It’s fair to say that menopause is finally becoming recognized as something that has a major impact on women’s lives. This is fantastic news when it comes to validating the experiences of those navigating this transition; but with the good often comes the bad. An increased awareness of the impact of menopause, means plenty of products are being promoted. Many of these not only do next to nothing to reduce menopausal symptoms, they also happily exploit women’s suffering.

Symptoms caused by perimenopause and menopause can be challenging and impact many different parts of your life, so it’s understandable that people look for ways to improve how they’re feeling at this time.  Hormonally has created this no-nonsense guide to the treatments that will help you through this tricky transition.

The menopausal process can last for many years so it’s worth knowing the basics about the various treatment options available to you. It’s important to remember, there’s no one right approach. A combination of strategies usually work best for women, and these include:

  • healthy lifestyle changes
  • a few key supplements
  • hormone therapy (if it’s right for you)
  • moisturizers, lubricants and vaginal estrogen
  • support from a community
  • speaking to a therapist.

Lifestyle changes are crucial, but changes to exercise and diet can be hard if you’re struggling with a lack of energy and motivation. For this reason you may want to try a treatment like hormone therapy (HT) to improve your symptoms, and then when you’re feeling better, look to introduce healthier habits into your daily routines.

Are you wary of taking HT?

Make sure to read the lowdown on all things HT– it’s the most effective way to treat your symptoms and it’s backed by research and is regulated by the FDA.

If you want support with your menopause, it’s best to seek help when your symptoms first start, rather than letting them get worse. There are lots of online platforms that claim to treat menopausal symptoms, but your best option will be to speak to a qualified healthcare provider. While using HT is perfectly safe for most women, your doctor will want to make sure you are well in other areas of your life and take a thorough medical history before prescribing you this treatment.

To read more about the benefits of attending an in person appointment check out this hello hormones piece.

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What is in HT?
HT helps you to balance your estrogen, progesterone and testosterone. The levels of these hormones change during perimenopause and menopause, and it is the fluctuations of these hormone levels that cause symptoms. Stabilizing these hormone levels and returning your body to a state of ‘regularity’, helps symptoms to subside.

HT therefore, refers to the hormones estrogen, progesterone and testosterone. You might take just 1 of these hormones, 2 of them, or all 3 as part of your HT routine.

Estrogen – the specific type of estrogen in most HT today is 17 beta-estradiol. You can take estrogen as either a tablet that you swallow, or more commonly, as a skin-patch, gel or spray which is absorbed through the skin (this is called transdermal estrogen).

Most women find it is the estrogen component of HT that offers them the most relief from menopausal symptoms. Estrogen can improve your clarity of thought, your mood and help to reduce any vasomotor symptoms like hot flashes and night sweats.

Progesterone – if you wish to take estrogen and you still have a uterus, you’ll need to take a progesterone medication to counteract the effect that estrogen can have on the lining of your womb. Estrogen can thicken the cells that line the womb, and progesterone helps to keep the lining thin and healthy. The safest type of progesterone is called micronized progesterone and it comes in a capsule that you swallow.

The other popular way to take progesterone as part of a HT regime is to have a hormonal intrauterine device (commonly called an IUD) inserted. This offers a slow release of a progestin called levonorgestrel. The IUD also acts as an effective contraceptive.

Remember, until you have gone through menopause it is still possible for you to get pregnant!

An IUD is particularly popular among women who feel the effects of progesterone more. This is because the progesterone in an IUD is absorbed ‘locally’, which means your body doesn’t have to metabolize the hormone. Some women say this helps to reduce any progesterone side effects.

Testosterone – using testosterone replacement as part of a HT regime is a more recent development in menopausal care.

Women produce testosterone too and this hormone offers many different benefits. When levels of testosterone drop sharply at menopause, your libido, cognitive function and mood can all suffer.

