The menopause can cause various symptoms such as hot flushes and changes to your vagina and genital skin. Hormone replacement therapy (HRT) eases your symptoms.This leaflet discusses alternatives to HRT which may ease menopausal symptoms.Strictly speaking, the menopause is your last menstrual period. However, most women think of the menopause as the time of life leading up to, and after, their last period. In reality, your periods don't just stop. First they tend to become less frequent. It can take several years for a woman to go through the menopause completely. Women are said to have gone through the menopause (be postmenopausal) when they have not had a period at all for one year.A natural menopause occurs because as you get older your ovaries stop producing eggs and make less of the main female hormone called oestrogen. The average age of the menopause in the UK is 51. Your menopause is said to be early if it occurs before the age of 45 and is called Premature Ovarian Insufficiency if it occurs before the age of 40 years.
There are certain things that may cause an early menopause. For example:Early menopause and premature menopause are not discussed in detail in this leaflet.The menopause is a natural event. Every woman will go through it at some point. You may have no problems. However, it is common to develop one or more symptoms which are due to the low level of oestrogen. About 8 out of 10 women will develop menopausal symptoms at some point. Around a quarter of women have very severe symptoms.Symptoms of the menopause can last much longer than most women realise. More than half of women actually have symptoms for more than seven years.These short-term symptoms only last for a few months in some women. However, for others they can continue for a few years after their last period:All types of HRT contain an oestrogen hormone. If you take HRT it replaces the oestrogen that your ovaries no longer make after the menopause. HRT is excellent at preventing hot flushes, vaginal dryness and related vaginal symptoms.
It can also help to improve sleep if your sleeping pattern is affected by the menopause. Long-term use of HRT also has a benefit in helping to prevent 'thinning' of your bones (osteoporosis) and can also reduce the likelihood of developing coronary heart disease in some women. HRT is much safer than many people realise. See separate the leaflet called Menopause and HRT for more details.Some women may choose not to take HRT or others may not be able to take HRT due to an underlying medical condition. If you are not sure whether or not you can take HRT then you should discuss this with your doctor who will be able to refer you to an expert in the menopause.The rest of this leaflet discusses some other treatment options for menopausal symptoms.There is some evidence that healthy lifestyle behaviours can improve some symptoms of the menopause - for example, hot flushes and night sweats. In addition, weight loss, mindfulness and cognitive behavioural therapy can have also a mild-to-moderate effect on these symptoms.
There is also some evidence that women who are more active tend to have fewer symptoms of the menopause. However, not all types of activity lead to an improvement in symptoms. High-impact exercise done now and then may even make symptoms worse. The best activity is regular sustained aerobic exercise, such as regular swimming or jogging.Wearing lighter-weight clothing, sleeping in a cooler room and reducing stress may reduce the number of hot flushes. Some women find that things such as spicy foods, caffeine (in tea, coffee, cola, etc), smoking, and alcohol may trigger hot flushes. Avoiding these things may help for some women.Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant medicine. They include paroxetine, fluoxetine, escitalopram and citalopram. Several years ago it was noticed as a side-effect that menopausal women who took these medicines for depression had fewer hot flushes. Since then, a few studies have shown that several SSRIs stop or reduce hot flushes in some (but not all) menopausal women, even those who are not depressed.
A similar antidepressant drug called venlafaxine, a serotonin and noradrenaline (norepinephrine) reuptake inhibitor (SNRI) antidepressant, has also been shown to have this effect. How SSRIs and SNRIs work to help hot flushes is not clear.When it works, an SSRI or SNRI provides relief from hot flushes almost immediately. A trial of one to two weeks is usually enough to find out whether it is going to work or not. If symptoms improve, a longer course may then be prescribed. However, the beneficial effect is often short-acting so does not last for long. The main drawback with these medicines is that they may cause side-effects in some women - for example:Note: You should not take paroxetine or fluoxetine if you are also taking tamoxifen, as these medicines can interfere with each other.Gabapentin is a medicine that is usually used to control epileptic seizures and pain. However, research has shown that it can ease menopausal flushing symptoms in some women. Side-effects, such as dizziness and tiredness, can occur with this medication.
Note: strictly speaking, SSRIs, SNRIs and gabapentin are not licensed for treating menopausal symptoms. However, many doctors are willing to prescribe one of these treatments, with the patient's consent, to see if it works.Some women consider taking complementary and alternative treatments instead of taking HRT. There is a massive market for products to help with menopausal symptoms and many of these are not safe or do not have good research to support their effectiveness.For example, the following have been marketed for menopausal symptoms: black cohosh, red clover, dong quai, evening primrose oil, ginseng, soy and St John's wort. However, just because a product is labelled 'natural' does not mean that it is automatically safe and free from potentially damaging chemicals.Herbal remedies are not regulated by a medicine authority and they should not be considered as a safer alternative to HRT, as there is so much variety in their effectiveness and potency. Many herbal medicines have unpredictable doses and purity.
In addition, some products have significant side-effects and can interfere with other medicines.The regulatory bodies have developed a system called Traditional Herbal Registration (THR). Any herbal products that have been approved by this system have a THR logo on their packs. This means that the product has the correct dosage and is of a high quality. The pack will also contain product information in it.Isoflavones and black cohoshThere is some evidence that isoflavones or black cohosh may improve some symptoms of the menopause. However, multiple preparations of these products are available and their safety is still uncertain. Different preparations can vary and these products can also interfere with other medicines.St John's wortSt John's wort can improve symptoms in some women. It does not seem to make any difference to low mood or anxiety symptoms though. There is still uncertainty about the most appropriate dose of St John's wort and also how long the effect of taking it lasts for.
There is a variation in the nature and potency of different preparations of this product. In addition, it can interfere with other medicines, including tamoxifen.Other treatmentsThere is good evidence that cognitive behavioural therapy can improve symptoms of low mood and anxiety which arise as a result of the menopause in some women.There is conflicting evidence regarding the use of soy and red clover. They should not be taken in women with hormone-dependent breast cancer or those taking tamoxifen.Bio-identical hormones are also not regulated and are not subject to any quality control.ClonidineClonidine used to be very popular for the treatment of the menopause. However, there is no good evidence that it is beneficial in improving symptoms. It frequently causes side-effects such as dry mouth, drowsiness, dizziness and feeling sick. It is therefore not commonly used any more.You can buy vaginal lubricants and moisturisers from pharmacies, which can help ease vaginal dryness. Some women only notice dryness when they have sex.