Menopause Symptom Management Options: What can help with menopause symptoms?
There is no ‘one size fits all’ approach to managing menopause symptoms and we need a toolkit of helpful things to help us through.
Hormone replacement is the recommended treatment but for those who can’t take it or do not wish to, there are other options. These include non-hormonal medications or therapies and lifestyle changes – or a combination of these.
It’s important to note we are all individuals and may experience different symptoms with different levels of severity and/or frequency, so what one individual finds helpful may not be useful to you.
Prescription medications:
Hormone Replacement Therapy (HRT) – also known as Menopausal Hormone Therapy (MHT) involves replacing oestrogen (and progesterone if you still have a womb). It has been shown to be very effective for vasomotor symptoms and new onset mood changes around menopause as well as other symptoms including brain fog, joint pains, low libido, disturbed sleep and genitourinary symptoms. HRT has additional benefits for bone, muscle and cardiovascular health especially when initiated within 10 years of onset of menopause.
If you cannot or do not want to take HRT/MHT there are other options especially to treat vasomotor symptoms (hot flushes/night sweats):
- Pregabalin and Gabapentin (these may help with anxiety, joint aches and vasomotor symptoms)
- Clonidine (helps with vasomotor symptoms)
- SSRI/SNRI antidepressants (these may help with both mood and vasomotor symptoms)
- Oxybutynin (helps with vasomotor symptoms and bladder urgency)
- Neurokinin 3 receptor antagonists (help with vasomotor symptoms and sleep)
Non-pharmaceutical/lifestyle options that may help:
- Exercise – cardio and resistance/weight training
- Not smoking (smoking makes vasomotor symptoms worse)
- Reducing alcohol consumption
- Sleep hygiene
- CBT (CBT can help with vasomotor symptoms, sleep and anxiety)
- Hypnosis (helps with sleep and vasomotor symptoms)
- Reducing stress (mindfulness, yoga, relaxation techniques)
There is little scientific evidence to support the use of supplements and herbs including black cohosh, dong quai, ginseng, chasteberry or soy extracts or foods for vasomotor symptoms. Regular Vitamin D supplementation especially during winter months in the UK and calcium rich diet is recommended during menopause for bone health.
Always let your doctor know if you are taking supplements as they may interact with any other medications that you take.
The Genitourinary Syndrome of Menopause (GSM)
When it comes to vaginal symptoms such as dryness, increased discharge, burning or itching, painful sex and vaginal skin tearing/bleeding – systemic HRT may help, but if not topical or vaginal HRT is very effective and considered safe, even for the majority of people where systemic HRT is considered a risk e.g. people with a history of breast cancer treatment. (Please consult your medical practitioner for specific advice in these circumstances.)
Topical oestrogen may also help reduce the risk of recurrent urinary tract infections (UTIs) and bacterial vaginosis.
There are a variety of topical treatments to choose from including:
- pessaries
- creams
- gels
- slow-release silicon rings that sit in the vagina for 3 months.
The majority are oestrogen-based but one contains DHEA, a hormone precursor that converts to testosterone and oestrogen.
References:
https://thebms.org.uk/wp-content/uploads/2024/06/04-BMS-ConsensusStatement-Non-hormonal-based-treatments-JUNE2024-B.pdf
https://www.menopause.org/docs/default-source/professional/2023-nonhormone-therapy-position-statement.pdf
https://bnf.nice.org.uk/drugs/prasterone/
https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/hormone-therapy-benefits-risks
https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#diagnosis-of-perimenopause-and-menopause
