Menopause - Treating the symptoms of 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 cancer, womb 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.