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Menopause - Treating the symptoms of menopause

NHS Choices Medical Reference

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Many women do not need treatment for the menopause, with about one in 10 women seeking medical advice.

If your symptoms are mild, you may be able to manage them yourself, without medication. Read more about self-help for managing your menopausal symptoms.

However, if your symptoms are more severe and are interfering with your day-to-day life, medication may be recommended.

Treatment options include:

The type of treatment suitable for you will depend on your symptoms, medical history and your own preferences.

HRT and tibolone do not provide contraceptive protection, and although your fertility will decrease during the menopause, it may still be possible for you to conceive. You should 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 various treatments for the menopause are outlined below.

Hormone replacement therapy

Hormone replacement therapy (HRT) is effective in treating a number  of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms and urinary tract infections, such as cystitis.

In the long-term, HRT can also reduce the risk of osteoporosis (weak and brittle bones) and combined HRT (see below) can reduce your risk of developing bowel cancer.

HRT works by replacing the female sex hormone, oestrogen, which naturally begins to decrease as the menopause approaches. There are three main types of HRT:

  • oestrogen-only HRT - recommended for women who have had their womb and ovaries removed; if oestrogen is taken on its own it can thicken the womb lining, increasing your risk of cancer
  • combined HRT - for women who are experiencing menopausal symptoms but are still having periods (you take both oestrogen and progestogen)
  • continuous HRT - for post-menopausal women

HRT is available as a cream or gel, a tablet, a skin patch or an implant.

A number of side effects are associated with HRT, including weight gain, tender breasts, nausea, headaches and mood changes. You may be able to be reduce any side effects that you have by changing the type or dose of HRT that you are using.

Your GP will be able to give you further information about the risks and benefits of HRT.

Read more about HRT, including how it is taken, side effects and risks.

Tibolone

Tibolone is a synthetic (man-made) hormone that acts in the same way as HRT. It may be recommended as an alternative to combined HRT 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 also 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 cancercancer of the womb and stroke. It is not suitable for women over 60 years of age.

Clonidine

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

Clonidine can cause unpleasant side effects including dry mouth, drowsiness, depressionconstipation and fluid retention.

You will need to take it for a trial period of two-four weeks to see whether 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 that 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, including:

Potential side effects of these antidepressants can include nausea, dizziness, dry mouth, anxiety and sleeping problems.

Follow-up

If you are taking HRT, you will need to return to your GP for a follow-up review three months after starting the treatment 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
  • examine your breasts and show you how to do it yourself
  • remind you about the benefits and risks of HRT

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

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

Early menopause

A premature menopause is where a woman under 45 years of age experiences the menopause.

If you are under 40 years of age and you experience the menopause, your GP will refer you to a gynaecologist for treatment and to discuss your fertility (ability to conceive).

You will need treatment to ease your symptoms and prevent osteoporosis (brittle bones) which is more likely to occur as the level of oestrogen in your body decreases.

HRT and the combined contraceptive pill are recommended treatments because they both contain oestrogen and progestogen.

Read about Johanna's experience of having an early menopause.

Medical Review: March 25, 2012
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