Aside from being used in gender affirming settings, testosterone had only ever been used among cisgendered women, as a treatment for a lack of libido (sometimes termed hypoactive sexual desire disorder). More recently however, menopause practitioners have been prescribing testosterone as a way to treat menopausal symptoms that are not responding to estrogen therapy alone.

Some report that testosterone can improve: energy; motivation; brain fog; sleep; mood related symptoms; and of course, sex drive. When given in doses that stay within the correct range, testosterone has been found to bring benefits, and poses no risk of causing masculinizing effects.

There is currently a lack of research about testosterone replacement and its effectiveness in treating menopausal symptoms among women. Most evidence is ‘colloquial’, meaning it is based upon the accounts of patients and healthcare providers, as opposed to drawing on data from a clinical trial. This lack of research means testosterone has not yet been approved by the FDA as a recommended part of an HT regime.

If you think testosterone could benefit you, talk to a certified menopause practitioner about whether it may be right for you. Be wary of pellet testosterone options that are implanted under the skin, as the dosing of pellets is more difficult to control.

Is HT safe to use?

For years, Hormone Replacement Therapy (HRT) has been misrepresented as posing a risk to your health. Over 20 years ago, a study called The Women’s Health Initiative (WHI) linked the use of HRT to the development of breast cancer and heart disease.

Despite countless experts reporting that HT is safe and effective for most women to use, some media sources and many clinicians continue to suggest that HT is a dangerous treatment. As a result, fear and mistrust have tended to surround conversations about HT, and this has sadly meant may women have opted not to pursue treatment for their menopause and have suffered in silence.

Current evidence shows that HT not only provides effective relief for menopausal symptoms, but that it also helps to protect you against the onset of health conditions associated with aging (such as osteoporosis).  Some studies suggest there could be a relationship between estrogen and conditions such as Alzheimer’s and dementia, while others find the connection to be less convincing.

Because of this, it’s difficult to say for sure whether using something like HT could mean you are less likely to develop dementia. What we do know is that many women find that using hormones helps them to feel cognitively sharper.

Professional associations, such as the Menopause Society (previously the North American Menopause Society), the American College of Obstetrics and Gynecologists and the International Menopause Society, have all released position statements that advocate for using HT, recognizing it to be the best treatment to ease menopausal symptoms. It is still not the best choice for everyone, depending on your unique circumstances and health, but it’s certainly worth exploring and discussing with your clinician.

What HT option is best?

HT involves taking estrogen, progesterone (if you still have a uterus) and in some cases, testosterone.

Here are the different ways you can take HT:

Estrogen (estradiol) available in skin patch, gel, spray, tablet to swallow or tablet to dissolve under tongue.

Progesterone (or progestin) available in capsules to swallow, cream, via IUD, other types of birth control.

Testosterone available in gel, cream or implant.

As there are countless options to choose from, including creams, patches, gels, pills and now even lozenges, how do you even begin to think about which option is best for you?

It is best to seek care from an experienced menopause practitioner that prescribes HT regularly. Look for a clinician that is certified by the Menopause Society and ensure that they prescribe transdermal estrogen (estrogen that is absorbed through the skin), as this is widely recognized as the safest way to take this hormone. The hormones your clinician prescribes should be what’s called ‘bioidentical’. This type of hormone therapy mimics the molecular structure of the hormones that are naturally produced in your body.

Bioidentical hormones are derived primarily from yam or soy plants and are FDA approved. Most experienced menopause specialist physicians will prescribe this type of HT for you, but it’s a good idea to check!

What are the risks involved with using HT?

As with most things in life, nothing is 100% risk free. However, the risks of using HT is may be smaller than you may think. For example, there’s less risk using HT, than there is with using birth control.

