Only one in 10 women seek medical advice when they go through the menopause, and many do not need any treatment at all. However, if you are having menopausal symptoms and they are severe enough to interfere with your daily life, there are treatments available that can help.
Medical treatment for menopause can be either with or without hormone replacement therapy (HRT). The kind of treatment you can take depends on your symptoms, medical history and your own preferences. The various treatments for menopause are detailed below.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) is effective in treating several of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms such as dryness and itching, and urinary symptoms such as recurrent lower urinary tract infections.
As the name suggests, HRT works by replacing oestrogen, which naturally begin to fall in the approach to menopause, causing menopausal symptoms.
For more information about HRT and how it is taken, go to our topic on hormone replacement therapy
Your GP may suggest HRT if they feel that it will be effective in treating your menopausal symptoms. However, there are certain circumstances in which you cannot take HRT. Find out more here
Benefits and risks:
Your GP should discuss these with you before you start any treatment. The benefits of HRT include:
- effective treatment for many common menopausal symptoms, including hot flushes, night sweats and vaginal and urinary symptoms,
- helping to prevent osteoporosis (weak and brittle bones), which menopausal women may be prone to due to dropping levels of oestrogen, and
- reducing the risk of cancer of the colon and rectum.
HRT is associated with slightly increased risks of certain medical conditions, including:
- breast cancer,
- cancer of the ovaries,
- cancer of the womb,
- venous thromboembolism (blood clots in the veins),
- coronary heart disease, and
- stroke.
It is important to remember that these risks are very small.
For more specific information on risks, go to our page on HRT risks
For more specific information on side effects, go to our page on HRT side effects
Tibolone
Tibolone is a synthetic steroid that acts in the same way as HRT. It may be used as an alternative to traditional combined HRT for post-menopausal women who want to end their periods.
Like HRT, tibolone is effective in treating menopausal symptoms such as hot flushes and night sweats, and it can help to prevent spine fractures. It may also improve sexual problems, such as a decreased sex drive.
Tibolone carries some small risks, including a small increased risk of breast cancer, cancer of the womb and stroke. It is also not suitable for women over the age of 60.
It is important to remember that neither HRT nor tibolone provide contraceptive protection, and although your fertility decreases during the menopause, it may still be possible for you to conceive. Therefore, you should continue to use contraception:
- for one year after your last period if you are over 50 years of age, or
- for two years after your last period if you are under 50 years of age.
How HRT or tibolone are prescribed
The way you take HRT or tibolone will depend on the stage of your menopause, your symptoms, and whether or not you have had a hysterectomy (removal of the womb).
However, you will always be prescribed the lowest effective dose of oestrogen to be taken for the shortest period of time, in order to minimise the risks. If your symptoms are not controlled using the lowest effective dose, your GP may try increasing your dosage of oestrogen.
If you are experiencing hot flushes and night sweats, you will need to take HRT for at least three months for the treatment to have its full effect. If after this time your symptoms have not improved, your GP may recommend a change of HRT.
If you have vaginal and urinary symptoms, such as vaginal dryness and itching and recurrent lower urinary tract infections, you may be prescribed a vaginal oestrogen treatment in the form of a cream, pessary, tablet or vaginal ring. Your GP may recommend that you use this long term because symptoms can reoccur as soon as treatment is stopped. Many menopausal women use this type of treatment lifelong.
If you are peri-menopausal, you have not had a hysterectomy, and you only have vaginal and urinary symptoms, you may be prescribed:
- cyclical or tri-cyclical combined HRT patches or tablets (tri-cyclical if you have infrequent periods), or
- a low-dose vaginal oestrogen treatment in the form of a cream, pessary, tablet or vaginal ring, if you do not want systemic treatment.
If you are peri-menopausal, you have not had a hysterectomy, and you have hot flushes and night sweats with or without vaginal and urinary symptoms, you may be prescribed cyclical or tri-cyclical combined HRT patches or tablets (tri-cyclical if you have infrequent periods).
Your GP may refer you for specialist treatment if:
- you have a change in pattern of withdrawal bleeds or breakthrough bleeding, or
- your prescribed HRT still does not control your symptoms after three treatment options have been tried.
Once your periods have stopped completely for at least one year and you are considered to be post-menopausal, your GP may switch your HRT treatment from cyclical or tri-cyclical to continuous. This means your HRT treatment will no longer induce a monthly or three monthly bleed.
If you are post-menopausal, you have not had a hysterectomy, and you only have vaginal and urinary symptoms, you may be prescribed:
- continuous combined HRT patches or tablets, or
- a low-dose vaginal oestrogen treatment in the form of a cream, pessary, tablet or vaginal ring, if you do not want systemic treatment.
If you are post-menopausal, you have not had a hysterectomy, and you have hot flushes and night sweats with or without, vaginal and urinary symptoms, you may be prescribed:
- continuous combined HRT patches or tablets or tibolone tablets.
- Tibolone tablets may be hepful if you are experiencing sexual problems, such as a decreased sex drive.
Your GP may refer you for specialist treatment if:
- you are still experiencing bleeding after four to six months of continuous combined HRT or tibolone,
- a bleed occurs after a spell of amenorrhoea (periods have stopped)
- your prescribed HRT still does not control your symptoms after three treatment options have been tried.
If you have had a hysterectomy and you only have vaginal and urinary symptoms, you may be prescribed:
- oestrogen replacement patches or tablets, or
- a low-dose vaginal oestrogen treatment in the form of a cream, pessary, tablet or vaginal ring, if you do not want systemic treatment.
