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Menopause and Perimenopause - Treatment Overview
Menopause is a natural change that doesn't require treatment. But symptoms of hormonal change can be difficult. If you have insomnia, mood swings, hot flashes, cloudy thinking, heavy menstrual periods, or other menopause symptoms, treatment can help you manage this transition more comfortably. As you review your options, consider the following:
- Healthy lifestyle habits will help you reduce menopause symptoms. These habits include eating a balanced diet; reducing stress; getting regular exercise; and avoiding smoking, heavy caffeine, and heavy alcohol use. An unhealthy lifestyle can make symptoms worse.
- Low-dose hormone therapy (HT) or low-dose birth control pills may be an option if you are still having periods and have multiple or severe symptoms. Birth control pills aren't used after menopause because they contain higher levels of hormones than women need.
- After menopause, hormone therapy can be used as a short-term treatment for severe symptoms when taken in as low a dose as possible.
- You may only need a specific treatment for certain symptoms, such as hot flashes or vaginal dryness.
- Meditative breathing or supplements such as black cohosh or soy may help relieve symptoms.
Research has led to a big change in how doctors use hormone therapy after menopause. For a long time, estrogen-progestin, or hormone replacement therapy (HRT), was thought to protect against heart disease or dementia. But studies now show that HRT use can cause serious health problems in a small number of women. These health problems include dangerous blood clots, stroke, heart disease, breast cancer, ovarian cancer, and dementia.5, 6, 7 The heart disease risk does not seem to affect women during their first 10 years after menopause.8
Average HRT- and ERT-related risks are low among the general population of women. But your personal risk that hormone therapy may stimulate breast cancer, ovarian cancer, cardiovascular problems, blood clots, or neurological changes may be lower or higher, depending on your risk factors for those health problems.
Treatment options for menopause symptoms
Hot flashes. Meditative breathing exercises (paced respiration) have been shown to reduce hot flashes.9 Medicines that can improve hot flashes include short-term, low-dose hormone therapy, antidepressants, the high blood pressure medicine clonidine, and the antiseizure medicine gabapentin (Neurontin).10, 11
Heavy periods. The hormone progestin can help relieve heavy menstrual bleeding caused by very low or very high progesterone levels (after you have an exam to rule out other possible causes). Other options include nonsteroidal anti-inflammatory drugs (NSAIDs), the levonorgestrel (LNg) IUD, or birth control pills. For severe blood loss, some women choose permanent surgical treatment. These options include removing the uterus (hysterectomy) or using heat energy to damage and scar the wall of the uterus (endometrial ablation). For more information, see the topic Dysfunctional Uterine Bleeding.
WebMD Medical Reference from Healthwise
Menopause and Perimenopause Topics
VIVELLE-DOT (estradiol transdermal system) IS AVAILABLE BY PRESCRPTION ONLY.
INDICATION
Vivelle-Dot is used after menopause to: reduce moderate to severe hot flashes; treat moderate to severe dryness, itching and burning in or around the vagina; help reduce your chances of getting osteoporosis (thin weak bones); and treat certain conditions in which a young woman's ovaries do not produce enough estrogens naturally. Vivelle-Dot 0.025 mg/day is only used to prevent osteoporosis from menopause. If you use Vivelle-Dot only to treat your dryness, itching, and burning in and around your vagina or if you use Vivelle-Dot only to prevent osteoporosis from menopause, talk with your healthcare professional about whether a different treatment or medicine without estrogens might be better for you.
IMPORTANT SAFETY INFORMATION
Estrogens increase the chances of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb).
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes. Using estrogens with or without progestins may increase your chances of getting heart attacks, strokes, breast cancer, and blood clots. Using estrogens with progestins may increase your risk of dementia (decline in memory and thinking skills).
Vivelle-Dot should not be used if you have unusual vaginal bleeding; currently have or have had certain cancers, including cancer of the breast or uterus; had a stroke or heart attack in the recent past (for example, in the past year); currently have or have had blood clots; currently have or have had liver problems; or think you may be, or know that you are, pregnant.
The most common side effects that may occur with Vivelle-Dot are headache, breast tenderness, and back pain.
You and your healthcare professional should talk regularly about whether you still need treatment with Vivelle-Dot.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Full Prescribing Information for Vivelle-Dot.
Ob-Gyn Laura Corio talks about the importance of exercise during menopause.
