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Living with hot flashes, bloating, and mood changes can be difficult and frustrating. These are some of the symptoms of menopause. Menopause is not a disease or condition but a normal part of aging. Treatments include lifestyle changes and prescription medications. Understanding what menopause is and how to alleviate symptoms at home and with medications are great first steps in feeling better. Continue reading to learn more about menopause and what can be done to help reduce symptoms.
What is menopause?
Menopause is when a woman’s period stops. In most women, menopause occurs between ages 45 and 55 and is a normal part of aging. Menopause occurs because ovarian function decreases, and the ovaries stop producing estrogen and progesterone hormones. Although changes and symptoms can start several years earlier, a woman reaches menopause when she has not had her period for 12 months. After menopause, a woman cannot become pregnant (except in rare cases involving specialized fertility treatments).Symptoms of menopause include:
- A change in menstrual cycles—they may be longer or shorter, with more or less bleeding than usual
- Hot flashes (sometimes referred to as hot flushes)
- Night sweats
- Trouble sleeping
- Vaginal dryness
- Pain during sexual intercourse
- Mood swings
- Depression
- Anxiety
- Difficulty focusing
- Hair loss (may have increased hair on the face)
How is menopause diagnosed?
Many women notice signs and symptoms of menopause, like menstrual changes and hot flashes, without a formal diagnosis by a healthcare provider. In most cases, blood tests are not required. However, in some cases, healthcare providers may order blood or urine tests to measure levels of hormones called estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). At menopause, estradiol levels decrease while FSH and LH levels increase.Menopause treatment options
While there is no cure for menopause because it is a normal part of aging, there are various treatments for menopause symptoms for those who need symptom relief (some individuals do not require any treatment). Prescription options include hormone therapy and other medications. Lifestyle changes and over-the-counter products (such as vaginal lubricants) may help with symptoms.Menopause medications
Hormone therapy (menopausal hormone therapy)
As you go into menopause, your body produces less of the hormones estrogen and progesterone. Menopausal hormone therapy (MHT), or hormone therapy (HT; previously known as hormone replacement therapy or HRT), helps increase hormone levels and reduce menopause symptoms. HT can be estrogen-only—or an estrogen combined with progesterone.There are many benefits (like improvement in menopause symptoms and lower risk of osteoporosis) and risks (see below) to consider before starting hormone therapy, so talk with your healthcare provider for more information. Because of the potential risks, HT should be prescribed at the lowest effective dose for the shortest time.
The type of HT depends on whether you have a uterus.
- If you still have your uterus, you’ll take progesterone along with estrogen. This is because estrogen therapy alone increases the risk of endometrial cancer in patients with a uterus.
- If you do not have your uterus (for example, if you have had a hysterectomy), you generally will not need to take progesterone. Estrogen alone has fewer long-term risks than a combination of HT with estrogen and progesterone.
Examples of combination therapy with estrogen and progesterone include oral medication such as Prempro; and transdermal patches such as CombiPatch.
Intrarosa is a vaginal insert that contains dehydroepiandrosterone (DHEA).
Some specialized pharmacies compound (mix) bioidentical hormones. These custom-made products usually contain several estrogen types, along with other hormones, to try to mimic the body’s natural functions.
Common side effects of hormonal therapy include breast tenderness, mood swings, and irregular spotting. Individuals with a uterus who take estrogen plus progesterone on a cycle, with several days off, may have monthly bleeding.
