Your menopause treatment options, explained

With as much attention as menopause hormone therapy (MHT) gets, you’d think that was the only choice you have to treat menopause symptoms. But while MHT, which is more commonly known as hormone replacement therapy (HRT), is a great option for many women, it’s not your only option. The right menopause treatment for you will vary depending on your symptoms, stage of menopause, personal preferences, and doctor recommendations. Here’s what’s out there:

“Even just a birth control pill is going to help control symptoms,” says Dr. Stephanie Faubion, M.D., the director for the Center 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 you avoid getting pregnant, but Faubion says she prescribes low-dose oral contraceptive pills to take care of symptoms like hot flashes and irregular periods during pre- and perimenopause stages. “Another option is an IUD that has a progestin, which will 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 flashes.)

MHT is the go-to for treating symptoms during perimenopause and early menopause stages, according to Faubion. “It’s the most effective therapy, and it’s dramatically underused.” She recently reported new data showing that MHT 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” estrogen 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 MHT during menopause to be safe and effective among the right patients — namely, those who are under 60 and have been in menopause for less than 10 years.

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

For more localized symptoms — like vaginal dryness, pain during sex, increased UTIs, and urgency around peeing, a low-dose topical form of MHT can help. You place a cream, tablet, or ring in your vagina to deliver estrogen 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, Veozah (fezolinetant), that’s FDA approved for hot flashes only. And the prescription medication paroxetine — best known as the antidepressant Paxil — is also FDA approved under the brand name Brisdelle for hot flashes.

Other antidepressants — both SSRIs and SNRIs — are sometimes prescribed off-label at a doctor’s discretion, as they may mitigate the frequency and intensity of hot flashes while also helping with the mood disorders that can occur during menopause.

You can also treat specific menopause symptoms with medications geared towards them. For example, a lubricant can help improve vaginal dryness. And GLP-1s like Wegovy (semaglutide) and Zepbound (tirzepatide) can help counter menopausal weight gain. (Research shows they may be even more effective in combination with MHT.)

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 minimize weight gain and maintain your muscle mass, which is lost with age. Since dips in estrogen speed up bone loss, calcium and vitamin D are also critical. And fiber can improve blood sugar, help you maintain your weight, and reduce your risk for conditions like type 2 diabetes and cardiovascular disease, which you’re 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, they don’t provide much relief. “There's no over-the-counter supplement that has been shown to be effective for hot flashes,” says Faubion.

Learn more about nutrition during menopause

Beyond a balanced diet, basic self-care 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 flashes 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.