What Are the Best Medical Treatments for Menopause?

When it comes to the perimenopause-to-menopause journey, you could let your symptoms knock you over like a pin in a bowling alley. Or, you could decide, “I’m not the pin, I’m the bowling ball!” and spare yourself the stress while striking down the voices that tell you you can’t conquer this life stage. You know what they say (who is “they” anyway?): Knowledge is power. This couldn’t be truer than during The Big M. After all, one of the best ways to empower your menopausal self is to know your options for everything from self-care strategies to medical treatments for menopause.

What Are All of My Menopausal Treatment Options?

How do you know which menopause treatment is best for you? Consider your options as pieces of a metaphorical pie. (Metaphorical pie is totally calorie-free!) Each piece represents a different choice that you can familiarize yourself with and eat one bite at a time. For example, you could start with a slice of positive mindset and then munch on preventative maintenance or self-care. Hungry for more? Try prescribed and non-prescribed treatments, such as hormone replacement therapy, essential oils, vitamins, supplements, etc. Then, enjoy a huge helping of professional help, such as talk therapy, pelvic floor specialists (to help with vaginal exercises or painful sex), an intuitive eating coach, or other experts who can help with your specific needs.

Ready to sink your teeth into one of the most important slices of this metaphorical pie—prescribed options? “What?,” you say. “My gyno is an old guy who has absolutely no idea what I’m going through. He’ll probably just prescribe me an antidepressant, pat my shoulder, and send me on my way. Or worse, tell me my symptoms are all in my head.” If that’s the case, your first step is to get another doctor (or better yet, create a whole health professional team)! You may even want to check out the menopause specialists at menopause.org. As with all the slices in your menopausal pie, you’ve got options when it comes to medical treatments for menopause. The first step is to get informed. So, serve up a slice of knowledge.

What Type of Prescription Medications Help Manage Menopause?

The best thing about medical treatments for menopause? You have a lot of options. Think of it like a fun shopping trip to Target. (Pronounced Targé, if you’re feeling French.) You can browse the seemingly endless aisles filled with a variety of products (most of which you don’t even need, amiright?) and pick those that are a fit for you. Unlike getting your shopping fix at Target though, medical treatments—those prescribed by a doctor—come in two categories: basic and other.

Basic Medical Treatments for Menopause

Medical treatments that fall into the “basic” category are those which doctors most often prescribe and tend to address the most common symptoms of menopause. These meds that help you manage Big M maladies include:

Birth control
Hormone replacement therapy
Selective serotonin reuptake inhibitors (SSRIs: anti-anxiety and antidepressants)
Testosterone

Note: Unlike essential oils and many supplements and vitamins, prescribed medicine such as those included in the basic and other medical treatment categories, falls into the “drug” category. They can treat or cure disease and illnesses (including menopausal symptoms) and are regulated by the Food and Drug Administration. As such, even to make it to market, these medical treatments go through stringent testing, involving thousands of humans. All medical treatments for menopause shared in this post follow the FDA’s drug review process, ensuring drugs are safe and effective.

Other Menopause Meds

The “other” category of treatments for menopause symptoms addresses specific, less-common ailments.

Note: Regardless of which option you choose and which meds you take, tracking your symptoms and meeting with an expert for your specific ailment is key in getting just the right medical treatments for menopause. As always, get educated and make decisions based on what is best for you.

What Are the Best Basic Medical Treatments for Menopause?

Birth Control

What Is Hormonal Birth Control?

Hormonal birth control is a form of hormone replacement therapy (HRT), although it might come in ways that conventional HRT does not (e.g., IUDs). You might not think that birth control would be something you would have to worry about anymore at this older (and wiser) age, but if you’re in the early stage of menopause—called perimenopause—and you are still ovulating, getting pregnant is still a possibility. Birth control offers the dual benefit of preventing pregnancy while regulating your hormones. It’s a two-fer, baby! (Or in this case, no-baby!)

