as estrogen but is a good option along with Paxil and clonidine to treat vasomotor symptoms in women who cannot take estrogen.

Bioidentical Hormones

Bioidentical hormones have the same chemical structure as the hormones in your body or those chemically produced for HRT, but are isolated from plant sources. They can be found in over-the-counter products as well as prescription preparations made by a compounding pharmacy.

The American College of Obstetricians and Gynecologists 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.

Vaginal Estrogen

Your doctor can prescribe vaginal estrogen to relieve vaginal dryness, which can result in discomfort or bleeding during sexual intercourse and may increase the risk of urinary symptoms. Vaginal estrogen comes in the forms of cream, tablet, or ring.

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. For some of these options, there is scientific evidence to support benefit and prove there is no harm from the treatment. For other options, there is no evidence to support safety or benefit. You may choose to seek an integrative approach combining both allopathic with naturopathic, homeopathic, or Eastern medicine.

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
  • Homeopathy
  • 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 interact with many different prescription drugs. If you are taking any herbal remedies for menopause it is important to let all your doctors know about it.

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

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. Ayurveda originated in India and is known as the "science of life." 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.

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.

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Additional Reading

  • American Congress of Obstetricians and Gynecologists (2012). Compounded bioidentical menopausal hormone therapy. Committee Opinion No. 532. Washington, D.C: American College Obstetricians and Gynecologists. 

  • National Center for Complementary and Integrative Health. Menopausal Symptoms: In Depth.

  • North American Menopause Society. (2014). Menopause Practice A Clinician's Guide. Mayfield, Ohio.

  • American College of Obstetricians and Gynecologists (2014). ACOG practice bulletin no.141: Management of Menopausal Symptoms. Obstet Gynecol 2014;123:202-16.