Menopause Treatment

Menopausal hormone therapy (MHT) or hormone therapy (HT) can help treat your symptoms. HT or MHT are used to replenish estrogen levels in the body, which helps to ease the symptoms of menopause and improve your quality of life. There are two types of hormone therapy: systemic (for the whole body) hormone therapy and low-dose vaginal products.  

HT can be estrogen alone (for women who have had a hysterectomy) or combined estrogen-progesterone (for women with a uterus). Progesterone protects against uterine cancer. 

Systemic Hormone Therapy: Estrogen/ progesterone preparations are available in oral, patch, vaginal ring forms to relieve menopausal symptoms. Patch forms are preferred if there is a moderate risk of heart disease and non-hormonal forms are considered for women who are at the highest risk for heart disease and breast cancer.  

Birth Control: A low dose birth control pill in addition to contraceptive benefits can relieve menopausal symptoms and found to helpful in women with irregular bleeding during the transition to menopause. 

Low Dose Vaginal Products: Sometimes women need treatment only for vaginal dryness. In this situation they can use low dose vaginal preparations (cream, tablet, capsule or ring) that will act only locally. In addition to reducing vaginal dryness these preparations can help reduce frequency of urinary tract infections. Side effects are rare but can include vaginal irritation and bleeding.  

Bioidentical hormones are identical to the hormones that women make in their bodies.  Bioidentical hormones are sometimes called “natural” hormones—even though they are made in a laboratory—because they come from plant sources before being altered to be like human hormones. Not all hormones made from natural sources are bioidentical. 

There are two types of bioidentical hormone products: pharmaceutical products and custom-made products.  

Pharmaceutical Products: These products have been approved by the U.S. Food and Drug Administration (FDA). Their quality and safety are regulated so it is the same high-quality product every time. 

Custom-made Products: When many people think of bioidentical hormones, they think of custom-made products. These are made in a compounding pharmacy (a pharmacy that mixes medications according to a doctor’s instructions). These products may contain varying amounts of two or three types of estrogen, often mixed with other hormones. Although the individual ingredients are approved by the FDA (except for estriol), the compounds themselves (the final product after the ingredients are combined) are not. Because these compounds are not regulated by the FDA, they can be of low quality. The amount of hormone can change with each batch. Supporters of compounded products claim customizing the hormone doses according to salivary hormone test  which have been shown to be neither consistent nor precise. Female hormone levels change on daily basis and during different times of the day making customization difficult. Often these preparations can be expensive and not covered by insurance plans. 

Most menopause specialists start with FDA-approved products, because they’ve been proven to be safe and effective. For women who cannot take these products due to allergies, or who need a special prescription, custom-made products are an option. Because the quality of custom-made products can vary, it is safer to use pharmaceutical products. This way, you’ll know exactly what you’re getting and how much. 

If your doctor prescribes HT, the FDA recommends using the lowest possible dose for the shortest time needed to relieve symptoms. The idea is to avoid taking too much medication for too long to reduce potential risks linked to HT. You might also want to consider the wide range of non-hormonal options available to treat menopausal symptoms. Finding the type of treatment that works best for you may take some time. Whatever you choose, your doctor will monitor your therapy regularly. 

CAM refers to practices and products that are not usually thought to be part of mainstream medicine. CAM includes herbs and other plant-based treatments (botanicals), non-botanical supplements, and mind-body therapies. Some women use only CAM, and others use CAM with mainstream treatments. Most CAM treatments are safe, but some can interfere with the action of other medicines. 

Some CAM treatments may have serious side effects, even when they are labeled “natural.” The U.S. Food and Drug Administration does not regulate dietary supplements. Therefore, they might contain more or less of the active ingredients than are listed on the label. CAM treatments can interfere with other medicines. Talk with your health care provider before you try CAM treatments or if you already use CAM. 

Botanical Supplements 

Black cohosh — Not proved to relieve menopausal symptoms more than placebo 

• Cautions and Side Effects: Not for women with liver disease; can cause headaches and stomach upset 

Dong quai — Does not reduce hot flashes more than placebo 

• Cautions and Side Effects: Not for women who take warfarin, a blood thinner; may include other untested herbs 

Evening primrose — No effect on menopausal symptoms; may help breast tenderness 

• Cautions and Side Effects: Can cause headaches and stomach upset 

Ginseng — May help improve sleep, mood, and sense of well-being; not proved to relieve hot flashes or improve memory or concentration 