Here’s what the research has shown about HT:

  • There’s no risk of a blood clot when estrogen is taken through the skin (e.g. via a patch, a gel, a spray) but there is a small increased risk of clot when you use an oral estrogen (a tablet that is swallowed)
  • No risks have been identified with micronized progesterone.
  • There is a very small risk your chances of developing breast cancer will increase if you are over the age of 51 and you take estrogen and progesterone. It’s worth remembering though, that you have more of a risk of developing breast cancer if you drink alcoholic beverages (wine or otherwise) every evening, smoke, have a higher than average body weight, or don’t exercise.
  • If you have relatives that have had breast cancer, taking HT does not mean you are at a greater risk of developing breast cancer.

HT is most beneficial when started before age 60, or within 10 years of menopause taking place. Remember, menopause is defined as going 12 consecutive months without a period.

Even though 80% of women and people born with ovaries will experience symptoms of menopause, a very small minority think about using HT. While this is changing and more women are exploring the benefits of using hormones, many still suffer in silence. The reasons why are complicated and relate often to: misconceptions about safety; a lack of awareness; cultural factors; a desire to navigate menopause ‘naturally’; financial barriers; and fears surrounding seeking support.

Despite menopause impacting all women, studies show that the use of HT varies considerably depending on your race. This demonstrates that menopause treatments still remain inaccessible for many women. The following shows how many women of different groups opt to use HT.
Black women – 2.5%
Asian women – 3.4%
Hispanic women – 8.2
White women – 11.3%

Again, there are lots of reasons as to why women may not want to use HT, but accessibility shouldn’t be one of them. Join our Hormone Allies community to help us make sure all women are able to access the care and support they need for their hormonal health.

Hormones and Headaches

If you suffer from migraine headaches you may have been told in the past to avoid using certain forms of birth control that contain the hormone estrogen. The exact definition of what a migraine headache is varies, but most clinicians agree that if your migraine headaches come with something called ‘aura’ (disturbances in your vision) you should avoid using forms of birth control that contain synthetic forms of estrogen. This is because you may be at a slightly increased risk of developing a blood clot or having a stroke. The type of estrogens used in menopausal treatments are, however, safe to use if you suffer with migraines. This is because most HT uses a different form of estrogen to most forms of birth control. Migraines should therefore not get in the way of you accessing treatment for your menopause.

Always talk to a healthcare professional before starting any form of HT. Your doctor will want to ensure that you complete a thorough medical assessment before prescribing you any medication. Equally, ensure you read the guidance included with any new medication you use. If you develop any concerning symptoms report these to your healthcare provider immediately!

During perimenopause and menopause, many women find they experience vulvovaginal symptoms. Things like dryness and discomfort down below, can have a big impact on your well being as well as take a toll on intimate relationships. The good news is, there are treatments available that can help with any discomfort you are experiencing around your vulva or inside your vagina. As well as HT you can also use an estrogen product that is applied directly to the vulval area and into the vagina.

This treatment can:

  • prevent thinning of the genital tissue
  • restore tissue that has already thinned
  • improve lubrication
  • ease discomfort
  • improve incontinence
  • reduce the occurrence of urinary tract infections (UTI’s).

You can choose from the following vaginal estrogen treatment options:
Pessaries/Suppositories – a pessary is inserted into the vagina with an applicator or your finger. The pessary will dissolve and only needs to be inserted once or twice a week.
Cream or gel – The product is applied with a finger or an applicator. At first, you may want to use the cream or gel daily to get maximum relief.
After 2 weeks you can reduce this to a maintenance dose of 2-3 times a week.
With the cream and gel, you can also spread it around your vulva if this area is sore or irritated.
A vaginal ring – A soft silicone ring is inserted by you or your doctor. This ring will release estrogen slowly over a three month period. The option of a ring is often preferred by women who don’t like the idea of using a cream or gel regularly.  The ring does not need to be removed for sex, however if it bothers you you can choose to remove it.

You may want to avoid sex on the evenings you use vaginal treatments, as it can get a little messy and small amounts of estrogen may be absorbed through the skin of your partner (which is best to avoid).

