Treatments for Menopausal and Perimenopausal Symptoms

Medical Treatments for Symptoms of Menopause and Perimenopause

1. Hormone Therapy (HT)

Most menopause symptoms (hot flashes, insomnia, night sweats, osteoporosis, mood swings, decreased libido) are caused by declining levels of estrogen, a hormone primarily produced by the ovaries. HT (aka hormone replacement therapy or HRT) is exactly what it sounds like — increasing estrogen levels via oral medication, skin patches, or vaginal creams, rings, or gels. It can contain estrogen alone or estrogen and progestin together. There has been controversy about HT in the past concerning its connection to a heightened risk for breast cancer and cardiovascular disease. While there is no one-size-fits-all recommendation (every woman should discuss the pros and cons with her healthcare team), a study found no appreciable difference in mortality between women who took estrogen only, estrogen and progestin in combination, or a placebo. (1)

2. Antidepressants

Some classes of antidepressants — notably, selective serotonin reuptake inhibitors (SSRIs) — not only can aid in mood stabilization but can also help reduce hot flashes. (7) Antidepressants are considered nonhormonal medical treatments for symptoms related to perimenopause and menopause. Currently, the SSRI paroxetine (Brisdelle) is one of the only nonhormonal therapies approved by the FDA for the treatment of hot flashes.

3. Gabapentin

Gabapentin is a drug designed to mimic the effects of the neurotransmitter gamma-aminobutyric acid (GABA). GABA sends chemical messages through the brain and the nervous system, and is involved in regulating communication between brain cells. GABA levels have been shown to be lower in postmenopausal women, leading to symptoms of depression. (2)

Gabapentin was originally a seizure medication, but it is also effective in reducing hot flashes and improving sleep. Since it does not contain reproductive hormones, it can be used by women with breast cancer. (3) It can carry significant side effects such as blurred vision, sleepiness, nausea, dizziness and tremors.

4. Clonidine (Catapres)

Another nonhormonal option, clonidine is usually used to reduce high blood pressure. But research has shown that it can have some effect in reducing hot flashes. Side effects include dizziness, sleepiness, dry mouth and constipation. (4)

5. Bioidentical Hormones

Bioidenticals are compounds that closely resemble the chemical and molecular structure of human hormones. Many false and misleading statements have been made out about these compounds, such as that they are safer and more effective than HT. The U.S. Food and Drug Administration (FDA) approved a new bioidentical combination drug called Bijuva (estradiol and progesterone) for hot flashes this past October.

A note of caution: One way that bioidentical hormones are prescribed and made available is through a compounding pharmacy. The North American Menopause Society (NAMS) and the Endocrine Society recommend caution when using compounded drugs. (5) The concern is mainly about bioidenticals that are custom compounded by pharmacists following a doctor’s script. These have no FDA oversight, and there is no evidence that they are superior to regular hormone therapy or bioidenticals that have FDA approval. “NAMS supports the actions of the U.S. Congress, FDA, and other scientific organizations that have warned about the potential harm from compounded bioidentical hormonea,” according to its website. (6)

Related Treatments Midlife Women May Need: Osteoporosis Medications 

To prevent further bone loss, experts recommend that women get the recommended doses of calcium and vitamin D. If there is evidence of osteoporosis, or if you are at higher risk for osteoporosis based on family history, medical history, or use of certain medications, your doctor may prescribe one of these osteoporosis medications:

• risedronate (Actonel, Atelvia), ibandronate (Boniva), alendronate (Binosto, Fosamax): Prevents bone deterioration.
• zoledronate (Reclast): Given once a year by IV, for people who have trouble taking the above medicines orally
• denosumab (Prolia): Antibody injection given twice a year
• raloxifene (Evista): Mimics estrogen
• teriparatide (Forteo): An injectable that contains a bone-building agent (8)

Complementary and Alternative (CAM) Remedies for Perimenopausal and Menopausal Symptoms

Ask your doctor about incorporating these modalities into your overall regimen.