Risks associated with HT, as seen in studies such as the Women’s Health Initiative hormone therapy trials, include:
- Increased risk of endometrial cancer (if you have a uterus and do not take a progestin with estrogen)
- Increased risk of stroke
- Increased risk of blood clots
- Increased risk of gallbladder problems and gallstones
- Increased risk of dementia if you start HT after midlife (starting HT during midlife may lower the risk of dementia)
- Increased risk of breast cancer with long-term use of combination HT
- Have (or had) breast cancer
- Have (or had) endometrial cancer
- Have abnormal vaginal bleeding
- Have had blood clots—or are at high risk for blood clots or vascular disease (such as an aneurysm)
- Have a history of stroke or heart attack
- Have liver disease
- Are pregnant (or may be pregnant)
Non-hormonal therapy
Non-hormonal treatment includes:- Selective estrogen receptor modulators (SERMs): SERMs, such as tamoxifen or Evista (raloxifene), act like estrogen in some body tissues. They can lower the risk of breast cancer and osteoporosis but do not help with hot flashes. They can also increase the risk of uterine cancer, stroke, and blood clots. Common side effects include hot flashes and weight changes.
- Osphena (ospemifene) is a SERM used to help with vaginal dryness and painful sex. Common side effects include hot flashes, vaginal discharge, muscle spasms, and headaches. This medicine can increase the risk of endometrial cancer, stroke, heart attack, and blood clots.
- Neurontin (gabapentin) is used off-label (a use that’s not FDA-approved) to reduce nighttime hot flashes and improve sleep. Common side effects may include dizziness, incoordination, and stomach problems.
- Selective serotonin reuptake inhibitor antidepressants (SSRIs): SSRIs may help treat mood swings, hot flashes, and sleep problems. Brisdelle (low-dose paroxetine) is the only SSRI that is FDA-approved for this use, but healthcare professionals may prescribe other SSRIs off-label for menopause symptoms. Common side effects include nausea, constipation, dizziness, excess sweating, drowsiness, weakness, headache, and sexual problems.
- Neurokinin 3 receptor antagonist: Veozah (fezolinetant) is the first drug in this category and was approved by the U.S. Food and Drug Administration (FDA) in May 2023. It can be used to treat hot flashes associated with menopause. Common side effects include back pain, trouble sleeping, stomach pain, and diarrhea.
What is the best medication for menopause?
There is no one “best” remedy for menopause symptoms. The best medication for menopause depends on symptoms, medical history, and medicines you already take that could interact with menopause medication. The table below outlines several common menopause treatments. You can use a free SingleCare card or coupon to save up to 80% off the cost of your medications.| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Brisdelle (paroxetine) | Selective serotonin reuptake inhibitor antidepressants (SSRIs) | Oral | 1 capsule by mouth daily at bedtime | Headache, fatigue, nausea, vomiting, sexual problems |
| Combipatch (estradiol/norethindrone) transdermal patch | Hormonal therapy (combination) | Transdermal (applied topically on the skin) | 1 patch applied to the skin twice weekly | Vaginal bleeding or spotting, breast pain, stomach cramps |
| Estrace (estradiol) vaginal cream | Hormonal therapy (estrogens) | Vaginal | 1 gram inserted vaginally one to three times weekly; dosage may vary | Vaginal bleeding or spotting, breast pain, stomach cramps |
| Estring (estradiol) vaginal ring | Hormonal therapy (estrogens) | Vaginal | 1 ring inserted vaginally every 3 months (may be given along with progestin) | Vaginal bleeding or spotting, breast pain, stomach cramps |
| Evista (raloxifene) | Selective estrogen receptor modulators (SERM) | Oral | 1 tablet by mouth daily | Hot flashes, muscle and joint pain, headache, weight gain |
| Osphena (ospemifene) | Selective estrogen receptor modulators (SERM) | Oral | 1 tablet by mouth daily | Vaginal discharge, hot flashes, muscle spasms, headache |
| Premarin (conjugated estrogens) | Hormonal therapy (estrogens) | Oral | 1 tablet by mouth daily | Vaginal bleeding or spotting, breast pain, stomach cramps |
| Prempro (estrogens/medroxyprogesterone) | Hormonal therapy (combination) | Oral | 1 tablet by mouth daily | Vaginal bleeding or spotting, breast pain, stomach cramps |
| Veozah (fezolinetant) Check pharmacy for availability information | Neurokinin 3 receptor antagonist | Oral | 1 tablet by mouth daily | Stomach and back pain, diarrhea, insomnia, hot flashes |
| Vivelle-Dot (estradiol) transdermal patch | Hormonal therapy (estrogens) | Transdermal | 1 patch applied to the skin twice weekly | Vaginal bleeding or spotting, breast pain, stomach cramps |
What is the best home remedy for menopause?
