Menopause treatment options, explained

With as much attention as Hormone Replacement Therapy (HRT), also known as Menopause Hormone Therapy (MHT) gets, you’d think that was the only choice women have to treat menopause symptoms. But while HRT is a common option for many women, it’s not their only option. The right menopause treatment for women will vary depending on symptoms, stage of menopause, personal preferences, and doctor recommendations. Here’s what’s out there:

“Even just a birth control pill can help to control symptoms,” says Dr. Stephanie Faubion, M.D., the director for the Centre for Women's Health at the Mayo Clinic, medical director for The Menopause Society, and member of the WeightWatcher Scientific Advisory Board.

These hormonal treatments are designed to help women avoid getting pregnant, but Faubion says she prescribes low-dose oral contraceptive pills to help manage symptoms like hot flushes and irregular periods during pre- and perimenopause stages. “Another option is an IUD that has a progestin, which may help take care of bleeding issues [as in heavy periods] around perimenopause,” she says. (Though an IUD usually doesn’t help with other perimenopause symptoms, like hot flushes).

“HRT is a therapy option for hot flushes, and it’s dramatically underused,” says Faubion. She recently reported new data showing that HRT usage rates have never been lower, with fewer than 4% of women, in their 50s using it.

That’s possibly due to a fear of “high” oestrogen levels in the body contributing to certain hormonally driven cancers, like breast cancer, which arose after a 2002 study concluded that the risk of hormone therapy outweighed the benefits.

A reexamination of that original study, along with a 2023 review of newer literature, determined HRT during menopause to be a great option among the right patients - namely, those who are under 60 and have been in menopause for less than 10 years.

“Doctors can often prescribe a very low dose of oestrogen - not anywhere near what ovaries would produce,” says Faubion. That typically happens via a transdermal patch. In addition to oestrogen, the hormone progesterone (which also declines during menopause) is typically included in HRT as well.

For more localised symptoms - like vaginal dryness, pain during sex, increased UTIs, and urgency around peeing, a low-dose topical form of MHT can be prescribed by a healthcare provider. Women can place a cream, tablet, or ring in their vagina to deliver oestrogen directly to the impacted area. Unlike the systemic forms of MHT, this form is safe for use at any stage of menopause, including postmenopause when vaginal symptoms tend to be most bothersome.

MHT isn’t the only prescription that can help with menopause symptoms. There is a non-hormonal medication, fezolinetant, that’s approved in the United States by the FDA for hot flushes only. And the prescription medication paroxetine is also approved in the United States by the FDA for hot flushes.

Healthcare providers can also treat specific menopause symptoms with certain medications geared towards them. For example, lubricant can help improve vaginal dryness. And GLP-1s can be prescribed to help counter menopausal weight gain for those who medically qualify.

Don’t discount the importance of eating well and exercising.

Protein and micronutrients are essential during menopause for overall health, and for treating certain menopausal symptoms. Protein helps minimise weight gain and maintain your muscle mass, which is lost with age. Since dips in oestrogen speed up bone loss, calcium and vitamin D are also critical. And fibre can improve blood sugar, help you maintain your weight, and reduce your risk for conditions like type 2 diabetes and cardiovascular disease, which women are at a higher risk for during menopause.

As for over-the-counter supplements (like black cohosh) that promise to make your hot flashes and night sweats disappear, don’t provide much relief. “There's no over-the-counter supplement that has been shown to be effective for hot flushes,” says Faubion.

Learn more about nutrition during menopause.

Beyond a balanced diet, basic self-care, like good sleep, can go a long way. One powerful habit is exercise - which can not only help regulate your mood, but also address multiple menopause symptoms like hot flushes and mood swings, according to board-certified OB/GYN Dr. Kerry-Anne A. Perkins, M.D.

That’s because exercise seems to improve the control and regulation of your body’s thermoregulation system. Strength training, meanwhile, helps you hold on to more muscle, improve bone density, and keep your metabolism up.

Another promising way of addressing some menopause symptoms is through stress-reduction skills like meditation or yoga, with one study finding that it significantly reduced symptoms of depression and anxiety among women during menopause.

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