1. Acupuncture

Preliminary studies show that acupuncture may help relieve vasomotor symptoms (hot flashes and night sweats). Research found that “the majority of women may experience a significant reduction in menopause-related VMS frequency after eight weeks of acupuncture treatment, and that there is a subgroup of women who are likely to experience an especially rapid and strong clinical response to acupuncture.” (9)

2. Hypnotherapy

In a paper from 2015, the North American Menopause Society noted that studies have shown that clinical hypnotherapy can aid in the reduction of hot flashes and night sweats, but cautions that the current studies have been very small. (10)

3. Yoga

It looks like this ancient practice can help with a variety of menopause symptoms: It lowers the risk of cardiovascular disease, hot flashes, and night sweats, and improves sleep, mood, and cognitive function. (11) Another study discovered that a 12-minute daily yoga program actually reversed bone loss from osteoporosis. (12)

4. Mindful Meditation

Mindfulness, the practice of staying in the moment, focusing on the “now,” and avoiding judgment, has been shown to reduce the degree of distress that women feel from hot flashes, night sweats, and stress, according to research published in Menopause. (13) Also, deep, controlled breathing when you feel a hot flash coming on signals your body to relax.

RELATED: Mindfulness May Help Improve Menopause Symptoms

Strategies for Coping With Specific and General Menopausal Symptoms

1. To Cope With Hot Flashes, Dress in Layers

You’re hot, then you’re cold, and then you’re hot again. Instead of changing outfits several times a day, pile on layers (camisole, T-shirt, cardigan) that can easily be removed and put back on. Avoid fabrics that don’t breathe, such as polyester and rayon.

RELATED: How Long the Menopausal Transition Will Last, and When You’ll Reach Menopause

2. To Cope With Vaginal Dryness, Use Vaginal Lubricants and Moisturizers

If your vagina or vulva is getting dry and irritated, stop using soap to clean there; clean water works just as well. If sexual penetration is painful because of dryness, try an over-the-counter lubricant or moisturizer. Use lubricants right before sexual activity; avoid ones with additives, which can cause irritation. Moisturizers are applied as a regular healthcare regimen, according to the Mayo Clinic. If this is insufficient, you may benefit from vaginal estrogen, which should be discussed with your doctor.

3. To Cope With Menopausal Health Risks, Eat a Bone-Healthy Diet

Add calcium and vitamin D to your plate: Low-fat dairy, canned salmon, sardines and shrimp, eggs, fortified juice, and leafy green vegetables help protect against osteoporosis. Check with your physician before taking vitamin C supplements, because they can interact with some medications, according to a study. (15)

RELATED: The Optimal Menopause Diet

4. To Cope With Various Symptoms, Avoid Caffeine, Alcohol, Sugar, and Spicy Foods

These ingredients and foods can trigger mood swings, night sweats, and hot flashes. Alcohol can increase your risk of cardiovascular disease and osteoporosis. (16)

5. Quit Smoking

Cigarettes can not only cause an earlier onset of menopause, but also increase the intensity of symptoms and the risk of developing cardiovascular disease and osteoporosis. (16,17)

6. Strengthen Your Pelvic Floor

Pelvic floor muscle exercises specifically designed for you by a physical therapist with special training in pelvic floor therapy can improve your strength and tone, relax tight muscles, and overcome embarrassing “leaking” (incontinence), pelvic organ prolapse, and sexual dysfunction. (18)

7. Get Regular Exercise

All different kinds of exercise are important! Two to three times a week for at least a half hour, work in:

• Aerobics to protect your heart and work off unwanted weight
• Weight-bearing exercises to strengthen bones
• Strength-training to prevent loss of muscle mass
• Stretching to loosen stiff muscles and tendons

As a bonus: Regular exercise is known to improve your mood and help minimize depression. If you don’t know where to start, see a trainer who can create an appropriate workout plan for you.