Menopause is a normal part of the aging process, affecting most people assigned female at birth in their mid 40s to early 50s.

During this transition, up to three-quarters will experience some kind of symptoms related to menopause, such as hot flashes, night sweats, or sleep problems.

Many people believe that menopause is just something you have to “deal with” and that there’s nothing you can do about it.

And while you can’t treat menopause exactly, recent advances have made it so that you can treat bothersome symptoms. This can make the menopausal experience more comfortable and help protect your long-term health.

In this article, we’ll take a look at some of the common treatment options for symptoms of menopause, including some of the newest research in menopausal care.

The menopausal transition represents the period of time in adulthood when hormone levels begin to decline and menstruation comes to a permanent end.

During this time, declining levels of estrogen and progesterone — two hormones produced by the ovaries — can lead to many of the bothersome symptoms that some people may experience during menopause.

As a result, treatment of menopausal symptoms has historically involved the use of hormone therapy to reduce symptoms.

But in 2013, results from a large study involving over 27,000 women with up to 13 years of follow-up found that long-term use of combination hormone therapy (estrogen plus progesterone) was associated with increased risk for heart disease, cancer, and stroke.

Since then, experts have changed the way that hormone therapy is used to treat menopause. There’s now more emphasis on ensuring that the benefits outweigh the potential risks.

Based on the most up-to-date research, the North American Menopause Society still considers hormone therapy the most effective treatment option for the vasomotor and genitourinary symptoms of menopause. It can also help prevent bone disease.

Healthcare professionals are starting to take a more personalized approach when prescribing hormone therapy based on your individual needs and circumstances. Your doctor may recommend avoiding hormone therapy if you’re over 60 years old or are at increased risk for heart disease or stroke.

To lower the risk for long-term health effects, your doctor will likely prescribe hormone therapy at a low dose for no more than 3 to 5 years. If you don’t have a uterus, you may also choose to use estrogen alone, which minimizes the risk for complications such as breast cancer.

Hormone therapy may be taken:

  • orally
  • topically as a patch or gel
  • vaginally as a cream, tablet, or ring

Bioidentical hormone therapy

Bioidentical hormones are plant-derived hormones such as estradiol and estriol that have the same structure as human hormones.

Some people claim that bioidentical hormone therapy is a safer alternative to traditional hormone therapy. But there’s no evidence to suggest this is the case.

In fact, most of these types of therapies are not regulated by the Food and Drug Administration (FDA), meaning they aren’t held to the same quality standards as traditional hormone therapy. They also don’t require the same safety warnings, which may lead people to underestimate the potential risks associated with their use.

It’s also unclear how well these treatments compare with nonhormonal options for menopausal symptoms. A recent randomized clinical trial found that for most people, a vaginal estriol cream was no better than a hormone-free moisturizing cream for treating vaginal discomfort.

If you’re interested in trying bioidentical hormone therapy, ask your doctor about your options. An FDA-approved formula of estradiol is available. This is typically taken in combination with progesterone.

Vasomotor symptoms (VMS) are some of the most recognized symptoms of menopause. These include:

  • hot flashes
  • night sweats
  • flushing

These types of symptoms are caused by rapid constriction and dilation of blood vessels.

In addition to hormone therapy, a variety of nonhormonal medications can help relieve VMS in menopause. These include different types of medications, such as:

  • antidepressants (paroxetine, citalopram, desvenlafaxine, escitalopram, venlafaxine)
  • blood pressure medications (clonidine)
  • anticonvulsants (gabapentin, pregabalin)

In August 2022, the FDA also accepted an application for a new potential treatment called fezolinetant that specifically treats VMS. This drug is thought to work by controlling the nerves that cause blood vessel dilation and constriction.

In clinical studies, fezolinetant treatment reduced both the frequency and severity of VMS in menopausal women.

If approved, fezolinetant would represent just the second FDA-approved nonhormonal treatment option — after paroxetine — for VMS in menopause.

Genitourinary symptoms refer to the collection of uncomfortable or bothersome effects of menopause on the genital and urinary systems. These may include:

  • vaginal discomfort, burning, or itching
  • pain during sex
  • urinary infections or urgency

Hormonal therapies such as vaginal estrogen or estradiol rings or creams are often used to treat genitourinary symptoms. Nonhormonal vaginal moisturizers can be used as well.

In 2013, the FDA also approved the oral medication ospemifene to treat pain during sexual activity as a result of menopause. Once daily treatment with this drug has been found to improve vulvovaginal health and sexual function after as little as 4 weeks.

During the early part of treatment, ospemifene may increase the frequency of VMS. These effects usually resolve within 4 weeks.

Another nonhormonal option for genitourinary symptoms in menopause is the prescription synthetic steroid prasterone. Prasterone is administered as a vaginal insert once daily. It can help with symptoms such as vaginal dryness and itching. It may also increase sexual desire and arousal.

Using prasterone may increase the likelihood of abnormal cervical Pap test results, requiring additional testing and surveillance.

A 2022 study involving 200 postmenopausal women found that more than half experienced hair loss during and after menopause.

Although it’s not usually considered a cornerstone of menopause treatment, therapy to help prevent or reverse hair loss could help improve self-esteem.

A 2019 study found that a topical combination of the hair growth-stimulating medications minoxidil (Rogain) and finasteride helped improve hair density and thickness in postmenopausal participants.

In addition to the symptoms discussed above, treatment options are available to help manage other bothersome symptoms or complications of menopause, including:

  • sleep problems
  • bone loss
  • mood changes
  • urinary incontinence

Menopause is a normal part of life, but that doesn’t mean you have to simply endure its uncomfortable symptoms.

A variety of hormonal and nonhormonal treatment options are available to treat even the most bothersome symptoms, and more new therapies are on the horizon.

If menopause symptoms are affecting your health or wellness, a healthcare professional can help you find the right treatment options to fit your needs.