Typically, if your periods have started becoming irregular but you’re not really experiencing any other symptoms of menopause, low-dose birth control, which contains only .1 to .35 mg of estrogen, can do the trick. The dosage can be increased if necessary. Regular-dose birth control can contain only estrogen, only progesterone, or both, and may be needed if you have heavier-than-normal, longer-than-normal, or more-frequent-than-normal periods.

What Does Hormonal Birth Control Primarily Treat?

Dr. Christiane Northrup, author of The Wisdom of Menopause, says that birth control pills are a convenient way to put the perimenopausal body and its symptoms on autopilot until it’s time to transition to conventional hormone therapy. Hormonal birth control is primarily used to regulate periods if you still have them.

What Are the Pros of Birth Control for Perimenopausal Women?

We all love cycles that are more regular and involve less bleeding, right? Besides those benefits and the pregnancy-inhibiting benefits, oral hormonal birth control pills may also:

Make your monthly Aunt Flo visits more regular.
Reduce menstrual bleeding.
Decrease cramping during menstruation.
Decrease risk of ovarian and uterine cancer.
Reduce hot flashes.
Maintain bone strength.
Decrease acne occurrences.

What Are the Cons of Birth Control for Perimenopausal Women?

Like every other option available, birth control also has some downsides. Birth control pills are said to increase the risk of blood clots and may be associated with some increase in the risk of heart attack, stroke, and breast cancer. Birth control pills can also mask signs of menopause—like menstrual irregularities—which can make it difficult to know when you actually enter menopause (the day marking when you haven’t had a period for a year). Not knowing where you are in the transition can make it difficult to know exactly what your body needs.

Is Hormonal Birth Control for Everyone?

It’s really up to you whether hormonal birth control is right for you. If it’s been at least 12 months since your last period, you’ll probably do better on hormone replacement therapy. If you’re still having periods, but they’re irregular, hormonal birth control is an option you’ll want to discuss with your doctor. Some perimenopausal people love how they feel on the pill; some women hate it! It’s all about how you feel! Going with your gut is a great rule when it comes to choosing medical treatments for menopause.

Hormone Replacement Therapy (HRT or HT)

What Is HRT?

HRT is likely the first menopausal treatment option you’ll hear about in any doctor’s office or read about in any book on menopause. Forewarning: It can be a controversial topic and people may voice strong feelings when discussing it. The underlying cause of most menopausal symptoms is an instrument or two playing off-key in the delicate orchestra that is your body’s hormones. Who are we kidding? Some of those instruments (hormones) might just have decided to run away with the melody and improvise a whole new tune ! Let’s face it: jazz and rock are each great, but they don’t exactly work together.

Hormone replacement therapy instructs them to play in harmony so that you can feel better. When your hormones (i.e. estrogen, progesterone, and yes, even testosterone) are balanced and in sufficient quantities, you’re better able to handle those hot flashes, ramp down any anxiety or depression, and otherwise love yourself and your body through the menopausal transition.

You may wonder what the difference is between birth control and hormone replacement therapy, since most forms of birth control and all forms of HRT involve hormones. Hormone replacement therapy is what you want to take if you’re experiencing hot flashes, night sweats, insomnia, mood swings, vaginal dryness, or other menopause symptoms so severely that they’re affecting your quality of life. You’ll generally take HRT for a longer amount of time than birth control, since some symptoms can go on for years, even after your last period. The estrogen in HRT is what helps most with symptoms like hot flashes and vaginal dryness; progesterone is added to protect against uterine cancer for women who have not had a hysterectomy.

What Does HRT Primarily Treat?

While there are a lot of options just within the HRT realm—synthetic vs. bioidentical, just estrogen (called estrogen replacement therapy), just progesterone, estrogen plus progesterone, oral, patch, pellet, cream, etc., etc.—they’re all primarily used to treat or ameliorate the most common menopausal symptoms. It can also help mask the heart palpitations and irritability often associated with perimenopause and promote healthy sleep (especially when natural progesterone is used).

Unfortunately, it is not an easy fix that can magically transport you back to your premenopause days. (For that, you’ll have to wait a few years, until we’ve developed Star Trek-level technology.) But It can help you navigate menopause more like the rockstar you are. Plus, who said we need to go back to our premenopause days anyway? This is your chance to not let menopause rule your life, but instead go rock midlife harder than a hair band groupie who just got a fresh perm.

