Medical And Herbal Treatments For The Menopause
Some women will only experience mild menopausal symptoms and may not need any treatment at all; others may be able to manage their symptoms with lifestyle changes (read details on the Menopause Facts page).
However, some women experience difficult symptoms and will need further help and support. If this applies to you, talk to your GP to discuss available treatments.
Read through the information below to find out more, or you can download it as a factsheet.
What medical treatments are available to help with the symptoms of menopause?
Hormone replacement therapy (HRT) is the most effective medical treatment for symptoms of the menopause, and also helps protect your brain, heart and bones. All HRT contains the hormone oestrogen and, for women who have not had a hysterectomy, a progestogen (a synthetic form of progesterone).
HRT is available as tablets, gel or skin patches. You take tablets or apply gels every day and skin patches are usually changed twice weekly.
HRT patches are applied below the waist. If you have short arms, the best place to apply these might be the thighs as oppose to the buttocks.
HRT in the gel form can be applied in a greater variety of places than the patches, for example, legs, arms, shoulder or stomach (anywhere apart from the breasts or vulval area). This form of HRT may be easier to apply than the patches, but the disadvantage of the gel is that it is applied every day.
If you choose to take HRT, talk to your doctor about which would be the best way for you to take it – especially if you’re concerned it may be difficult to apply patches/gel and/or don’t like taking tablets.
Women who are prescribed HRT when they are still having periods will be given a type that still gives you monthly bleeds. However, as most of you will be post-menopausal (and will not have had a period in recent years) you will be given a type of HRT that does not give you a bleed.
Some women only need to take HRT for vaginal symptoms (such as dryness, soreness or painful sex). In this case, they may require only topical treatment (medication which is applied to skin or absorbed through mucous membranes) – a low dose oestrogen in the form of a pessary, cream or a silicone ring (inserted into the vagina).
The ring (called Estring in the UK) may be the best option for you if you have difficulty inserting the pessaries or cream into your vagina yourself as the Estring only has to be changed once every 3 months and could be done at your GP surgery. This might be the best option if you have short or no arms. You can take topical vaginal treatment in conjunction with systemic HRT (as above) or use it on its own.
Some women are unable to take HRT for medical reasons (for example if they have a hormone dependent cancer). In these cases, there are alternative medications which may help - like certain types of anti-depressants such as fluoxetine or venlafaxine. These can improve symptoms such as hot flushes, even in women who are not depressed.
Is HRT safe?
You may have heard, or read scare stories about the safety of HRT. Most of these came about following the results of some large studies, published more than 15 years ago. These studies raised concerns over the safety of HRT (in particular relating to heart disease and breast cancer).
However, since their publication, several of these studies have been shown to be flawed; the results were misinterpreted and inaccurate.
More up to date studies have shown numerous benefits of taking HRT and that any associated risks are very small.
For most women, if started within ten years of the menopause, below the age of 60, HRT has more benefits than risks and is generally safe and effective.
Within this in mind, as many of you are approaching 60, now would be a good time to approach your GP if you’re thinking about taking HRT to help with your menopausal symptoms.
What are the benefits of taking HRT?
HRT helps reduce symptoms of the menopause, and many women who choose to take it feel that they have regained their quality of life.
HRT also reduces your risk of osteoporosis (thinning of the bones), heart disease (if started within ten years of menopause) and colorectal (bowel) cancer (if taking combined HRT).
HRT is also very important for brain health in women who experience an early or premature menopause, and reduces their risk of developing dementia.
What are the risks of taking HRT?
If HRT is started within ten years of menopause, when you’re under 60, there is no increased risk of heart disease (a heart attack or stroke); in fact, as mentioned above, there is evidence that HRT appears to reduce this risk.
However, if HRT is started after the age of 60, there is possibly a very small increased risk (although we are not entirely clear why, and more research is needed). Nevertheless, a woman’s actual risk of developing heart disease depends on many things, such as family history, lifestyle and general health.
Some women do choose to start HRT when they’re over 60, if their menopausal symptoms are severe, and in these cases, tend to experience far more benefit than harm.
Many women worry about the risk of developing breast cancer on HRT. This is a complex subject, as breast cancer is a complex disease. If you are taking certain forms of combined HRT (both oestrogen and a progestogen), then you may have a small increased risk of breast cancer if you take it for more than five years. However, the overall increase in risk is very small, and taking HRT does not appear to increase a woman’s risk of dying from breast cancer.
Women who are overweight, who smoke, regularly drink alcohol, or do little to no exercise have a higher risk of developing breast cancer than those who choose to take HRT; so it’s important to put this into perspective if you think you may benefit from HRT. When you stop taking HRT, any associated increased risk of breast cancer returns to normal.
Women who have had a hysterectomy and are on oestrogen-only HRT have no increased risk of breast cancer. Likewise, there is no increased risk of breast cancer in women who take HRT under the age of 51.
For women who take HRT in tablet form, there is a small increased risk of developing a blood clot. This risk is greater for women who are overweight, who smoke, who have had a clot in the past, or who have a medical history of diabetes or migraine.
However, there is no increased risk of developing a blood clot if you take HRT in the form of a gel or patch (which means that women who do suffer with migraine, or have diabetes, for example, can take this form safely).
What are the side effects of HRT?
As with any new medication, there may be a few side effects when you first start HRT (although not everyone will experience these, by any means).
The most common side effects are nausea (feeling sick), breast tenderness and leg cramps. These usually settle within the first month (and usually within a few days).
Some women experience some vaginal spotting or irregular bleeding when they first start HRT. This usually happens in the first three to six months of treatment as your body gets used to the hormones. If any unscheduled bleeding happens after this time it’s very important that you see your doctor. Most of the time all that will be required will be a change in medication.
In some cases, you may be referred for an ultra-sound scan to check the thickness of the lining of your womb (again, this is rarely anything to worry about but may be important to rule out a more serious cause for your bleeding).
Are there any non-medical alternatives to HRT?
Some women choose not to take HRT, or are unable to take it for medical reasons.
There is some evidence that phyto-oestrogen supplements, which are plant-based oestrogens, such as soya and red clover, can improve menopausal symptoms. If you have a hormone dependent cancer, it would be worth talking to your oncologist as to whether phyto-oestrogen supplements can be used safely.
Herbal preparations, like black cohosh and sage, may also be helpful.
However, if you choose to go down the herbal route it is important to understand that herbal remedies may interact with other medications you’re taking.
Always discuss herbal medications with your doctor or a pharmacist before you start taking them.
If you buy herbal medicine over the counter, ensure that it has the THR registration (for quality standard and safety). You might want to consult with a trained medical herbalist who is registered with the National Institute of Medical Herbalists (NIMH), visit the NIMH website to find your nearest trained herbalist.
They can advise you on all your options and will be aware of possible interactions between herbs and prescribed medications.
In some cases, women have found cognitive-behavioural therapy (CBT), acupuncture and magnet therapy (e.g. the LadyCare magnet) helpful in managing their symptoms. Be aware, however, there is limited evidence to recommend their widespread use.
Need to know more about the menopause?
Call the Health and Wellbeing team, talk to one of our Medical Advisors on 01480 474074 or email us.