Exploring Menopause Treatment Options: What's Right for You?

Menopause is a natural phase of life, marked by the end of having menstrual cycles. It can bring a variety of symptoms, and we'll all experience menopause differently. As we move from perimenopause to postmenopause, what we go through and how we deal with our symptoms may change.

There are many options to help relieve menopause symptoms — from lifestyle changes to menopause hormone therapy (MHT). Start a conversation now with your doctor (or telemed provider) about what treatments may be right for you.

Prescription treatments for menopause

Some treatments must be prescribed and managed by a healthcare provider. They can include:

• Systemic hormone therapy. This treatment has a higher dose of estrogen. It's used to treat many common symptoms of menopause. It’s available in a pill, skin patch, vaginal ring, gel, cream, or spray foam. Progesterone is added for people with a uterus.
• Low-dose vaginal estrogen. It minimizes the amount of estrogen your body absorbs. This makes it a good option for treating localized symptoms like vaginal dryness. It's available as a vaginal ring, tablet, or cream.
• Low-dose antidepressants. Antidepressants are medicines usually used to treat depression. But certain low-dose antidepressants can be used to treat hot flashes in people who aren't able to take estrogen.
• Birth control pills. Even if they're irregular, during perimenopause you may still get a period because ovulation is occurring. And this means that there's still a risk of pregnancy. Birth control pills may be a more effective treatment in early perimenopause to help with hot flashes and irregular bleeding. According to Dr. Liss, OB-GYN and Versalie Advisor, "While there are currently no commercially available oral contraceptives with FDA approval for menopause symptoms, in clinical practice, we use them this way since they work in a similar way to traditional menopause hormone therapy (MHT). But they can offer both effective pregnancy prevention and symptom relief."
• Intra-uterine devices (IUDs). Recent research shows that IUDs with low levels of progestin have many benefits for those going through perimenopause. In addition to being a very effective way to prevent pregnancy, it also helps protect the lining of the uterus for those taking estrogen hormone therapy. It can also help people who have heavy bleeding, endometrial hyperplasia, and uterine fibroids.
• Non-hormonal medications for symptoms. There's a recent medication approved by the FDA that treats menopause symptoms without using hormones. The approved medication targets hot flashes by blocking a chemical in the brain called neurokinin B (NKB), which is found in the hypothalamus. The hypothalamus helps control body temperature. When the medication blocks NKB, it helps reduce the number and intensity of hot flashes.

Talk to your doctor about which treatments may be right for you based on your health history and symptoms.

Alternative treatment for menopause symptoms

There are complementary and alternative treatments that some people claim may help with menopause symptoms. Most of these do not have strong scientific evidence to back up those claims and have not gone through the FDA’s regulatory and approval process. Please talk to your doctor before giving any of these a try. Some of the treatments that are being studied include:

• Plant estrogens (phytoestrogens). Naturally-occurring estrogens in certain foods can sometimes help ease menopause symptoms.
• Compounded bioidentical hormones. Instead of coming directly from a manufacturer, these medications are prepared by a compounding pharmacist. They often use synthetic (manmade) hormones that are chemically identical to the hormones your body makes. While they're not reviewed or approved by the FDA for safety or effectiveness, the components that are put together by the compounding pharmacist are FDA-approved drugs. They're prone to contamination and may not have the strength, quality, or purity of the FDA-approved medication. They can be labeled incorrectly, omitting directions and warning for safe use. Compounded medications are often used to help meet the demand when there's a shortage of the medication. 
• Black cohosh and other botanical supplements. Using these supplements may carry potential risks and side effects. Always talk to your doctor before using these.
• Non-botanical supplements. Learn more about the pros, cons, and background of menopause supplements in Why Should I Consider Menopause Supplements?
• Mind and body practices. Yoga, tai chi, and mindfulness can help you manage stress and improve overall well-being.
• Acupuncture. Studies over the last 10 years have shown that acupuncture could help with menopause symptoms related to mood, sleep, and pain.
• Clinical hypnosis. Research has shown that clinical hypnosis can help reduce hot flashes and improve mood and sleep. It should be done by a licensed professional.

Menopause self-care

Many menopause symptoms are temporary and can be managed without medications. You may even be doing some of these activities already.

• Try your best to get enough quality sleep. We know this can be challenging during menopause, but making small changes can help. Get better sleep by going to bed and waking up at the same time each day, even on weekends. Make sure your bedroom is dark, quiet, and cool. Minimize screentime before bed. Consider adding deep breathing or meditation to your bedtime routine.
• Practice relaxation and stress management techniques. There are many types of relaxation techniques to try. Try a few out to see which might work best for you. Some good choices including box breathing, progressive muscle relaxation, meditation, mindfulness, visualization, and guided imagery.
• Eat a healthy, balanced diet. Good menopause nutrition starts with a foundation of whole grains, lean proteins, fruits, vegetables, and healthy fats. Foods that contain calcium, vitamin D, and omega-3 fatty acids are great to add to your diet. They can help with bone health, heart health, and the healthy functioning of the body's cells.
• Avoid smoking. We know there are many health benefits of not smoking or quitting smoking. New research shows that smoking increases your risk of starting menopause at an earlier age.
• Reduce alcohol consumption. As we get older, there are physical changes caused by age and sex that change how our bodies process alcohol. In addition, drinking alcohol can make some of your existing symptoms worse, such as trouble sleeping, digestive issues, hot flashes/night sweats, osteoporosis, mood changes, depression, and anxiety.
• Get regular physical activity. This should include a mix of aerobic activities, strength training, and stretching. The benefits of exercise during menopause are both mental and physical.
• Strengthen your pelvic floor through exercise. Strong pelvic floor muscles can help improve bladder and bowel control, sexual function, and the muscles used in orgasm.
• Improve vaginal dryness and discomfort. Opt for water-based or silicone-based lubricants or moisturizers. Lubricants can be applied right before sex and are designed to reduce friction and discomfort.
• Be prepared for hot flashes and night sweats. Dress in layers and carry cool water and a fan with you. Figure out if you have triggers for your hot flashes and if possible, avoid them.
• Schedule regular appointments with a mental health professional. It can be helpful to talk to a trained professional as you go through the physical, mental, and emotional changes that can happen during the menopause transition.