What Are the Pros of HRT?

Besides alleviating some of the most common symptoms of menopause, HRT also has been shown to reduce the risks of cardiovascular disease, high cholesterol, osteoporosis, dementia, some cancers, diabetes, and osteoarthritis. Also, I’ve been told it can improve mood and an overall sense of well-being in some people . I’m always in the mood to be in a better mood!

What Are the Cons of HRT?

Although some very large studies have explored the risks of HRT and the science behind it is still evolving, what we do know is this: for most people, the benefits far outweigh the risks, depending on the type of HRT they choose to take, the dosage, the length of time they take it, and other factors. Generally, the risks include:

An increased risk of endometrial cancer (only if you still have your uterus and are not taking a progestin along with estrogen)
Increased risk of blood clots and stroke
Increased chance of gallbladder/gallstone problems
Increased risk of dementia if hormone replacement therapy is started after midlife. (HT started during midlife is associated with a reduced risk of Alzheimer’s disease and dementia.)

Then, of course there are those “lovely” side effects to consider—like nausea, breast tenderness, or leg cramps—although they tend to disappear after a few months. As always, just keeping it as real with you about the cons as I do with the pros.

Is HRT for Everyone?

HRT isn’t for everyone, especially if you have existing cardiovascular disease, a history of blood clots, an already increased risk of stroke, severe liver disease, abnormal vaginal bleeding that hasn’t been evaluated, or if you have or have had breast or endometrial cancer. Also, if you start taking it and have any kind of adverse reaction, talk to a doctor immediately. That could mean that you need to go off of HT or that you just need to adjust your dosage or preparation (i.e., cream, tablet, gel, spray, etc.).

Antidepressants

What Are Antidepressants?

Many people are, in fact, prescribed antidepressants as an initial treatment before HRT. Amanda Thebe, fitness expert and author of Menopocalypse: How I Learned to Thrive During Menopause and How You Can Too, says that “some antidepressants do … offer some off-label benefits … like relief from … hot flashes and night sweats.” If you’re not a good candidate for HRT, either because you choose to avoid it or you have other health conditions, then antidepressants might be a good alternative. As always, talk to your healthcare provider about all options.

What Do Antidepressants Primarily Treat?

Antidepressants relieve depression, hot flashes, and night sweats, as well as anxiety. So if you’re wondering if Prozac can help with the depression of menopause, the answer is yes! Popular antidepressants include fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft). Antidepressants tend to be either SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin and noradrenaline reuptake inhibitors), which treat not only depression, but also long-term pain and anxiety. They do this in part by increasing the availability of serotonin in your brain.

What Are the Pros of Antidepressants?

For some people on The Big M Express, they are lifesavers, once they’re able to find the kind and dosage that works best for them. While they’re not a cure-all, some antidepressants do also offer a sedative effect, so they can help you sleep better, and, as mentioned, they help with those pesky hot flashes. It can be hard to know when or if you need an antidepressant (i.e., if you’re experiencing the temporary blues or the harder-to-deal-with, I’m-going-to-be-in-menopause forever depression), so talk with your doctor. Your health care team can be your best allies when it comes to determining if you need an antidepressant and what kind and how much, or if changes in your lifestyle, diet, exercise, and adding things like meditation practices will do the trick.

What Are the Cons of Antidepressants?

Antidepressant side effects differ depending on which type you take, but can include:

Headaches
Dizziness
Nausea
Loss of appetite
Nervousness
Insomnia
Restless Leg Syndrome
Sexual dysfunction

As with any of these medications, you may experience all or none of these side effects. The only way to find out is to be open to experimentation, looking at whether your particular pros outweigh your particular cons.

Anti-Anxiety Medications

What Are Anti-Anxiety Medications?

If you feel like the world might end because you didn’t start defrosting the chicken you’re cooking for dinner early enough, that’s not reality talking, it’s the anxiety of menopause. Anxiety includes catastrophizing and excessive worrying or apprehension, leading to compulsive actions or panicking. If you feel that way more than once, anxiety is new to you, and you’re in the stages of menopause, talking to a therapist and then, to a medical doctor about anti-anxiety medications, is a great first step to helping ease your symptoms.

