Treatment Options for Menopause

Menopause is a natural part of aging. It occurs when a person has not had a period for 12 months in a row. Menopause happens because the body makes less estrogen and progesterone. Many people have symptoms like hot flashes and night sweats. Others may have sleep problems, weight gain, and/or mood changes.¹

Who treats menopause?

When living with menopause, you have many choices for your healthcare team. You can start by talking to your primary care doctor. This can be an internal medicine or family doctor. Obstetrician-gynecologists (OB/GYNs) also specialize in this area.²

Some doctors have extra training in menopause care. They are called Menopause Society Certified Practitioners (MSCP). These specialists stay up to date on the latest research. They can help you find a safe treatment plan that fits your needs. The Menopause Society has a list of these providers that you can search online.²

What are the treatment options for menopause?

Several treatment options can help alleviate the symptoms of menopause. Treatments can include:¹

• Medications
• Lifestyle changes
• Complementary and integrative medicine
• Emerging therapies

Medications

Several medicines can help alleviate menopause symptoms. These are listed below. Your doctor will help you choose the right one.¹

Hormone therapy

Hormone therapy is the most effective way to treat hot flashes. It can also be helpful with other symptoms of menopause, such as bone density loss. Hormone therapy replaces the hormones your body no longer makes. Many people can safely use HT if they start it within 10 years of menopause.^1,3

For people without a uterus, estrogen therapy is used. For people with a uterus, combined hormone therapy – estrogen and progestogen – is used. This helps protect you from uterine cancer. ^1,3

Medicines to help with vaginal dryness

Some people need help with vaginal dryness or pain during sex. These treatments help to thicken the vaginal lining.^1,3,4

• Vaginal estrogen – You can apply this as a cream, tablet, or ring. The tissue takes in a small amount of estrogen. It helps with dryness and some urinary issues. This is a very safe drug and can even be appropriate for some people with a history of breast cancer.
• Prasterone (Intrarosa®) – This is a hormone normally produced by the adrenal gland that you put into the vagina. It acts like estrogen to heal vaginal tissue, easing pain during sex.
• Ospemifene (Osphena®) – This is a pill you take by mouth so it can have effects throughout the body. It treats painful sex by helping vaginal tissue. You should not use this if you have a high risk of breast cancer.
• Vaginal lubricants – If you are unable to use hormonal options or would like to try a non-hormonal treatment, there are vaginal lubricants or moisturizers. They do not thicken the vaginal lining but may help keep it moist.

Non-hormonal options for menopause symptoms

Some people cannot use hormones for health reasons. Other drugs can help manage body temperature.^1,3,5

• Elinzanetant (Lynkuet®) – This is a new drug used to treat moderate to severe hot flashes. It works by blocking 2 signals in the brain that cause hot flashes.
• Fezolinetant (Veozah®) – This drug is a hormone-free treatment that is approved to help with hot flashes.
• Antidepressants – Low doses of drugs like SSRIs or SNRIs can ease hot flashes, especially in those who cannot take estrogen. These can also be helpful if experiencing mood changes.
• Gabapentin (Neurontin®) – This drug helps to reduce night sweats and may improve sleep.
• Clonidine – This is a blood pressure pill or patch. It may give some relief, but it can cause sleepiness and headaches.
• Oxybutynin (Oxytrol®) – This drug is for an overactive bladder or urinary incontinence. Some people with menopause have urinary problems, like having to pee more often. This drug may affect brain functioning in older people.

Medicines for improving bone health

A drop in estrogen can cause bones to get thin. This is called osteoporosis. Your doctor may suggest medicine to stop bone loss. This reduces the risk of broken bones. You might also take vitamin D and calcium to keep bones strong.^1,3

Lifestyle changes

Making small changes to your daily life can improve how you feel. These steps are often the first line of care.^1,3

Diet and nutrition

Eating a Mediterranean diet can help your heart and bones. This diet includes many fruits, vegetables, whole grains, and healthy fats. It is also important to get enough calcium and vitamin D. These nutrients keep your bones strong.^1,3

Healthy habits

During menopause, the body is going through a lot of changes. Adopting healthy habits can lessen the symptoms of menopause and improve overall health. These include:^1,3

• Regular, weight-bearing exercise – Activities like walking and lifting weights strengthen your bones and help to keep you at a healthy weight. Weight gain can make hot flashes worse. These exercises may also improve your balance to prevent falls.
• Avoid triggers – Spicy foods, caffeine, and alcohol can cause hot flashes, so it is best to avoid them. You may want to track what you eat and drink to see if you have specific triggers.
• Stop smoking – Smoking can make hot flashes worse and lead to early menopause.

Complementary and integrative medicine

Some people use home remedies or natural products to manage symptoms. It is important to know that the evidence for these varies.^1,3

• Plant estrogens (phytoestrogens) – Foods like tofu have plant-based estrogens. These may reduce hot flashes for some people.
• Black cohosh – This herb is often used to help with night sweats, but it has not been proven to be effective in studies.
• Ginseng – This herb may help with sleep, mood, and fatigue.
• Yoga and meditation – These can help improve sleep and lower stress.
• Acupuncture – Some research shows this may help with insomnia, mood swings, or hot flashes.

Always talk to your doctor before taking supplements. Some herbs can interfere with other drugs you take. Supplements are not regulated by the US Food and Drug Administration (FDA) the same way other drugs are. This means that no outside agency confirms the ingredients or suggested dose.

Emerging treatments

New research continues to bring more options to people in menopause. Scientists are studying drugs that target the brain's "thermostat,” which could be a game-changer for hot flashes.^1,3

Researchers are also looking at how to make current menopause treatments safer. This includes people with a history of breast cancer who cannot use some hormone therapies. These new tools offer hope for personalized care in the future.^1,3

You don’t have to manage menopause alone

Menopause is a big transition, but you do not have to manage it alone. There are many options ranging from hormone therapy to diet and lifestyle changes. Work with your healthcare provider to find what works best for your body. The goal is to feel comfortable and stay healthy as you age.