Because menopause is not a disease but a natural, biological process, it does not require medical treatment. However, treatments to help relieve symptoms are available.
Hormone therapy (HT), formerly known as hormone replacement therapy, is a treatment that provides the body with additional hormones when the body doesn’t produce enough, such as during menopause.
Women who still have a uterus are typically prescribed a combination of estrogen and progestin, a synthetic version of the naturally-occurring hormone progesterone. The combination is necessary because estrogen alone can cause the lining of the uterus to grow and increases the risk for endometrial cancer. Women who have had their uteruses removed can typically take estrogen only.
These prescription hormones come in different forms, including pills, creams, and skin patches, among others. They are usually administered in the following ways:
- Cyclic therapy: You take estrogen for about 25 days each month; progestin is added on certain days, and this varies from patient to patient. While you are taking progestin, it is possible that you’ll experience some bleeding.
- Combined therapy: You take estrogen and a low dose of progestin daily. You may experience irregular bleeding during the first few months of this treatment, but most women stop bleeding altogether within one year.
- Estrogen-only therapy: You take estrogen every day for 25 days or more each month. When estrogen is taken alone, you may experience some bleeding.
In 2010, the North American Menopause Society (NAMS) issued new guidelines about HT, stating that the benefits of treatment outweigh the risks only for women who initiate HT close to the onset of menopause, and that the benefit-to-risk ratio decreases significantly with age. According the NAMS (as well as many other experts and advocacy groups), a woman who is 45 will benefit from the therapy much more than will a woman age 65. And the benefits that 45-year-old initially experiences will start to decline as she ages. Nevertheless, the decision to initiate HT is one that should only be made by you in consultation with your doctor.
Taken for a short period of time, the increased levels of estrogen and progestin have helped reduce symptoms such as hot flashes. They may also help with other symptoms, such as chills, faintness, or dizziness. They can help relieve vaginal atrophy as well. Hormone therapy has shown some promise in treating osteoporosis, colorectal cancer, and heart disease. The lowest dose of a hormone therapy that still relieves symptoms is usually prescribed, as recommended by the Food and Drug Administration (FDA).
Although some believe estrogens can help women feel young or delay the onset of wrinkles, there is no scientific evidence to support this. Estrogens have also not been proven effective in relieving emotional or nervous symptoms unless caused by other menopausal symptoms, such as hot flashes.
There are known risks in using the estrogen-progestin combination on a long-term basis. Studies have shown an increased risk for heart disease, breast cancer, stroke, blood clots, and abnormal mammograms, especially with false positives. However, taking estrogen alone has shown no increased risk of breast cancer or heart disease. The increased risk of stroke, blood clots, and abnormal mammograms remains. Long-term use of hormone therapy is not routinely prescribed, however.
Birth Control Pills
Low-dose oral contraceptives are sometimes prescribed during the perimenopause phase to help control heavy, frequent, or irregular menstrual periods. Hot flashes may be relieved with the use of these pills, and contraceptives will prevent pregnancy.
A vaginal suppository, ring, or cream can be used to deliver small doses of estrogen to the area around the vagina, helping to relive symptoms such as vaginal dryness, physical discomfort during intercourse, and problems with the urinary tract.