What Do Anti-Anxiety Medications Usually Treat?

Anti-anxiety meds, similar to antidepressants, tend to be either SSRIs or SNRIs, and are primarily used to help beat the anxiety monster into submission. As just one example, Buspar (Buspirone), one of the most-common anti-anxiety medications, affects chemicals in the brain that may be unbalanced in people with anxiety. Specifically, it treats anxiety disorders or symptoms of anxiety, such as fear, tension, irritability, dizziness, pounding heartbeat, and other physical symptoms. Depending on your hormonal situation, you may opt to take them in addition to HRT or birth control.

Note: For more information, view this quick, 2-minute video to see how SSRIs and SNRIs work.

What Are the Pros of Anti-Anxiety Medications?

As with antidepressants, anti-anxiety medications can make a big difference for some women—depending on the type and dosage—not only in terms of mood but also in reduction of hot flashes. Again, talk with your doctor to assess whether you’re in full-on anxiety or even panic mode; if you’re not already chucking the cheesecakes and bumping up the burpies, he or she may suggest doing those things first or in addition to the anti-anxiety medications.

What Are the Cons of Anti-Anxiety Medications?

Consistency is very important with anti-anxiety medications like buspar, meaning they’re pills that have to be taken at the same times each day and either consistently with or without food.

Some anti-anxiety medications are benzodiazepines, which work slightly differently than SSRIs or SNRIs by enhancing the activity of the neurotransmitter GABA, your friendly, calming brain chemical. The Centre for Addiction and Mental Health, Canada’s largest mental health teaching hospital and one of the world’s leading research centers, reports that “when used on occasion or daily for a few weeks, benzodiazepines have a low risk of addiction. This risk increases, however, when benzodiazepines are taken regularly for more than a few weeks, especially when they are taken in higher than normal doses. People with a history of substance abuse should avoid or minimize use of benzodiazepines as they are at higher risk of becoming addicted.”

Hormone-Free Medications

If hormones aren’t your thing, then you still have options. Here are hormone-free prescription treatment options:

Gabapentin (Neurontin): Dr. Stephanie S. Faubion, director of the Mayo Clinic Women’s Health Clinic and the Office of Women’s Health, says this medication, which is typically used to prevent seizures, has also “proved effective in treating hot flashes. The typical treatment requires taking pills three times a day, which some women may find burdensome. Gabapentin [also] has a sedative effect…so it may be a better choice than antidepressants if night sweats are your primary complaint.” [source]
Pregabalin (Lyrica): Though some preliminary studies have shown this drug to be effective in treating hot flashes, it hasn’t been studied extensively in menopausal women.
Testosterone: Low testosterone, which your doctor would determine from a blood test, can cause fatigue, low libido, and impaired cognitive ability. If these are your main symptoms, you may benefit from a supplemental dose.

Other Medical Treatment for Menopause Options (Symptom-Specific)

Joint Pain: Diclofenac (Voltaren)

I bet you never thought that joint pain could be one way that menopause manifests itself. But, joint pain can, in fact, be one of the various ways that menopause can trample on your “I’m-doing-fine” party. Other symptoms can include sleep problems, fatigue, dry skin, tinnitus, and worsening allergies. So what’s a menopausal warrior to do?

Joint pain (technical term: arthralgia, for all you sciency-types out there) is experienced by more than 50% of people around the time of menopause, according to this study. The causes of joint pain in postmenopausal people can be difficult to determine as middle-aged women also tend to have rising incidences of rheumatic conditions like osteoarthritis. Nevertheless, it can be one more thing caused by your estrogen levels bidding adieu.

Your doctor will want to ascertain as best as possible what the underlying cause of your joint pain is first. If the cause isn’t obviously menopause-related, he or she may prescribe oral medications like Diclofenac for osteoarthritis, the most common type of arthritis. Diclofenac is an NSAID (non-steroidal anti-inflammatory drug).