If you have had a hysterectomy and you have hot flushes and night sweats with or without vaginal and urinary symptoms, you may be prescribed oestrogen replacement patches, tablets or high-dose vaginal ring.
If you have had a sub-total hysterectomy (where the main part of your womb was removed, but your cervix was left) your GP may need to make sure there are no traces of womb tissue left before prescribing oestrogen replacement therapy. Taking oestrogen on its own can cause endometrial hyperplasia (thickening of the womb) and cancer of the womb, so it is not safe to do so if you have any womb tissue remaining.
In order to find out whether any of your womb tissue still remains, your GP may prescribe a three-month course of cyclical combined HRT. If you do not have any bleeding while taking this treatment, it is unlikely there is any womb tissue left and you can start oestrogen replacement therapy.
However, if you have a withdrawal bleed while you are taking this treatment, it means that there is some womb tissue still present, and you cannot take oestrogen replacement therapy. Instead, your GP can prescribe combined HRT (see treatment for post-menopausal women who have not had a hysterectomy).
Your GP may refer you for specialist treatment if your prescribed HRT still does not control your symptoms after three treatment options have been tried.
Monitoring your health while taking HRT
You will need to return to your GP for a follow-up review three months after starting HRT, and once a year after that.
At your three month review, your GP will:
- make sure that your symptoms are under control,
- ask you about any side effects and bleeding patterns, and
- check your blood pressure and weight.
At your annual review, your GP will:
- review the type of HRT you are taking and make any necessary changes,
- perform a breast examination and show you how to do it yourself, and
- remind you of the risks and benefits of HRT.
Stopping HRT
Once you have been taking HRT for one to two years and your menopausal symptoms have stopped, your GP may suggest a trial withdrawal of treatment. Your symptoms may recur for a short while after stopping HRT, but as long as this does not continue long term, you may be able to stop taking HRT permanently.
However, if your symptoms do recur long term and you decide to continue taking HRT for longer than five years, your GP should discuss the risks and benefits with you again.
Treating menopause without HRT or tibolone
If you do not wish to take HRT, or you cannot due to medical reasons, non-HRT treatments are available that may ease hot flushes. These treatments are detailed below.
Antidepressants:
Although they are not licensed for treating hot flushes, there are several antidepressant medications that may be effective for this. These medications include venlafaxine, fluoxetine, citalopram and paroxetine.
Clonidine:
Clonidine is a medication designed to treat hot flushes and night sweats in menopausal women. However, it can sometimes cause unpleasant side effects including dry mouth, drowsiness, depression, constipation and fluid retention. If your GP prescribes clonidine, you will need to take it for a trial period of two to four weeks to see if it will be effective. If your symptoms do not improve during this time or if you experience side effects, the treatment should be stopped and you should return to your GP.
Vaginal lubricants:
If you experience vaginal dryness, your GP can prescribe a vaginal lubricant or moisturiser such as Replens, which can be used indefinitely.
Complementary therapies:
There are many unlicensed complementary therapies available for menopausal symptoms, but there is no medical evidence that any of them are effective. These treatments, which may contain products such as soy, red clover, black cohosh and ginseng, can be potentially harmful.
There is very little control over the quality of the products used in complementary therapies, and their long-term safety has not been assessed. They may have unpleasant side effects and can interfere with other medications. Therefore, it is not recommended to use any complementary therapies for menopausal symptoms.
Stopping non-HRT treatment for menopause
You will need to return to your GP for a review of your treatment at least once a year. If your symptoms have stopped after one to two years of treatment, your GP may suggest a trial withdrawal of treatment.
Your symptoms may recur for a short while after stopping your treatment, but as long as this does not continue long term, you may be able to stop taking it permanently.
Treating premature menopause
If you are diagnosed as menopausal and you are under the age of 45, it is known as a premature menopause. If you are under the age of 40, your GP will be able to refer you to a gynaecologist for specialist treatment and to discuss your fertility.
For women who go through a premature menopause, treatment is needed to ease menopausal symptoms and prevent osteoporosis, which becomes more likely as oestrogen levels in your body fall. The ways of treating premature menopause are detailed below.
HRT:
If you are going through a premature menopause, the way in which you will take HRT will depend on the stage of your menopause, whether or not you are still having periods, or whether or not you have had a hysterectomy (removal of the womb).
- If you are going through a premature menopause and you are still having periods, your GP may prescribe cyclical or tri-cyclical combined HRT patches or tablets (tri-cyclical if your periods are irregular).
- If you are going through a premature menopause and you are post-menopausal but have not had a hysterectomy, your GP may prescribe continuous combined HRT patches or tablets.
- If you are going through a premature menopause and you have had a hysterectomy, your GP may prescribe oestrogen replacement patches or tablets.
Combined oral contraceptive pill (COC):
If you are going through a premature menopause and contraception is still required, your GP may suggest treatment using the combined oral contraceptive pill (COC). Like combined HRT, the pill contains both oestrogen and progestogen and helps to prevent osteoporosis.
However, you cannot take the pill if you are over 35 years of age and a smoker, as it may be unsafe. It may also be unsafe to take the pill if you have (or ever have had) blood clots, raised blood pressure, heart abnormalities or circulatory disease, liver or gall bladder disease, diabetes, migraines or unexplained vaginal bleeding.