Although not a substitute for medication prescribed by your healthcare provider, some women find benefits in home remedies in reducing menopause symptoms.Dietary supplements
Talk to a healthcare provider before trying any dietary supplement. Popular menopause supplements, such as black cohosh, have not been proven to be effective. Certain supplements may also interact with medications or medical conditions.Mind-body therapy
Some people benefit from mind-body therapies such as massage, meditation, yoga, acupuncture, and breathing exercises. However, clinical trials regarding these interventions are limited.Lifestyle changes
Lifestyle changes can help reduce some menopause symptoms (as well as related conditions). Some tips include:
- Exercise for at least 30 minutes, five days per week.
- Maintain a healthy weight.
- Include plenty of fruits, vegetables, lean proteins, and whole grains in your diet—as well as calcium to help keep bones strong
- Stop smoking or vaping
- Decrease alcohol intake
- Manage stress
- Keep all doctor’s appointments and get preventive vaccines and testing such as mammograms, colonoscopies, and others
- Sip ice cold water throughout the day, especially when you feel a hot flash starting.
- Dress in lightweight layers, so you can add or remove a layer of clothing as needed.
- Keep a fan by your bed. You can also keep a small fan at your workplace.
- Keep your bedroom cool and sleep in lightweight clothing.
- Take slow, deep breaths when you feel a hot flash starting.
Vaginal lubricants
Women who experience vaginal dryness may benefit from a vaginal lubricant. While not as effective as vaginal estrogen, there are over-the-counter vaginal lubricants that can be applied before and during sexual activity. Those with more severe dryness may require vaginal estrogen in addition to lubricants. There are also longer-acting vaginal lubricants that are applied every one to three days, on a regular basis.Frequently asked questions about menopause
What is the best treatment for menopause?
The best treatment for menopause varies based on symptoms and other individual factors such as other medical conditions or health problems, risk factors, other medications you take, and more. Talk to a healthcare provider about the best treatment for your menopause symptoms.How can I treat my menopause naturally?
You can discuss natural treatments with your healthcare provider. Some natural methods or lifestyle changes may help, possibly in combination with your prescription medication, if required. Some natural methods to reduce menopause symptoms include massage, meditation, yoga, acupuncture, and breathing exercises—combined with lifestyle changes like a healthy diet, increased physical activity, and limited alcohol intake.What is the first-line treatment for menopause?
The most effective treatment for hot flashes in menopausal women is considered to be estrogen, taken alone or in combination with a progestin. However, this treatment is not appropriate for everyone, so talk to a healthcare provider about the best treatment for you.What medications do doctors prescribe for menopause?
Although treatment will vary based on individual factors, commonly prescribed medications include hormone therapy, selective estrogen receptor modulators, and SSRI antidepressants. In many cases, other medication may be needed for associated conditions, such as Neurontin (gabapentin) for hot flashes, or a bisphosphonate such as Fosamax (alendronate) for bone loss.Does estrogen make you gain weight?
The decrease in estrogen and progesterone that occurs during perimenopause (the time before menopause when the ovaries gradually stop working) and menopause can actually cause weight gain. However, hormone therapy with estrogen will not help you lose weight and may cause some bloating. Experts recommend a healthy diet and exercise to combat weight gain associated with menopause. Consult with a healthcare provider for more help or professional medical advice about weight loss.Related resources for menopause
- Menopause, National Institutes of Health
- Menopause, U.S. Department of Health & Human Services
- Menopause treatment, Endocrine Society
- Hot flashes: what can I do?, National Institute on Aging
- What is menopause?, National Institute on Aging