Menopause and Perimenopause
Treatment Overview
Menopause is a natural change that doesn't require treatment. However, symptoms of hormonal change can be difficult. If you have insomnia, mood swings, hot flashes, cloudy thinking, heavy menstrual periods, or other menopause symptoms, treatment can help you manage this transition more comfortably. As you review your options, consider the following:
- Healthy lifestyle habits will help you reduce menopause symptoms. These habits include eating a balanced diet; reducing stress; getting regular exercise; and avoiding smoking, heavy caffeine, and heavy alcohol use. An unhealthy lifestyle can make symptoms worse.
- Low-dose hormone therapy (HT) or low-dose birth control pills may be an option if you are still having periods and have multiple or severe symptoms. Birth control pills aren't used after menopause because they contain higher levels of hormones than women need.
- After menopause, hormone therapy can be used as a short-term treatment for severe symptoms when taken in as low a dose as possible.
- You may only need a specific treatment for certain symptoms, such as hot flashes or vaginal dryness.
- Meditative breathing, as well as supplements such as black cohosh or soy, may help relieve symptoms.
Recent studies have led to a big change in how health professionals use hormone therapy after menopause. For a long time, estrogen-progestin, or hormone replacement therapy (HRT), was thought to protect against heart disease or dementia. But studies now show that HRT use can cause serious health problems in a small number of women. These health problems include dangerous blood clots, stroke, heart disease, breast cancer, ovarian cancer, and dementia.8, 9, 10 The heart disease risk does not seem to affect women during their first 10 years after menopause.11
Average HRT- and ERT-related risks are low among the general population of women. However, your personal risk that hormone therapy may stimulate breast cancer, ovarian cancer, cardiovascular problems, blood clots, or neurological changes may be lower or higher, depending on your risk factors for those health problems.
Treatment options for menopause symptoms
Hot flashes.Meditative breathing exercises (paced respiration) have been shown to reduce hot flashes.1 Medications that can improve hot flashes include short-term, low-dose hormone therapy, selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetine and paroxetine (for example, Paxil and Prozac), the high blood pressure medication clonidine, and the antiseizure medication gabapentin (Neurontin).12, 13
Heavy periods. The hormone progestin can help relieve heavy menstrual bleeding caused by low progesterone levels (after you have an exam to rule out other possible causes). Other options include nonsteroidal anti-inflammatory drugs (NSAIDs), the levonorgestrel (LNg) IUD, or birth control pills. For severe blood loss, some women choose permanent surgical treatment. These options include removing the uterus (hysterectomy) or using heat energy to damage and scar the wall of the uterus (endometrial ablation). For more information, see the topic Dysfunctional Uterine Bleeding.
Vaginal dryness and irritation. A vaginal lubricant can help with dryness. Estrogen creams, rings, or tablets can help thin skin, dryness, and irritation. Less estrogen is absorbed into your system with vaginal use, so the risks associated with ERT are less likely.
Multiple or severe symptoms.Hormone therapy can relieve multiple or difficult menopause symptoms. For symptom relief before menopause, low-dose estrogen-progestin birth control pills or low-dose HRT (estrogen-progestin) can reduce heavy menstrual bleeding and other symptoms. After menopause, low-dose HRT is an option. Also, for severe symptoms that don't improve with estrogen-progestin, there is an estrogen-testosterone therapy. But testosterone is not FDA-approved for women, because it is not yet well studied. Talk to your health professional about short-term HRT along with checkups every 6 months.
Bioidentical hormone replacement therapy (BHRT) is an alternative to HRT. But it has not been well studied. The hormones are made in a laboratory from wild yams or soy. BHRT is thought to be more similar to human-produced hormones than synthetic HRT is. (Well-designed studies have yet to prove this theory.14) However, bioidentical HRT may carry the same heart, stroke, blood clot, breast cancer, ovarian cancer, and dementia risks that are linked to traditional HRT. Any form of hormone therapy, including BHRT, is best taken for as short a period as possible after menopause.
Testosterone is sometimes used to increase sexual desire in postmenopausal women who have low testosterone. The U.S. Food and Drug Administration (FDA) has not approved testosterone treatment for this purpose. Studies of testosterone in women have not lasted longer than 6 months.15 FDA experts want to know more about long-term risks before they approve testosterone for female use.
If you have a problem with low sexual desire, consider that most sexual problems in women relate to such things as relationship troubles, depression, or medicine side effects. For more information, see the topic Sexual Problems in Women.
Other treatment options
Because of concern about HRT health risks, many women have turned to alternative medicine for menopause symptom relief.
- Black cohosh (Remifemin) is a plant-based alternative to hormone therapy for hot flashes, mood problems, and other symptoms. It is not clear how black cohosh works in the body.16 It is also not known whether black cohosh increases the risk for breast or uterine cancer.
- Dietary soy is thought to ease symptoms, although there is little evidence to support this. Dietary soy may also reduce heart disease risk and improve bone health, but these benefits also are not yet well proven by research.1
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| Author: | Kathe Gallagher, MSW | Last Updated: May 26, 2006 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Carla J. Herman, MD, MPH - Internal Medicine | |
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