What are the treatment options for menopause

Treatments for menopause can be divided based on those symptoms that are present in a given woman at a specific time.

Treatment of Early Onset Symptoms

Abnormal Vaginal Bleeding

Prior to treatment, a doctor excludes other causes of erratic vaginal bleeding. Women in menopausal transition tend to have considerable breakthrough bleeding when given estrogen therapy. Therefore oral contraceptives are often given to women in menopause transition to regulate their periods, relieve hot flashes, as well as to provide contraception. Oral contraceptives are considered safe in healthy, non-smoking women.

Hot Flashes

The choice of medication for treating hot flashes depends on whether a woman is still having periods or not. For women experiencing unpredictable bleeding and hot flashes during menopause transition, oral contraceptives are commonly used (even up to 50 years of age) to control both erratic perimenopausal bleeding vaginal bleeding and hot flashes. For women without periods, hot flashes can be treated with either oral (by mouth) or transdermal (patch) forms of estrogen. Both oral and transdermal estrogen therapies are available either as estrogen alone, or estrogen combined with progesterone. For more, please read the Hormone Therapy article. All available prescription estrogen therapies, whether oral or transdermal, are effective in reducing hot flash frequency and severity. Generally, available treatments decrease hot flash frequency by about 80 to 90%.

Mood Symptoms

Even though moodiness, irritability, and tearfulness are commonly attributed to menopause, studies are underway to determine which of these symptoms are actually due to menopause versus other conditions such as medical depression. Even though many women experience improvement in irritability with oral hormone therapy, hormone therapy alone will not be adequate treatment for a woman suffering from true medical depression (a true depression may require antidepressant medications that are different from medications for menopause). Accordingly, women who are experiencing significant mood symptoms should be evaluated by their doctors to exclude depression and other medical illnesses.

Treatment of Late Onset Symptoms

Vaginal Symptoms

Prior to being treated for vaginal irritation, burning, and itching, women should first undergo an evaluation by a doctor, including a pelvic exam, to verify that the symptoms are due to estrogen deficiency.

There are local (meaning vaginal) and oral treatments for the symptoms of vaginal estrogen deficiency. Local treatments include the vaginal estrogen ring, vaginal estrogen cream, or vaginal estrogen tablets. Oral treatments include multiple types of estrogen either alone, or estrogen given with progesterone (read the Hormone Therapy article). Local and oral estrogen treatments are both effective in relieving vaginal symptoms and are sometimes combined for this purpose. In women for whom oral or vaginal estrogens are deemed inappropriate, such as breast cancer survivors, or women who do not wish to take oral or vaginal estrogen, there are a variety of over-the-counter vaginal lubricants. However, they are probably not as effective in relieving vaginal symptoms as replacing the estrogen deficiency with oral or local estrogen.