• Cautions and Side Effects: Can cause headaches and stomach upset 

Kava — May help relieve anxiety; not shown to help other menopausal symptoms 

• Cautions and Side Effects: Possible link between kava and liver damage 

Phytoestrogens (estrogen-like substances in cereal, soy, vegetables, and herbs)— Soy supplements may help hot flashes but not proved; red clover not proved to relieve hot flashes more than placebo

• Cautions and Side Effects: May not be for women with conditions affected by hormones (such as breast, ovarian, or uterine cancer); consult your doctor before taking phytoestrogens 

Valerian — May help insomnia but effects not proved 

• Cautions and Side Effects: Can cause headaches, dizziness, stomach upset, and fatigue the morning after use 

Flaxseed- Did not help with hot flashes but improved blood cholesterol levels 

• Cautions and side effects –abdominal bloating, nausea and diarrhea 
  
  

Non-botanical Supplements 

Melatonin — Can help older people fall asleep and may help others overcome insomnia 

• Cautions and Side Effects: May be safe when used short term at recommended doses 

Vitamin E — Not proved to relieve hot flashes 

• Cautions and Side Effects: May interact with other medications 

Mind-Body Therapies 

Acupuncture — May help some women with insomnia, mood swings, or hot flashes 

Homeopathy (highly diluted natural substances intended to stimulate the body to heal itself) — Not proved to help symptoms more than placebo 

Magnet therapy — Not shown to relieve pain or hot flashes 

• Cautions and Side Effects: Can interfere with medical devices such as pacemakers 

Mindfulness training – reduced distress from hot flashes and night sweats 

Paced breathing — May provide relief of hot flashes when done for 20 minutes three times a day 
Relaxation therapies (including massage, meditation, and yoga) — May relieve stress, insomnia, and fatigue 

• Cautions and Side Effects: Massage may not be safe for women with certain health problems, such as advanced osteoporosis 

Reflexology (pressure or massage applied to the feet) — Not shown to relieve hot flashes 

Gabapentin: This is an antiseizure medication that has been found useful in reducing hot flashes. When taken at bedtime it helps to reduce nighttime hot flashes and improves sleep 

Ospemifene: This is a selective estrogen receptor modulator that helps with vaginal dryness and relieves painful sex: 

Selective Estrogen Receptor Modulators: For women who want the benefit of estrogen treatment without the dangers of hormone treatment, selective estrogen receptor modulators, or SERMs, may provide a solution. These drugs, including tamoxifen and raloxifene, act like estrogen in some body tissue. These can help lower the risk of breast cancer and osteoporosis, but they do not help with hot flashes and can increase the risk of uterine cancer. 

Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs (selective serotonin reuptake inhibitors) can be effective in treating mood swings and other symptoms, such as hot flashes and sleep issues, but have side effects; some doctors suggest effectiveness is increased when a woman is first treated with estrogen 

Some of the symptoms of menopause are better treated through lifestyle changes. Exercise and a healthy diet with an adequate amount of calcium help lessen osteoporosis and heart disease risks. Other lifestyle changes to consider include: 

• Stop smoking 
• Lower alcohol consumption 
• Aim for 30 minutes of exercise five days per week 
• Healthy weight management 
• Yearly mammogram 
• Stress management 

You may consider using vaginal lubricant if you are experiencing vaginal dryness due to menopause. There are generally fall into two categories short-acting and long-acting vaginal lubricants.  

Short-acting vaginal lubricants and moisturizers: These are over-the-counter products that are effective for the initial treatment of vaginal dryness. They are applied to vagina and vulva right before and during sexual activity. They serve to reduce friction and increase lubrication and comfort. They can be water-, silicone-, or oil-based. However, they are not as effective as vaginal estrogen, which thickens the vaginal lining. If you experience more severe vaginal dryness, you may require vaginal estrogen in addition to lubricants and moisturizers. 

Long-acting vaginal lubricants: The longer acting than lubricants and are not timed with sexual activity. Rather, you can apply them to the vagina and vulva on a regular basis, typically every 1 to 3 days, depending on the severity of dryness and symptoms. Vaginal moisturizers stick to the lining of the vagina, allowing the tissues to retain moisture. 

• What do you think are possible triggers for my hot flashes? 
• Are there any lifestyle or dietary interventions that may diminish my symptoms? 
• Should I consider medication for treatment of my symptoms?  Hormonal or non-hormonal? 
• If you are interested in hormonal therapy: Am I a good candidate for hormonal therapy, specifically are my cardiovascular and breast cancer risks low? 
• Which lifestyle changes can I make that will decrease my menopause symptoms without medicine? 
• Are there any alternative medicine treatments you would recommend I try for relief of my menopause symptoms? 
• Are there any alternative medicines I should not use because they could interfere with medicines I take?