What Are the Pros of Diclofenac?

Diclofenac works by stopping the body’s production of a substance that causes pain. If joint pain is a problem you’re experiencing, then your doctor may also prescribe celecoxib (a.k.a Celebrex) or even Duloxetine, which not only helps alleviate joint pain but is also an antidepressant and anti-anxiolytic (anti-anxiety) medication.

What Are the Cons of Diclofenac?

Diclofenac is actually available both over-the-counter, as an NSAID that can relieve joint pain from arthritis in the knees, ankles, feet, elbows, wrists, and hands. Prescription diclofenac is mainly used to relieve osteoarthritic pain in the knees. Both are gels.

Diclofenac has many possible mild and severe side effects. MedLinePlus.gov, part of the U.S. National Library of Medicine, says the mild ones can include:

Dryness, redness, itching, swelling, pain, hardness, irritation, swelling, scaling, or numbness at application site
Acne
Stomach pain
Constipation
Gas
Dizziness
Numbness, burning, or tingling in the hands, arms, feet, or legs.

These side effects are more rare, but can be more severe:

Hives
Itching
Difficulty swallowing
Swelling of the face, throat, arms, or hands
Unexplained weight gain
Shortness of breath or difficulty breathing
Swelling in the abdomen, ankles, feet, or legs
Wheezing
Worsening of asthma
Yellowing of the skin or eyes
Nausea
Extreme tiredness
Unusual bleeding or bruising
Lack of energy
Loss of appetite
Pain in the upper right part of the stomach
Flu-like symptoms
Dark-colored urine
Rash
Blisters on skin
Fever
Pale skin
Fast heartbeat
Excessive tiredness

High Blood Pressure: Clonidine (Catapres, Kapvay, Nexiclo)

What’s one of the main things that decreases during menopause? Estrogen levels. With a decrease in estrogen levels comes all sorts of fun side effects like a potential for high blood pressure. According to Dr. Deepak Bhatt, professor of medicine at Harvard Medical School, and director of the Integrated Interventional Cardiovascular Program at Brigham and Women’s Hospital, “Blood pressure is really a tricky disease,” he adds. “The risk of developing high blood pressure over a lifetime is extremely high if a person lives long enough.”

The fine folks at Harvard went on to explain that it’s “especially true in women after menopause, when blood pressure may rise. By the time they reach their 60s and 70s, 70% of women have high blood pressure. After age 75, that figure rises to nearly 80%, according to the CDC.”

Go get your blood pressure checked regularly and talk to your healthcare provider about options. For example, Clonidine is a non-hormonal treatment that has been used for many years to lower blood pressure, prevent migraines, and treat hot flashes (or “hot flushes,” for you bright-as-a-button British women).

What Are the Pros of Clonidine?

Uh, less pressure. That’s a good thing all the way around! According to the Royal Women’s Hospital of Victoria, Australia, Clonidine can also prevent migraine headache and reduce menopausal hot flushes (I’m sensing a “football” vs. “soccer” debate coming on; it appears that only in the U.S. are they called “hot flashes;” everywhere else, they’re “hot flushes.”). Clonidine treats high blood pressure by essentially decreasing your heart rate and telling your blood vessels to relax so that blood can flow more easily through your body. Let’s keep the pressure to our Queen and Billy Joel song selections, shall we?

What Are the Cons of Clonidine?

Common side effects can include dry mouth, drowsiness, dizziness, constipation, and difficulty sleeping. The Mayo Clinic states that Clonidine may be prescribed with other medications to achieve the desired effect, so there are, as with any medication, the possibility of not-great drug interactions, as well as some less common and rare side effects.

Osteoporosis: Bisphosphonates

We already know as we grow older our bones become weaker, right? This bone-aging process speeds up during menopause due to hormonal changes. The process slows down during the postmenopausal years, but does not stop completely. How do you fight that bone-depreciating-bully? With another “B” word: Bisphosphonates.

