Menopause treatments & medications

Living with hot flashes, bloating, and mood changes can be difficult and frustrating. These are some of the symptoms of menopause. Menopause is not a disease or condition but a normal part of aging. Treatments include lifestyle changes and prescription medications. Understanding what menopause is and how to alleviate symptoms at home and with medications are great first steps in feeling better. Continue reading to learn more about menopause and what can be done to help reduce symptoms.

What is menopause?

Menopause is when a woman’s period stops. In most women, menopause occurs between ages 45 and 55 and is a normal part of aging. Menopause occurs because ovarian function decreases, and the ovaries stop producing estrogen and progesterone hormones. Although changes and symptoms can start several years earlier, a woman reaches menopause when she has not had her period for 12 months. After menopause, a woman cannot become pregnant (except in rare cases involving specialized fertility treatments).

Symptoms of menopause include:

• A change in menstrual cycles—they may be longer or shorter, with more or less bleeding than usual

• Hot flashes (sometimes referred to as hot flushes)

• Night sweats

• Trouble sleeping

• Vaginal dryness

• Pain during sexual intercourse

• Mood swings

• Depression

• Anxiety

• Difficulty focusing

• Hair loss (may have increased hair on the face)

How is menopause diagnosed?

Many women notice signs and symptoms of menopause, like menstrual changes and hot flashes, without a formal diagnosis by a healthcare provider. In most cases, blood tests are not required. However, in some cases, healthcare providers may order blood or urine tests to measure levels of hormones called estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). At menopause, estradiol levels decrease while FSH and LH levels increase.

Menopause treatment options

While there is no cure for menopause because it is a normal part of aging, there are various treatments for menopause symptoms for those who need symptom relief (some individuals do not require any treatment). Prescription options include hormone therapy and other medications. Lifestyle changes and over-the-counter products (such as vaginal lubricants) may help with symptoms.

Menopause medications

Hormone therapy (menopausal hormone therapy)

As you go into menopause, your body produces less of the hormones estrogen and progesterone. Menopausal hormone therapy (MHT), or hormone therapy (HT; previously known as hormone replacement therapy or HRT), helps increase hormone levels and reduce menopause symptoms. HT can be estrogen-only—or an estrogen combined with progesterone.

There are many benefits (like improvement in menopause symptoms and lower risk of osteoporosis) and risks (see below) to consider before starting hormone therapy, so talk with your healthcare provider for more information. Because of the potential risks, HT should be prescribed at the lowest effective dose for the shortest time.

The type of HT depends on whether you have a uterus.

• If you still have your uterus, you’ll take progesterone along with estrogen. This is because estrogen therapy alone increases the risk of endometrial cancer in patients with a uterus.

• If you do not have your uterus (for example, if you have had a hysterectomy), you generally will not need to take progesterone. Estrogen alone has fewer long-term risks than a combination of HT with estrogen and progesterone.

Some examples of commonly used postmenopausal hormones that contain estrogen only include oral medications such as Premarin; vaginal creams such as Estrace; vaginal rings such as Estring; vaginal tablets such as Vagifem; transdermal patches such as Climara, and a transdermal spray called Evamist.

Examples of combination therapy with estrogen and progesterone include oral medication such as Prempro; and transdermal patches such as CombiPatch.

Intrarosa is a vaginal insert that contains dehydroepiandrosterone (DHEA).

Some specialized pharmacies compound (mix) bioidentical hormones. These custom-made products usually contain several estrogen types, along with other hormones, to try to mimic the body’s natural functions.

Common side effects of hormonal therapy include breast tenderness, mood swings, and irregular spotting. Individuals with a uterus who take estrogen plus progesterone on a cycle, with several days off, may have monthly bleeding.

Risks associated with HT, as seen in studies such as the Women’s Health Initiative hormone therapy trials, include:

• Increased risk of endometrial cancer (if you have a uterus and do not take a progestin with estrogen)

• Increased risk of stroke

• Increased risk of blood clots

• Increased risk of gallbladder problems and gallstones

• Increased risk of dementia if you start HT after midlife (starting HT during midlife may lower the risk of dementia)

• Increased risk of breast cancer with long-term use of combination HT

Not everyone can safely take HT. HT may be prescribed to women at low risk for stroke, heart disease, blood clots, and breast cancer. Those who cannot take HT include individuals who:

• Have (or had) breast cancer

• Have (or had) endometrial cancer

• Have abnormal vaginal bleeding

• Have had blood clots—or are at high risk for blood clots or vascular disease (such as an aneurysm)

• Have a history of stroke or heart attack

• Have liver disease

• Are pregnant (or may be pregnant)

Non-hormonal therapy

Non-hormonal treatment includes:

• Selective estrogen receptor modulators (SERMs): SERMs, such as tamoxifen or Evista (raloxifene), act like estrogen in some body tissues. They can lower the risk of breast cancer and osteoporosis but do not help with hot flashes. They can also increase the risk of uterine cancer, stroke, and blood clots. Common side effects include hot flashes and weight changes.

• Osphena (ospemifene) is a SERM used to help with vaginal dryness and painful sex. Common side effects include hot flashes, vaginal discharge, muscle spasms, and headaches. This medicine can increase the risk of endometrial cancer, stroke, heart attack, and blood clots.

• Neurontin (gabapentin) is used off-label (a use that’s not FDA-approved) to reduce nighttime hot flashes and improve sleep. Common side effects may include dizziness, incoordination, and stomach problems.

• Selective serotonin reuptake inhibitor antidepressants (SSRIs): SSRIs may help treat mood swings, hot flashes, and sleep problems. Brisdelle (low-dose paroxetine) is the only SSRI that is FDA-approved for this use, but healthcare professionals may prescribe other SSRIs off-label for menopause symptoms. Common side effects include nausea, constipation, dizziness, excess sweating, drowsiness, weakness, headache, and sexual problems.

• Neurokinin 3 receptor antagonist: Veozah (fezolinetant) is the first drug in this category and was approved by the U.S. Food and Drug Administration (FDA) in May 2023. It can be used to treat hot flashes associated with menopause. Common side effects include back pain, trouble sleeping, stomach pain, and diarrhea.

Additionally, other conditions may be associated with menopause that require treatment. For example, osteoporosis and bone loss may be treated with a bisphosphonate drug such as Fosamax (alendronate).

What is the best medication for menopause?

There is no one “best” remedy for menopause symptoms. The best medication for menopause depends on symptoms, medical history, and medicines you already take that could interact with menopause medication. The table below outlines several common menopause treatments. You can use a free SingleCare card or coupon to save up to 80% off the cost of your medications.

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Best medications for menopause