Menopause Treatment
Approximately 70 percent of all women approaching menopause will experience symptoms of menopause. The symptoms may begin in perimenopause and last for the whole menopause transition. Some women experience these symptoms for the rest of their lives.
Menopause is not a disease to be cured, but rather a natural process of aging in a woman’s body. The symptoms indicate changing levels of the hormones estrogen, progesterone and testosterone.
Some symptoms can be relieved through medication, but this is not the only treatment solution. Here are several options:
Lifestyle changes as menopause treatment
Eating right and getting plenty of exercise can help to minimize the symptoms of menopause, and will help maintain overall good health.
Getting plenty of exercise and participating in stress reduction activities may be helpful. Cognitive behavioral therapy and hypnosis have been shown to reduce hot flashes in some studies. Dressing lightly and layering clothing are common ways that women adapt to unexpected hot flashes. For problems with vaginal dryness, moisturizers and non-estrogen based lubricants can be beneficial.
Prescription medicine menopause treatment
Women struggling with menopausal symptoms should talk to their doctor about treatment options. The most commonly prescribed and most effective drug therapy for menopausal symptoms is hormone therapy (HT).
For women who still have their uterus, treatment with estrogen and progesterone (combination hormone replacement therapy) can be prescribed. Women who have had a hysterectomy are prescribed estrogen alone.
Hormone therapy
In the past, HT was widely recommended and was believed to have a role in preventing the development of chronic diseases of aging such as heart disease, osteoporosis and even dementia. Multiple clinical trials have failed to demonstrate a long-term benefit of HT for any of these outcomes. One trial by the Women’s Health Initiative also documented some risks associated with long term use of HT.
For women with a uterus who take estrogen plus progesterone or progestin, the risk of breast cancer was found to increase slowly over time. Women who had a hysterectomy and took estrogen only had a decreased risk of breast cancer but an increased risk of stroke. Both treatments, which were given in pill form, increased the risk of blood clots.
Follow-up studies of the participants in the Women’s Health Initiative trials have looked at very long-term health almost 20 years later, and overall there is not an increase in risk of mortality associated with taking hormones or not taking hormones.
A woman’s health status and family history will help her physician advise on whether she is a good candidate for HT and how long it should be taken. For most women, hot flashes subside but it can take 10 years or more for some, and for others hot flashes never go away. Fortunately, for those who cannot take HT or who do not want to take HT, there are alternatives.
Other menopause medications
Fezolinetant (Veozah) is a new, Food and Drug Administration (FDA) approved medication that treats hot flashes at the level of the brain where they originate. It is non-hormonal and has not been in widespread use for a long time. However, it has been studied in more than one thousand women to date and demonstrates relief of hot flashes that is almost as good as that achieved with hormone therapy.
Fezolinetant cannot be used in conjunction with medications that are metabolized by an enzyme called CYP1A2 inhibitors and it requires some additional monitoring for safety. A healthcare provider can help women determine whether this medication is appropriate for them.
Paroxetine mesylate (Brisdelle) is also FDA approved for the treatment of hot flashes. It is an antidepressant medication that was found to also have effectiveness for this purpose. It is not as effective as HT or fezolinetant.
Other medications in the antidepressant class of drugs such as venlafaxine (Effexor), citalopram (Celexa) and escitalopram (Lexapro) have also been shown in clinical studies to be effective against hot flashes, although not as good as HT. Gabapentin (Neurontin) and oxybutynin (Ditropan) have also been shown to be helpful for hot flashes. A woman’s doctor can help her select a non-hormone treatment that is right for her.