As we get older, certain hormone levels in our bodies start decreasing. Women usually enter menopause between 45 to 55 years old when our ovaries stop making eggs. At this point, we stop having menstrual periods and the level of estrogen in our bodies drops. Because of this drop, some of us experience symptoms of menopause.
What are the Symptoms of Menopause?
These symptoms can include hot flashes, night sweats, mood changes, sleep problems and vaginal dryness. Some of us may also have weight gain and decreased sex drive.
Do I Have to Treat These Symptoms?
If the symptoms don’t bother you, then you don’t need to treat them. If you are bothered by your symptoms, then you should speak with your doctor about what treatments are best for you. Make sure you talk with your doctor about all your options and the risks and benefits involved with each option.
What Kind of Options are Available for the Treatment of Menopausal Symptoms?
We have many options for treating symptoms of menopause. Treatments include both medications and hormone therapies. You may want to try a combination of the different treatments depending on your types of symptoms and how bad your symptoms are. These medications can have side effects, so you should talk to you doctor about your options and the risks of each medication. Also, if you have certain medical problems, your health care provider might recommend certain treatments over others.
What are the Different Types of Hormone Therapy?
There are two hormones that are used to treat symptoms of menopause – estrogen and progestin. Estrogen is available in many different forms, and it is the best medication to relieve bothersome symptoms of menopause such as hot flashes, sleep problems, mood changes, and vaginal dryness. If you still have your uterus, that is, if you have not had a surgery such as a hysterectomy to remove your uterus, you will need to take a combination of estrogen and progestin. The second hormone progestin helps to keep the estrogen from stimulating the lining of the uterus, which can cause cancer.
Doctors can treat hot flashes using estrogen. You can get estrogen from a patch worn on the skin, an oral pill, or a “ring” or tablet that you put in your vagina. There are also creams and sprays that you can put on your skin.
- Patch: If you have hot flashes, you might want to try an estrogen patch. Experts think that the risk of getting a blood clot with the patch is lower than taking estrogen pills.
- Pills: If you are bothered by your menopausal symptoms, you can take oral tablets. There are many different kinds of estrogen tablets, and they all can help treat symptoms of menopause.
- Very low-dose birth control pills: If you are in your 40s and have hot flashes and irregular bleeding, your doctor might start you on a very low-dose birth control pill. If you are obese, you are at higher risk for developing blood clots while taking low-dose birth control pills than an average weight woman, so please discuss this with your doctor. If you are already in menopause, then you should not take these kinds of pills because you are at high risk of developing blood clots and other problems from this pill.
If your vagina is dry, then you can try using estrogen cream to treat your symptoms. You can put the cream directly on your vaginal tissue. Since the amount of estrogen in the cream is very low, the cream will not help with hot flashes, but this is very good at treating vaginal dryness from menopause and pain with sex caused by vaginal dryness. You can chose from a number of different vaginal estrogen products:
- You can put estrogen cream (Premarin or Estrace cream) into the vagina using an applicator or using your finger. Women usually use the cream every day for two to three weeks, and then two times a week at bedtime.
- You can use Vagifem, which is a small tablet that you can put inside the vagina. Like the vaginal cream, you can use it every day for two weeks and then twice a week.
- You can use Estring, which is a flexible plastic ring that you place in your vagina. The ring slowly releases estrogen, and you replace the ring every three months. You can replace the ring yourself or you can see your healthcare provider. The ring does not need to be removed during sex or bathing.
As mentioned, if you are postmenopausal and still have your uterus, then you also need to take progestin with the estrogen to prevent changes in the lining of your uterus. Your doctor might prescribe you a pill or may place something inside your uterus, called an intrauterine device, which slowly releases progestin over time. These devices also prevent pregnancy, which is important for women who are not yet in menopause.
“Natural” or “Bioidentical” Products:
You can find “natural” or “bioidentical” estrogen products in many different forms including pills, creams and vaginal suppositories. We don’t know how good or how much estrogen are in each of these products since the U.S. Food and Drug Administration (FDA) does not control the quality of these products. We don’t know if these bio-identical hormones are safer or better than other hormone products, but the benefits and risks are likely to be similar.
What are the Different Kinds of Non-Hormonal Therapy?
Even though estrogen is the best treatment for menopausal symptoms, some women can’t or don’t want to take hormones. If you have had breast cancer, a blood clot, a heart attack or a stroke, then you should not take hormone therapy. You should also not take hormone therapy if you have heart disease, liver disease, or abnormal vaginal bleeding, or if you are at high risk for any of these medical problems. If there is a chance that you could be pregnant, then you should not use hormone therapy.
You can try non-hormonal medications to treat your menopausal symptoms.
Your hot flashes might improve if you take certain antidepressants. The only antidepressant that the FDA has approved for the treatment of hot flashes is Paroxetine, but there are other antidepressants that some women use to treat hot flashes (Venlafaxine, Desvenlafaxine, Citalopram and Escitalopram). You should not take Paroxetine if you have breast cancer and are taking tamoxifen.
This medication was originally made to treat seizures, but some women find that it helps hot flashes. This medication can be particularly helpful if you mainly have hot flashes in the middle of the night.
This medication is available in both a pill and a patch form and was originally made to treat high blood pressure, but it can help hot flashes for some women.
What about Herbal Treatments for Menopausal Symptoms?
Some women say their symptoms get better with taking herbs. Researchers have done some studies on these herbs but we don’t know how well these herbs really do in treating various menopausal symptoms. These herbs may be prepared in tea, capsules, pills or extracts.
You might find the following herbs helpful in treating hot flashes: black cohosh, red clover, dong quai, and evening primrose oil.
You might find the following herbs helpful in treating that mood symptoms and sleep disturbances: ginseng and kava.
Before starting any of these herbal treatments, speak to your doctor. If you have liver problems, fibroids, bleeding problems, cancer or seizures, then you might have problems if you take an herbal treatment. You also should stop using the herbs if you have to have a surgery.
What About Behavioral and Other Such Treatments for Menopausal Symptoms?
If you do not want to try medications or medications haven’t helped your symptoms, then you can try therapies such as aerobic exercise, yoga, tai chi and acupuncture. These therapies can help sleep and mood problems and muscle and joint pain. Your symptoms might get better if you manage your stress with strategies such as relaxation and deep breathing, but not all people will improve with these therapies.
Take Home Points
- Symptoms of menopause include hot flashes, night sweats, mood changes, sleep problems and vaginal dryness.
- If you are not bothered by these symptoms, then you don’t have to do anything about them.
- If you are bothered by these symptoms, then you can try hormonal, non-hormonal, herbal or behavioral treatments.
- You should speak to your doctor about which treatments are best for you.
Emi Bretschneider, MD
Fellow, Urogynecology & Reconstructive Pelvic Surgery,
OB/GYN & Women’s Health Institute
Cleveland Clinic, Cleveland, Ohio, USA
No conflicts of interest to report.