The main treatment for menopausal symptoms is hormone replacement therapy (HRT), although other treatments are also available for some of the symptoms.
HRT replaces the hormones that are missing. Most symptoms are caused by low oestrogen levels, so this is the most important hormone to replace. If you have a womb you also need a progestogen to protect the lining of the womb.
HRT is extremely effective at relieving menopausal symptoms.
HRT is available as tablets, skin patches, a gel to rub into the skin or implants.
Benefits and risks of hormone replacement therapy (HRT)
The main benefit of HRT is that it can help relieve most menopausal symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness.
It can also help prevent thinning of the bones, which can lead to fractures (osteoporosis). Osteoporosis is more common after the menopause.
Some types of HRT can slightly increase the risk of breast cancer and blood clots in some women. You need to discuss whether you have any risk factors with a doctor or nurse.
Evidence says that the risks of HRT are small and usually outweighed by the benefits.
Your GP can give you more information about the risks and benefits of HRT to help you decide whether or not you want to take it.
Hot flushes and night sweats
- wearing light clothing
- keeping your bedroom cool at night
- taking a cool shower, using a fan or having a cold drink
- trying to reduce your stress levels
- avoiding potential triggers, such as spicy food, caffeine, smoking and alcohol
- taking regular exercise and losing weight if you're overweight
If the flushes and sweats are frequent or severe, your GP may suggest taking HRT.
If HRT isn't suitable for you, or you would prefer not to have it, your GP may recommend other medications that can help, such as clonidine (a high blood pressure medicine) or certain antidepressants.
These medications can cause unpleasant side effects, so it's important to discuss the risks and benefits with your doctor before starting treatment.
Some women experience mood swings, low mood and anxiety around the time of the menopause.
Self-help measures such as getting plenty of rest, taking regular exercise and doing relaxing activities such as yoga and tai chi may help. Medication and other treatments are also available, including HRT and cognitive behavioural therapy (CBT).
CBT is a type of talking therapy that can improve low mood and feelings of anxiety. Your GP may be able to refer you for CBT on the NHS, or recommend self-help options such as online CBT courses.
Antidepressants may help if you've been diagnosed with depression.
Reduced sexual desire
It's common for women to lose interest in sex around the time of the menopause, but HRT can often help with this. If HRT isn't effective, you might be offered a testosterone supplement.
Testosterone is the male sex hormone, but it can help to restore sex drive in menopausal women. It’s not currently licensed for use in women, although it can be prescribed by a doctor if they think it might help.
Vaginal dryness and discomfort
If your vagina becomes dry, painful or itchy as a result of the menopause, your GP can prescribe oestrogen treatment that's put directly into your vagina as a pessary, cream or vaginal ring.
This can safely be used alongside HRT.
You'll usually need to use vaginal oestrogen indefinitely, as your symptoms are likely to return when treatment stops. However, side effects are very rare.
You can also use over-the-counter vaginal moisturisers or lubricants in addition to, or instead of, vaginal oestrogen.
Women who have been through the menopause are at an increased risk of developing weak bones that may break more easily (osteoporosis) as a result of the lower level of oestrogen in the body.
You can reduce your chances of developing osteoporosis by:
- taking HRT – HRT can help to prevent your bones getting weaker, although this effect doesn't tend to last after treatment stops
- exercising regularly – including weight-bearing and resistance exercises
- eating a healthy diet that includes plenty of fruit, vegetables and sources of calcium, such as low-fat milk and yoghurt
- getting some sunlight – sunlight on your skin triggers the production of vitamin D, which can help to keep your bones strong
- stopping smoking and cutting down on alcohol
- taking calcium and/or vitamin D supplements if you don't feel you're getting enough of these – discuss this with your GP
If you're having treatment for your menopausal symptoms, you'll need to return to your GP for a follow-up review after 3 months, and once a year after that.
During your reviews, your GP may:
- make sure your symptoms are under control
- ask about any side effects and bleeding patterns
- check your weight and blood pressure
- review the type of HRT you're taking and make any necessary changes
- discuss whether you should continue it or if you decide to stop, how this should be done
Many women will need treatment for a few years, until most of their menopausal symptoms have passed.
Some women may wish to take HRT for many years. Their individual benefits and risk should be assessed every year.
Complementary and alternative therapies
Complementary and alternative treatments, such as herbal remedies and bioidentical ("natural") hormones, aren't recommended for symptoms of the menopause. This is because it's generally unclear how safe and effective they are.
Bioidentical hormones are not the same as body identical hormones. Body identical hormones, or micronised progesterone, can be prescribed to treat menopausal symptoms.
Some complementary and alternative therapies can also interact with other medicines and cause side effects.
Ask your GP or pharmacist for advice if you're thinking about using a complementary therapy.