It can take a few months for vulvovaginal symptoms to improve, so it’s worth persevering with vaginal treatments for a while. The benefits are usually well worth it. Symptoms will also most likely return if you stop using these treatments.

Remember to always read the information provided with whatever product you purchase. Follow the application and dosage instructions clearly.

Prescription medicines

Medical treatments for menopause can be grouped into hormonal and non-hormonal options.

According to current evidence, HT is the most effective treatment option for menopausal symptoms. In some cases, contraception medications may also be used with the aim of improving certain symptoms.

Non-hormonal medications can sometimes be given to help with menopausal symptoms. Most often this will be an antidepressant. Some antidepressants reduce the number of hot flashes women experience and for some it can also help to improve mood. For others, antidepressants can actually make your symptoms worse. If you have been prescribed an antidepressant such as Zoloft or Prozac for your menopause, and you feel it is making your symptoms worse, be sure to tell your doctor about this, and ask for additional support with managing your symptoms.

Lifestyle measures

We’re all aware that changing our diets and exercising more can often make a big difference to our health. However, when it comes to reducing and managing symptoms of perimenopause and menopause, changes to your lifestyle really do make a big difference. Read our body and mind section for details on the ways you can help yourself through:

  • healthy nutrition
  • regular exercise and physical activity
  • avoiding drugs and limiting caffeine and alcohol intake
  • prioritizing good quality sleep
  • reducing stress
  • making time for self-care
  • nurturing personal and social connections.

Psychological therapies

Talking therapies such as Cognitive Behavioral Therapy (CBT) can be very helpful during perimenopause and menopause. CBT has been shown to be beneficial in not only helping the psychological and emotional changes women go through, but some studies suggest it can even help with physical symptoms like hot flashes too.

CBT can be a particularly good option if you can’t take HT for an additional health reason.

Supplements, sex and alternative therapies

Although there are plenty of herbal remedies that claim to help reduce menopause symptoms, the established more popular ones are black cohosh, St John’s Wort, red clover. The evidence that these help to improve symptoms is mixed, but some women do find them to be helpful.

Make sure supplements or remedies you take come from trusted sources and check they are not going to interact with other medication you take. Always buy them from a reputable supplier so you know exactly what you’re getting.

There are three supplements that are also worth a mention and you may want to think about including these in your daily routine.

Vitamin D – Many women are actually vitamin D deficient and find that taking a supplement (regardless of how often they are out in the sun) can make a big difference to their skin, hair and mood.
Calcium – A good quality calcium supplement can help to protect your bones if you are struggling to get enough calcium in your daily diet.
Magnesium – A magnesium supplement can help you to absorb calcium from the blood into your bone, in order to keep the bones strong. It also helps to balance glucose and may calm the nervous system which could help with headaches.

Many supplements claim to have ‘more’ of the recommended daily amount than is needed, and promote this as beneficial. The truth is however, you don’t actually need a higher dose than is recommended. The main thing to ensure is that your supplement is from a reputable source. A good rule of thumb is to ask your doctor what brands of supplement they would recommend. This avoids a google rabbit hole and the task of searching through what’s legitimate and what’s not! Our eating for healthy hormones resource has lots of information on diet and the recommended daily doses of nutrients you need.

As well as trying things like vaginal estrogen for symptoms down below, you may also want to think about introducing a vaginal moisturizer to your morning routine, and using a good quality lubricant when you have sex. These additions can make sex more comfortable and even increase your pleasure.

When it comes to lubricants and moisturizers, it’s worth spending a little more if you can afford too. Try to steer clear of anything with added fragrance or flavor, as these additions can upset your vaginal pH balance. Using a water based lubricant as opposed to something with a silicone base is best when choosing a lubricant as it’s less likely to cause irritation.

Finally, alternative therapies like aromatherapy, acupuncture, reiki, and reflexology do help some women manage their symptoms. These therapies may not have scientific research or backing, or be regulated in the same way as traditional medical interventions, but it doesn’t mean that many people don’t find these measures helpful.