Women’s health centre

Only 1 in 10 women seek medical advice when they go through the menopause and many do not need any treatment. However, if your menopausal symptoms are severe enough to interfere with your daily life, there are treatments that can help.

The treatment options are:

• hormone replacement therapy (HRT)
• tibolone (similar to HRT)
• clonidine
• vaginal lubricants
• antidepressants

The kind of treatment you can take depends on your symptoms, medical history and your own preferences.

HRT and tibolone do not provide contraceptive protection, and although your fertility decreases during the menopause, it may still be possible for you to conceive. Therefore, continue to use contraception:

• for one year after your last period if you are over 50 years of age
• for two years after your last period if you are under 50 years of age

The treatments for menopause are detailed below.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is effective in treating several of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms and cystitis.

As the name suggests, HRT works by replacing oestrogen, which naturally begins to fall in the approach to menopause, causing menopausal symptoms. There are three main types:

• oestrogen-only HRT, for women who have had their womb and ovaries removed
• cyclical HRT, for women who are experiencing menopausal symptoms but are still having periods (you take both oestrogen and progestogen)
• continuous HRT, for women who are post-menopausal

HRT can be taken as a cream or gel, a tablet, a skin patch or an implant.

For more information on HRT, including how it is taken, who can use it, how it works, side effects and risks, go to Health A-Z: HRT.

Tibolone

Tibolone is a synthetic hormone that acts in the same way as HRT. It may be used as an alternative to combined HRT (which contains both oestrogen and progestogen) for post-menopausal women who want to end their periods.

Like HRT, tibolone is effective in treating menopausal symptoms such as hot flushes and night sweats, and it can help prevent fractures of the spine. It may also improve sexual problems, such as a decreased sex drive.

Tibolone carries some small risks, including a small increased risk of breast cancer, cancer of the womb and stroke. It is also not suitable for women over the age of 60.

Clonidine

Clonidine is a medicine that was originally designed to treat high blood pressure, but it may also reduce hot flushes and night sweats in some women.

However, it can sometimes cause unpleasant side effects including dry mouth, drowsiness, depression, constipation and fluid retention. If your GP prescribes clonidine, you will need to take it for a trial period of two to four weeks to see if it will be effective. If your symptoms do not improve during this time or if you experience side effects, the treatment should be stopped and you should return to your GP.

Vaginal lubricants

If you experience vaginal dryness, your GP can prescribe a vaginal lubricant or moisturiser, such as Replens, which can be used for as long as you like.

Antidepressants

Although they are not licensed for treating hot flushes, there are several antidepressant medications that may be effective for this, including:

• venlafaxine
• fluoxetine
• citalopram
• paroxetine

Side effects of these antidepressants may include nausea, dizziness, dry mouth, anxiety and problems sleeping.

Follow-up

If you are taking HRT, you will need to return to your GP for a follow-up review three months after starting HRT, and once a year after that. At your three-month review, your GP will:

• make sure your symptoms are under control
• ask you about any side effects and bleeding patterns
• check your blood pressure and weight

At your annual review, your GP will:

• review the type of HRT you are taking and make any necessary changes
• perform a breast examination and show you how to do it yourself
• remind you of the risks and benefits of HRT

If you are on a non-HRT treatment, you will need to return to your GP for a review of your treatment at least once a year. If your symptoms have stopped after one to two years of treatment, your GP may suggest a trial withdrawal of treatment.

Your symptoms may recur for a short while after you stop your treatment, but as long as this does not continue in the long term, you may be able to stop taking it permanently.