Menopause - Treatment 

Treating the symptoms of menopause 

Menopause

The menopause is marked by the ending of menstruation (when a woman's periods stop), and changes in the hormones. As a result of these hormonal changes, many women have physical and emotional symptoms, such as hot flushes, night sweats and irritability. In this video, family doctor Dawn Harper talks about how to ease the symptoms of the menopause, whether to take HRT, and more.

Media last reviewed: 06/08/2014

Next review due: 06/08/2016

Complementary therapies

There's little scientific evidence to show that complementary therapies are effective in reducing the symptoms of the menopause.

Herbal remedies  such as evening primrose oil, black cohosh, angelica and ginseng  aren't recommended because they may interact with other medications and cause side effects.

Some women have reported that relaxation therapies – such as yogaaromatherapy (PDF, 451kb) and reflexology (PDF, 272kb) – reduce their menopausal symptoms, but there's no scientific evidence to show that they're completely effective.

Ask your GP or pharmacist for advice if you're thinking about using a complementary therapy.

Menopause: support your partner

Advice for men on how to support their partner through the menopause

Many women don't need treatment for the menopause, with only about 1 in 10 seeking medical advice.

If your symptoms are mild, you may be able to manage them yourself, without medication. Read more about self-help for managing menopausal symptoms.

However, medication may be recommended if your symptoms are more severe and they're interfering with your day-to-day life.

Treatment options include:

The type of treatment that's suitable for you will depend on your symptoms, medical history and your own preferences.

HRT and tibolone don't provide contraceptive protection, and although your fertility will decrease during the menopause, it may still be possible for you to conceive. You should therefore continue to use contraception:

  • for one year after your last period if you're over 50 years of age
  • for two years after your last period if you're under 50 years of age

The various treatments for the menopause are outlined below.

Hormone replacement therapy (HRT)

HRT is effective in treating many of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms and urinary tract infections (UTIs), such as cystitis.

Long-term, HRT can also reduce the risk of osteoporosis (weak and brittle bones), and combined HRT (see below) can reduce your risk of developing bowel cancer.

HRT works by replacing the female sex hormone, oestrogen, which naturally begins to decrease as the menopause approaches. There are three main types of HRT:

  • oestrogen-only HRT  recommended for women who have had their womb and ovaries removed; if oestrogen is taken on its own, it can thicken the womb lining, increasing your risk of cancer
  • combined HRT  for women who are experiencing menopausal symptoms but are still having periods (you take both oestrogen and progestogen)
  • continuous HRT  for post-menopausal women

HRT is available as a cream or gel, a tablet, a skin patch or an implant.

A number of side effects are associated with HRT, including weight gain, tender breasts, nausea, headaches and mood changes. You may be able to be reduce any side effects by changing the type or dose of HRT that you're using.

Your GP can give you more information about the risks and benefits of HRT.

Read more about HRT, including how it's taken, possible side effects and risks.

Tibolone

Tibolone is a synthetic (man-made) hormone that acts in the same way as HRT. It may be recommended as an alternative to 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 also help prevent spinal fractures. It may also improve sexual problems, such as a decreased sex drive.

Tibolone carries some small risks, including a slight increased risk of breast cancerwomb cancer and stroke. It's not suitable for women over 60 years of age.

Clonidine

Clonidine is a medicine that was originally designed to treat high blood pressure (hypertension), but it has been found to reduce hot flushes and night sweats in some menopausal women.

Clonidine can cause unpleasant side effects, including dry mouth, drowsiness, depression, constipation and fluid retention.

You will need to take it for a trial period of two to four weeks, to test its effectiveness. If your symptoms don't improve during this time, or if you experience any 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 that can be used for as long as you like.

Antidepressants

Although antidepressant medications aren't licensed for treating hot flushes, there are several that may be effective, including:

Potential side effects of these antidepressants include nausea, dizziness, dry mouth, anxiety and sleeping problems.

Follow-up

If you're taking HRT, you'll need to return to your GP for a follow-up review three months after starting the treatment and once a year after that. At your three-month review your GP will:

  • make sure your symptoms are under control
  • ask about any side effects and bleeding patterns
  • check your weight and blood pressure

At your annual review your GP will:

  • review the type of HRT you're taking and make any necessary changes
  • examine your breasts and show you how to do it yourself
  • remind you about the benefits and risks of HRT

If you're using non-HRT treatments, you'll need to return to your GP for a review at least once a year. If your symptoms have stopped after one to two years of treatment, your GP may suggest that treatment is stopped altogether.

Your symptoms may return for a short period of time. However, as long as this doesn't continue over the long term, you may be able to stop taking it permanently.

Early menopause

A premature menopause is where a woman under 40 years of age experiences the menopause.

If this happens to you, your GP will refer you to a gynaecologist for treatment. Gynaecologists specialise in treating conditions that affect the female reproductive system, and they will be able to discuss your fertility (ability to conceive) with you.

You will need treatment to ease your symptoms and prevent osteoporosis (brittle bones), which is more likely to occur as the level of oestrogen in your body decreases.

HRT and the combined contraceptive pill are recommended treatments, as they both contain oestrogen and progestogen.

Read about Johanna's experience of having an early menopause.