Bisphosphonates are drugs that bind to bone mineral. Who knew science could be so cool? Some common biphosphonates are:

Alendronate (Fosamax), which is a weekly pill
Risedronate (Actonel), which is a weekly or monthly pill
Ibandronate (Boniva), which is a monthly pill or quarterly IV infusion
Zoledronic acid (Reclast), which is an annual IV infusion

What are the pros of biphosphonates?

Stronger bones? Yes please! According to the Cleveland Clinic: “Bisphosphonate osteoporosis treatments are considered antiresorbtive drugs. They stop the body from re-absorbing bone tissue. In other words, they help the bone tissue where it needs to be: on your bones. Interestingly, you may be able to stop taking bisphosphonates after three to five years and still get benefits after you stop.

What Are the Cons of Biphosphonates?

The most common side effects of biphosphonates are upset stomach issues and heartburn, because they aren’t absorbed very well by the stomach. It might be best to take them on an empty stomach with lots of water.

Breast Cancer: Tamoxifen

First, let me be VERY CLEAR: breast cancer is NOT a typical symptom of menopause nor is menopause associated with a higher risk of breast cancer. However, says WebMD, “the rates of various cancers, including breast cancer, do increase with age.” Plus, some drugs prescribed to manage menopausal symptoms may increase or decrease a woman’s cancer risk. Tamoxifen is a drug that may head breast cancer off altogether [source]. Whoa!

In order to grow, breast cancer needs estrogen or progesterone (or sometimes both), which are hormones our bodies naturally produce before menopause, produce erratically during perimenopause, and not at all during postmenopause. Tamoxifen is a type of hormonal therapy also known as a selective estrogen receptor modulator (SERM), meaning that the drug attaches to specific hormone receptors or proteins in breast cancer cells. Once it’s absorbed by the cells, it stops the cancer cells from accessing the hormones it needs to grow. It’s like little teeny tiny force fields around those nasty breast cancer cells, preventing them from running amok, just like the force fields on Star Trek help dangerous criminals in the Enterprise brig!

What Are the Pros of Tamoxifen?

According to BreastCancer.org, Tamoxifen has been used to treat millions of women and men diagnosed with hormone-receptor-positive breast cancer since 1998. “While an aromatase inhibitor is the first hormonal therapy medicine choice for postmenopausal women, tamoxifen is the first choice for premenopausal women and is still a good choice for postmenopausal women who can’t take an aromatase inhibitor.

Tamoxifen can:

Reduce the risk of breast cancer coming back by 40% to 50% in postmenopausal women and by 30% to 50% in premenopausal women.
Reduce the risk of a new cancer developing in the other breast by about 50%.
Shrink large, hormone-receptor-positive breast cancers before surgery.
Slow or stop the growth of advanced (metastatic) hormone-receptor-positive breast cancer in both pre- and postmenopausal women.
Lower breast cancer risk in women who have a higher-than-average risk of disease but have not been diagnosed.”

Also, because it’s a SERM, it either blocks or activates estrogen’s action on specific cells. While tamoxifen blocks estrogen’s action on breast cells, it activates estrogen’s action in bone and liver cells. So tamoxifen can also:

Help stop bone loss after menopause.
Lower cholesterol levels.

It’s a Wrap!

Wow! The topic of medical treatments for menopause is one of the biggest and most dense slices of the metaphorical, menopausal pie. You may be feeling like you need a knowledge antacid! I get it, there’s a lot to learn and process. You’re probably either excited about all of these options or overwhelmed, in which case I recommend you go a la mode and pull out the not-at-all-metaphorical Caramello or Rocky Road ice cream right now and set a reminder to make an appointment with your doctor. Drop your overwhelm in your professionals’ laps and let them help make your decision making easier. Keep in mind, though, that:

It may take time to work out your own menopause medical treatment plan, because you are your own special you, even through menopause.
None of these options will work at their maximum level if you’re not also giving yourself self-care (let’s face it: it’s a necessity these days, not a luxury), eating well, exercising, and avoiding things that can make your symptoms worse.

Remember: Empower and educate yourself and work with the right health professionals. If you do, you’ll kick to the curb any menopausal symptoms that are sucking the life out of, what can and should be, your best life phase yet. You’ve got this!

Sources

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