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    Menopause treatment options

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      Lady wearing HRT patch on tummy

      If you’re a woman going through the menopause and you’re finding it difficult to manage your symptoms, it’s a good idea to speak to a doctor about treatment options.

      For an introduction to the kinds of treatments available, read on for our simple guide.

      Hormone replacement therapy for the menopause

      The main treatment option for the menopause is hormone replacement therapy, or HRT. It can be used to combat symptoms like hot flushes, mood changes, vaginal dryness and reduced sex drive. It can also help reduce your risk of osteoporosis.

      In the past, HRT has been the subject of debates about safety, because it is associated with some health complications, including a slightly increased risk of blood clots and cancer. However, it’s now widely agreed that the benefits of HRT outweigh the risks for most women.

      How HRT works

      The menopause is caused by falling levels of oestrogen. HRT works by artificially “topping up” your oestrogen levels, which helps reduce symptoms. 

      Most women who use HRT will need to use a combination type i.e. one that contains oestrogen and progestogen (synthetic progesterone). This is because, taken on its own, oestrogen increases your risk of developing endometrial cancer (cancer of the lining of the womb). If you’ve had a hysterectomy, you can safely use oestrogen-only HRT.  

      The type of HRT you  get will depend on your age, whether you still have periods or not, and whether you've had a hysterectomy.

      Combined or oestrogen-only tablets

      Most women who use HRT will take tablets, and will normally take one a day.

      Tablet HRT is a good option as it’s easy and non-invasive. However, it is associated with a slightly higher risk of health complications like blood clots when compared to other types.

      Combined or oestrogen-only skin patches 

      HRT skin patches are small squares like plasters that stick to the skin and release hormones over a few days, before being replaced. 

      As with tablets, skin patches are an easy and straightforward treatment option. Unlike tablets, there’s no increased risk of blood clots. Patches can also help you avoid side effects like nausea. 

      Oestrogen gel 

      As with skin patches, oestrogen gel is absorbed through the skin and doesn’t come with an increased risk of blood clots. For it to work, you’ll need to rub it into your skin once a day.

      However, if you still have your womb, you’ll need to take some form of progestogen to stay safe. For women who have an intrauterine system (IUS) for contraception, it’s safe to use this gel. 

      Vaginal oestrogen 

      If your main menopausal symptom is vaginal dryness, you could benefit from vaginal oestrogen. This is a localised form of HRT which specifically helps with vaginal dryness and discomfort, but not any of the other symptoms of the menopause.

      Vaginal oestrogen comes as a cream, pessary or ring that’s inserted directly into the vagina. It doesn’t carry the usual risks associated with HRT because it’s so localised – this means that you don’t have to take progestogen alongside it.

      Oestrogen implant

      A rare type of HRT is an oestrogen implant, which is designed to sit under the skin (usually of your abdomen) and release oestrogen for several months before being replaced. Oestrogen implants are unlicensed and are only available through specialist clinics. Unless you've had a hysterectomy, you'll need to have a source of progestogen as well. This could be progestogen pessaries or tablets or the intrauterine system (IUS).

      Testosterone gel 

      For some women, a loss of sex drive is one of the main symptoms of the menopause. If this has been a problem for you, and you’ve been referred to a menopause specialist for help, they might prescribe testosterone gel, which is rubbed into the skin. 

      Other prescription treatments for the menopausal symptoms

      If you don’t want to use HRT, or if it’s not safe for you to do so, there are some other prescription medications you can try. 

      Tibolone is similar to combined HRT and comes as a tablet, taken once a day. It can relieve menopausal symptoms like hot flushes and low mood, although it’s thought to be less effective than HRT. You can only take tibolone if you’re post-menopausal i.e. your periods stopped more than a year ago.

      As with HRT, tibolone is associated with health complications, like an increased risk of breast cancer and strokes.

      Clonidine is a tablet medication taken two or three times a day that specifically combats hot flushes and night sweats. Clonidine doesn’t carry an increased risk of cancer or blood clots, but like any medicine, it can cause unpleasant side effects, and success isn’t guaranteed. 

      Antidepressants are a good option if you’re experiencing low mood as a symptom of the menopause. Antidepressants in the SSRI family might also help with hot flushes, but more research is needed to confirm this. 

      Pharmacy medication for the menopausal symptoms

      If vaginal dryness and discomfort are your main menopausal symptoms, you can try using vaginal moisturisers and lubricants. 

      Lifestyle changes for the menopausal symptoms

      For many menopausal women, symptoms can be eased by making changes to your daily routine, and giving up some unhealthy habits.

      Exercising regularly will help you sleep better, boost your mood, and keep your bones strong. Combined with a healthy diet, exercise can help you maintain a healthy weight.

      If hot flushes and night sweats are the problem, try to take steps to keep cool. Wear looser clothes, keep your home well-ventilated, and invest in fans or air conditioning. You can also reduce the frequency of hot flushes by avoiding triggers like spicy food and caffeine.

      If your mood is affected, you can take up relaxation techniques like yoga, meditation and guided breathing. 

      Finally, you’ll feel better if you cut back on unhealthy habits like smoking and drinking a lot of alcohol. 

      Should I use herbal remedies to help with menopausal symptoms?

      There are some herbal remedies that have been tried for treating menopausal symptoms, however these should be approached with caution. Some types, including black cohosh and red clover can be effective at combatting hot flushes. However, it can be difficult to use herbal remedies in the right doses, and some may cause side effects interact negatively with other treatments or be harmful. For example, if you have an oestrogen sensitive breast cancer you mustn't take plant-based oestrogen supplements.

      If you’re thinking about trying any herbal remedy for your symptoms, it’s best to discuss it with your doctor first. Find out more about speaking to your doctor about the menopause here

      How about plant-based oestrogens?

      Some plants and vegetables contain natural oestrogens- also called "phytoestrogens". There are several subgroups, the most known are isoflavones. Soy products would be an example of food groups that contain a significant amount of isoflavones. 

      There is some evidence that Asian women who consume a lot of soy-based foods, suffer less from menopausal symptoms; but other factors might come into play. In summary there is conflicting opinions about this, but if you are keen to avoid taking hormones to help with menopausal symptoms you could certainly try adding more plant-based oestrogen foods to your diet.

      VideoGP by LloydsPharmacy

      References

      https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/
      https://www.nhs.uk/conditions/menopause/
      https://patient.info/womens-health/menopause/hormone-replacement-therapy-hrt
      https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/types/
      https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/alternatives/
      https://www.bmj.com/content/359/bmj.j5101
      https://menopause-exchange.co.uk/blog/?p=3553
      https://www.bda.uk.com/resource/menopause-diet.html 

      Authors and editors

      • Reviewed and updated by

        Dr Tatjana Street
        GMC number: 4569536
        Date reviewed: 19th November 2021

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