Treatment for menopause

Talking to somebody that you don’t already know is so helpful. Sometimes it’s so much easier to be open and honest with a stranger because they’re not going to judge you.

Hormone Replacement Therapy (HRT)

HRT replaces hormones that are at low levels because of menopause.

It can help treat physical and mental health symptoms of menopause. It may help on its own, or combined with other treatments like talking therapies.

There are three hormones involved in HRT:

• Oestrogen. Our bodies produce less oestrogen as we reach menopause. Replacing this oestrogen can help to treat the physical and mental health effects of menopause. It can also help to keep your bones strong.
• Progesterone. Taking oestrogen on its own can thicken the lining of your womb. This can slightly increase the risk of womb cancer. Progesterone protects your womb lining from this and reduces this risk. So if you have a womb, you'll need to take oestrogen with either progesterone or progestogen (medication which produces similar effects to progesterone). This is called combined HRT.
• Testosterone. If you're struggling with reduced sex drive, you may be offered testosterone if other treatments haven't worked. It can also improve mood and energy levels. Testosterone isn't a licensed treatment for menopause. But specialist doctors can prescribe it if they think it may help.

HRT can come in a combination of:

• Skin patches
• Gels or sprays to put on your skin
• Implants
• Tablets
• A coil placed inside your womb
• Creams

You may need to try different types and doses of HRT to find what works best for you. And what you need may change over time. Your doctor can help if you want to adjust your treatment.

The National Institute for Health and Care Excellence (NICE), recommends HRT as a treatment option for physical and mental health impacts of menopause.

Benefits and risks of HRT

Lots of people find HRT very helpful. It can make the symptoms of menopause go away, or reduce them. Or it may help you feel more able to cope or more like yourself again. It can also have other longer-term health benefits.

As with many treatments, there are possible side effects and risks that come with HRT. There's been lots of media coverage about the risks of HRT in the past. You might worry about this.

But past research and media stories have been criticised for overstating the risks. Recent research suggests that the risks are usually quite low. This is especially if you start taking HRT before you're 60.

The benefits and risks of taking HRT are different for different people. This could depend on any illnesses, treatments or hormone therapies you may have had in the past.

It's important to do what feels best for you. See our information on knowing whether a treatment is right for you.

You can also visit these websites for more information:

• The Menopause Charity - benefits of HRT
• NHS - benefits and risks of HRT
• NHS - side effects of HRT

I started my HRT journey. Firstly patches, these didn’t stick to my skin! Then tablets. Then I went onto the gel, which I am coping with now, but I do have regular check-ups with my GP to ensure the dose is correct as it does get adjusted periodically.

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of talking therapy. It focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour. It can also teach you coping skills.

You may have CBT individually, just you and the therapist. Or it might be as part of a group session. You may be able to have it in-person or online.

You could also try to learn CBT techniques by yourself using self-help books from your local library. Or by using free online apps.

CBT is a recommended treatment for the mental health effects of menopause. It may also help you manage physical effects, such as hot flushes or sleeping problems.

See our page on CBT to learn more.

Non-hormonal medications

There are some medications, other than HRT, which may help treat the symptoms of menopause. These include:

• Gabapentin - a drug often used to treat epilepsy. It can sometimes be used to treat menopause symptoms, such as hot flushes. If you have breast cancer, you may be offered this as an alternative to HRT. The NHS has more information about gabapentin.
• Clonidine - a drug used to prevent migraines, and to treat hot flushes or night sweats due to menopause. This may be offered as an alternative treatment if HRT isn't the right choice for you. The NHS has more information about clonidine.

Should I take antidepressants for menopause?

NICE guidelines recommend HRT and CBT as treatments for the mental health effects of menopause. Antidepressants are not recommended for treating the effects of menopause, unless you also have depression.

But some doctors prescribe antidepressants without considering HRT or CBT. This is even though the guidance says not to do this.

Some people find antidepressants helpful. You may be offered them as an alternative treatment for menopause if you can't take HRT. Or you may find it helpful to take both HRT and antidepressants if you struggle with depression generally.

