If you’re a woman going through the menopause, it can be a challenging time. Many treatments are available and it can be a bit confusing understanding what each one does.
For an introduction to the kinds of treatments available, read this simple guide for advise, but always discuss with a doctor to asses the treatment that is right for you.
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.(1)
Combined or oestrogen-only skin patches (2)
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.
Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissues. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
Low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. A low-dose antidepressant for management of hot flashes may be useful for women who can’t take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
Gabapentin (Gralise, Horizant, Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can’t use estrogen therapy and in those who also have nighttime hot flashes.
Clonidine (Catapres, Kapvay). Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes.
Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. Your doctor might prescribe vitamin D supplements to help strengthen bones.(2)
Oestrogen gel (1)
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 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.
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 (I)
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.
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