 

Page last reviewed: 05/02/2014

Next review due: 05/02/2016

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Comments

The 8 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Alternative said on 06 July 2014

Gerij, consider trying meditation or relaxation classes, or try hypnotherapy, aromatherapy or Reiki healing. Look for a good therapist in your area. Look on the Federation of Holistic Therapist website, they have a directory of qualified therapists. Therapies can help and teach you how to reduce your anxiety and manage your panic attacks. Hope you are feeling better soon.

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Alternative said on 06 July 2014

I do wish that the nhs would more open minded about complementary therapies. Actually there is more evidence to show the benefits now, but the reason there is little research is because we in the complementary therapy professions don't have heaps of money to research like drug companies do. There are no harmful side effects with therapies such as massage, healing ,reflexology and the like and most therapists are members of professional bodies with high standards. People who use complementary therapy are taking responsibility for their own health and the NHS should welcome that. Complementary therapy works alongside conventional medicine and care. Perhaps if the NHS and GPs were more proactive in promoting self help we would all be better off.

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littlefish said on 10 August 2013

NHS GPs in UK are not interested in this area, they normally prescribe antidepressants and pain relief and a slap of vaseline! they do not know how to encourage their female patients to discuss vaginal atrophy, subsequent urinary infection, lack of libido. they are not interested in bio identical hormone therapy, that it changes lives, they are unable to interpret the statistics regarding risk, they rely on 50 year old data, they do not know the difference between topically applied bio identical hormone replacement and taking a pill made from horse urine and synthetic high dose hormones - Lazy ignorant and arrogant. this cumbersome stalinist NHS encourages ignorance and apathy on this subject.

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Gerij said on 05 August 2013

Hi just wondered if any one can give me some comfort. have started having panic attacks since my periods stopped managed but after two days of non stop ones I went to my GP who put me on hrt patches which I have been taking for 6 days. I haven't noticed any improvement still getting panic attacks once or twice a day. is it too soon for the HRT to work.

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ribas said on 16 January 2013

I started experiencing all the usual menopausal symptoms 3 years ago at the age of 50: strong migraines, hot flashes, insonia, short memory, tiredness, anxiety, etc. and they were making my life a misery. My GP did not give me much advice other then prescribing pills for the migraines and suggesting I could take HRT after my periods finished. Through the Internet and books I've found a lot of good quality imformation and I started taking Evening Primorose Oil and Fish Oils. I also take Menosan (herbal sage drops by A Vogel) and find it helps with the hot flushes. I am now eating soya / tofu, beans, lentils and chickpeas daily, one of them at least and my symptoms have disapeared! I'm also reading a few books, one of them I think every woman should read is Dr Marilyn Glenville's Natural solutions to Menopause. Changing my diet is a very small price to pay for feeling well, and I am already feeling the good results! I think I will survive the menopause and will get back to being myself again! Pitty our GPs do not give us this kind of information: I did not need to spend the last 3 years in hell!

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butterfly1960 said on 20 June 2012

Hello!
So glad to know that there are others out there being missinformed!?!? My GP pretty good as male doctors go by the sound of some comments from other ladies...
I had a blood test in April that came back "menopausal".... just learned from a lady dr (my own dr on hols) that they look for FSH of atleast 26 (not sure how high it can go) mine was 86....
In April my GP prescribed HRT Elleste duet and gave all the usual warnings... cancer, weight gain etc. But did not warn me of the emotional side effects that might occur!! Had to go back (in tears!) to see him, and he upped dosage and antidepressant citalopram. Finished the month strip of HRT, better with the citalopram but not great... but my main reason to try HRT was to stop the terrible joint pains I have suffered from since August 2011.... HRT not for me!!
I had a period in May and now June and on 2nd day of both cycles the joint pain was less (but not gone!)
I take codeine with paracetamol in between. I believe I normally have a high pain threshold, and I am not mormally a crybaby either!!
Hopefully, all these symptoms will pass as my body adjusts to new hormonal levels?!?!
Good luck ladies! x

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Dorelle said on 13 April 2012

Just this last week, having been aware for a significant period that I had symptoms, I approached my GP for help and advice. I was seen by locum doctor who told me that "HRT caused breast cancer"...

He then suggested that I "search it on the internet" and to this end went and found a colleague who gave me two websites to check...As he "never uses the internet"..He went on to say that once I had done the research I could return and we could talk some more as he wouldn't want me making a choice I "might later regret"...

Now whilst I am all for patients making well informed choices, this doctor had no information for me...not even leaflets...Nothing...except an aversion to furnishing me with any information...Having checked the recommended websites it appears that he has either misunderstood or too narrowly interpreted the research regarding breast cancer and HRT...Either way, I as a patient having arranged to go late to work and make up the time at the end of my day, waited 30 minutes to be seen, to then be told to check the internet for information...Did I miss something?

I don't ever expect a doctor to chose whether or not I have a treatment, I do however expect that they are able to offer unbiased and reasonable advice about what is available, even if they then suggest seeking more extensive information via other avenues.

Of course the end result of this was I wasted an hour of my precious time, received no treatment, no advice and now will have to wait another week to get a new appointment to see another doctor...Is this reluctance to advise a common problem?

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Soapbox said on 21 March 2012

Why do you only offer information on drug treatment (other than lubricant). The side affects sound worse than the symptoms they are meant to alleviate, and no less harmful that the complementary therapies you give a big warning against. For example, surely there is dietary advice you could give, like what to avoid and what to have more of?

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