Visit the Menopause Charity page on antidepressants and menopause to learn more. 

Complementary and alternative therapies

Some complementary and alternative therapies may help you manage or treat the effects of menopause.

But there isn't enough evidence on how safe or effective these treatments are. More research is needed.

Therapies could include body-based therapies such as aromatherapy, massage or acupuncture. Or herbal remedies such as black cohosh or soy isoflavones. It could also include things like meditation, mindfulness or yoga.

Some alternative therapies and herbal remedies can cause side effects. And they can interact with other drugs. If you're not sure whether something is safe, seek advice from your GP or pharmacist.

See our pages on complementary and alternative therapies. There's more information on the different types of treatments, what they may help with and how safe they are.

You may also find other types of therapy helpful. For example, other types of talking therapy or mindfulness-based therapies.

How do I know if a treatment is right for me?

It can be difficult to work out whether a treatment is right for you. These ideas may help you make sense of your options:

• Balance the possible benefits and risks. Think about how menopause is affecting your life and the ways a treatment could help. And about any side effects or risks. You could write these down or discuss them with your doctor or someone you trust.
• Think about your circumstances. This could include any other medications you currently use. Or any other health conditions. Speak to your doctor about any concerns you may have.
• Speak to other people who've experienced menopause. You could ask them which treatments worked best for them. This could be people you know, through support groups or online. Or you could read, listen or watch people's personal stories about their experiences of menopause.
• Remember that everyone is different. Just because something has or hasn't worked for someone else, doesn't mean it'll be the same for you. And what helps you may change over time.
• Try things out to see if they help. This could include trying more than one treatment at the same time. If anything you try isn't working, you can stop or change it. But always speak to your doctor before stopping medication or HRT, so you can stop safely.
• Remember that you shouldn't have to suffer. You might feel like you should accept menopause as a natural process. And that you should wait as long as you can before trying treatments like HRT or talking therapy. This might make you feel worse or more alone. Or it could mean that you're struggling for longer than you need to. Try to make treatment decisions based on what you want and need, rather than what you feel like you should be doing.

I also had some counselling, and very slowly started to feel myself again.

Accessing treatment for menopause

The best way to access treatment is to talk to your GP about your experiences and the support you need. But not all doctors have enough training or experience in menopause. And some doctors can be reluctant to prescribe treatments such as HRT.

It can feel very frustrating if doctors aren't listening to you or giving you the support you need. To help you get treatment and access to services, you could:

• Track your symptoms. Even if you're not sure whether they're because of menopause or not. Note down how often you experience each one and how they affect your life. You could use The Menopause Charity's menopause symptoms questionnaire. Or you could try a symptom tracking app. See our page on finding reliable information online for tips on finding safe and reliable apps.
• Prepare for GP appointments. It may help to write down, record or practise what you want to say beforehand. You could take notes in with you. Or you could ask someone you trust to go with you. The Menopause Charity has information about asking your GP for help with menopause. Our pages on talking to your GP about your mental health might also be useful.
• Try to be as clear as possible. If you think you could be experiencing menopause or perimenopause, you can tell your GP. You don't need to wait for them to bring it up. And let them know if there's a treatment you'd prefer to try. The NICE guidelines for menopause explain how your GP should treat you, and the types of treatment they should offer. 
• Find an advocate. An advocate is someone who helps you express your wishes and stand up for your rights. Our pages on advocacy have more information.
• Challenge decisions. It's ok to question what doctors are saying or to share your concerns. If an appointment hasn't gone well, try asking for another one, or to speak to a different person. The Balance website has advice for when doctors aren't listening to menopause concerns. It includes a GP template letter for requesting HRT. If you're not happy with how you're being treated, you can also complain about health and social care.
• Seek support from others. Hearing other people's stories can help you feel less alone and more empowered to seek support. See our information on peer support groups.

Published: September 2024

Next review planned: September 2027

References and bibliography available on request.

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