Treatment Options for Menopause

What you will learn in this article:

1. Hormone replacement therapy (HRT)
2. Testosterone gel for reduced sex drive
3. Non-hormone medicines
4. Complementary and alternative therapies
5. Compounded Bioidentical Hormones
6. Cognitive behavioural therapy (CBT)

The main medicine treatment for menopause and perimenopause symptoms is hormone replacement therapy (HRT), which replaces the hormones that are at low levels. There are other treatments if you cannot, or choose not to, have HRT.

HRT is a safe and effective treatment for most going through menopause and perimenopause. Your GP will discuss any risks with you.

HRT involves using oestrogen to replace your body's own levels around the time of the menopause. There are different types and doses of HRT. Using the right dose and type usually means your symptoms improve.

Benefits of HRT

• The main benefit of HRT is that it can help relieve most menopause and perimenopause symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness.
• Hot flushes or night sweats often improve within a few weeks. Other symptoms like mood changes and vaginal dryness can take a few months to improve.
• Taking HRT can also reduce your risk of hormone-related health problems including osteoporosis and heart disease.
• Risks of HRT. The risks of HRT are small and usually outweighed by the benefits. If you’re interested in HRT, your doctor or nurse can discuss the risks with you.

Estrogen for vaginal dryness and discomfort

Your vagina may become dry, painful or itchy as a result of the menopause and perimenopause.

• A GP can prescribe oestrogen treatments you can insert into your vagina, as a tablet, cream or ring.
• This can also improve any urinary symptoms caused by menopause and perimenopause, like discomfort when you pee.
• These vaginal oestrogen treatments do not get into your bloodstream and only work on the bit of the body where you put them.
• You can use them for the rest of your life.
• Symptoms usually come back when you stop using them.
• It's safe to use vaginal oestrogen with HRT.

Hot flushes and night sweats

• There are some medicines that can help with hot flushes and night sweats. These include: a blood pressure medicine called Clonidine an epilepsy medicine called Gabapentin.
• Talk with a GP about these medicines and their side effects, and if they might be suitable for you.

Non-hormone medicines

There are non-hormone treatments if your symptoms are having a big impact on your life and you cannot, or choose not to, have HRT.

• Mood Symptoms: Antidepressants can help with mood symptoms if you've been diagnosed with depression or anxiety.
• Cognitive behavioural therapy (CBT) is a talking therapy which can help with: low mood and anxiety caused by menopause and perimenopause some physical symptoms like hot flushes and joint pain.
• You can get NHS talking therapy without going to a GP first. Find an NHS psychological therapies service
• Follow-up appointments If you're having treatment for your symptoms of menopause or perimenopause, you'll need to return to the doctor or nurse who is prescribing your HRT for a follow-up review after 3 months.

When you and your doctor or nurse agree your treatment is working well for you, you'll need to see them once a year. During your reviews, your doctor or nurse may:

• make sure your symptoms are under control ask about any side effects and vaginal bleeding check your weight and blood pressure review the type of HRT you're taking and make any necessary changes.
• You may need treatment for a few years, until most of your menopause and perimenopause symptoms have passed.
• You can choose to continue taking HRT. The doctor or nurse prescribing your HRT can discuss with you the benefits and risks, so you can decide what’s right for you. You can take HRT for as long as you need it. You can discuss this with your doctor or nurse at your yearly review.

Compounded Bioidentical Hormones

• Compounded bioidentical hormones are sometimes offered in private clinics as HRT. They are not recommended because it's not known how well they work or how safe they are. They are not available on the NHS.
• They are different from regulated bioidentical hormones, also called body identical hormones.
• Bioidentical hormones are available on the NHS as HRT. They have been tested to see how well they work and how safe they are.

Follow-up appointments

If you're having treatment for your symptoms of menopause or perimenopause, you'll need to return to the doctor or nurse who is prescribing your HRT for a follow-up review after 3 months.

• When you and your doctor or nurse agree your treatment is working well for you, you'll need to see them once a year. During your reviews, your doctor or nurse may:
• make sure your symptoms are under control
• ask about any side effects and vaginal bleeding
• check your weight and blood pressure
• review the type of HRT you're taking and make any necessary changes
• You may need treatment for a few years, until most of your menopause and perimenopause symptoms have passed.
• You can choose to continue taking HRT. The doctor or nurse prescribing your HRT can discuss with you the benefits and risks, so you can decide what’s right for you. You can take HRT for as long as you need it. You can discuss this with your doctor or nurse at your yearly review.

Useful Organisations and connections

• https://thebms.org.uk/find-a-menopause-specialist
• https://www.womens-health-concern.org
• https://www.menopausematters.co.uk/
• https://www.daisynetwork.org/
• https://www.menopausecafe.net/
• https://www.queermenopause.com/resources
• https://joinourdorset.nhs.uk/wellbeing/how-can-we-help-you/menopause