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Menopause treatments: What works, what doesn’t

Women's Health Week
A woman weighing up her options

A quick, no-nonsense guide with insights from experts in menopausal care.

Struggling with menopausal symptoms but not quite sure how best to manage them?

“There is a lot of misinformation about management strategies available for bothersome menopausal symptoms,” says Jean Hailes endocrinologist Dr Sonia Davison. Add to that “a lot of fear” about menopausal hormone therapy and breast cancer risk, she says.

To allay these fears and clear up any confusion, we’ve put together this quick guide to menopause treatments. Learn what’s available, what works and what doesn’t, according to the experts…

Menopausal hormone therapy (MHT)

In the lead-up to menopause, changes in your hormone levels may cause symptoms, such as night sweats and hot flushes. MHT is used to help relieve bothersome symptoms by medically replacing hormones, including oestrogen. But it’s not without criticism. Decades ago, a research paper prompted many women to avoid MHT over fears it caused breast cancer.

Today, international expert committees generally agree that for healthy women around the time of menopause, “the benefits of MHT far outweigh the small risks”, says Dr Davison.

Adds Jean Hailes GP Fiona Jane: “Oestrogen therapy is the most effective treatment for alleviating the symptoms of menopause.” But, she says, “there are a number of safety issues to consider” before deciding if MHT is right for you. For example, some medical conditions, such as high blood pressure or hormone-sensitive cancers, may make the treatment unsuitable for you. Ultimately, Dr Jane says the type and amount of MHT you take, plus the time spent using it, affect how safe the treatment is.

Midlife woman at work carrying books

Non-hormonal prescription medications

These types of medications may be an option for women who cannot or prefer not to have MHT. They include antidepressants, gabapentin and clonidine. According to Dr Davison, evidence shows the drugs may improve hot flushes, sleep and mood, depending on which one you take.

But like any medication, they may cause unwanted effects. Dr Jane mentions changes in sexual function, blood pressure and energy. Ultimately, she says they aren’t as effective as MHT at treating menopausal symptoms, but they “are relatively well tolerated”.

There is no one-size-fits-all approach at menopause.

Menopause treatments looking up on phone

Pharmacy-compounded hormone therapy

Pharmacy-compounded hormones are synthetic hormones that are mixed together in some pharmacies for individual patients.

While the treatment contains oestrogen (which is known to help relieve menopausal symptoms), Dr Jane says that it lacks quality research and “safety is a major issue”.

That’s because unlike MHT, pharmacy-compounded hormones aren’t regulated. There are also questions about the treatment’s effectiveness.

Ultimately, Dr Davison says that “none of the expert bodies recommend using custom compounded hormone therapy, as we cannot [verify] the safety or the content of these preparations”.

Exercise

Unfortunately, we don’t yet have evidence that exercise can relieve menopausal symptoms. But, that’s no reason to avoid it as keeping active can have indirect benefits. Exercise can “help to reduce the risk of abdominal and general weight gain, which can worsen hot flushes by acting as a layer of insulation”, says Dr Davison. “Women who exercise may also sleep better and may have better mood and wellbeing,” she adds.

Treatments for vaginal dryness

Vaginal dryness is common after menopause due to the drop in oestrogen levels causing changes in vaginal tissues. Creams, gels, vaginal tablets and pessaries (vaginal inserts) are types of ‘topical’ treatment for the condition. (Topical treatments are those that are applied to a particular surface on or inside your body.)

According to Dr Jane, the most effective form of topical treatment for vaginal dryness is one that contains oestrogen. It “treats the underlying problem and is very safe, with studies showing no increase in breast cancer or endometrial cancer diagnosis”.

As for other topical treatments, Dr Jane says lubricants can offer temporary relief during intercourse and, like moisturisers, they are a non-hormonal alternative to vaginal oestrogen. However, she adds both lubricants and moisturisers “are less effective”, vary widely in their make-up and may have negative effects due to additives changing the vaginal environment.

Cognitive behavioural therapy (CBT) and mindfulness

CBT is a form of psychological therapy that helps you identify and deal with negative thinking, while mindfulness meditation is about focusing on the present moment, nonjudgmentally. Both treatments can be used to develop practical ways of managing symptoms by providing new coping skills and useful strategies.

The good news is that “evidence is in favour for these techniques improving sleep, mood and how to deal with menopausal symptoms in general”, says Dr Davison.

Adds Dr Jane: Research even suggests CBT may help with sexual concerns, hot flushes and night sweats associated with menopause.

Pills and capsules on leaf

Natural therapies

Of all the herbal remedies used for treating menopausal symptoms, black cohosh is the most studied. It is a plant native to North America and available in a range of products.

While research papers regarding black cohosh have at times been conflicting, Jean Hailes naturopath Sandra Villella says the latest evidence suggests that serious side effects are uncommon. It also appears to be reasonably effective at relieving some menopausal symptoms such as hot flushes, mood swings and vaginal dryness, she adds.

Phytoestrogens are not associated with an increased risk of breast cancer and in fact are associated with reduced risk, especially if consumed in amounts consistent with an Asian diet or before puberty.

Phytoestrogens

Phytoestrogens are substances that occur naturally in plant foods and have a similar chemical structure to human oestrogen, a key female hormone.

According to Ms Villella, there is no shortage of misinformation about phytoestrogens. However, she says overall they tend to “behave well in the body”. When consumed in ‘real-food’ form rather than via supplements or highly processed foods, “they are not associated with an increased risk of breast cancer and in fact are associated with reduced risk, especially if consumed in amounts consistent with an Asian diet or before puberty”, she says.

Sources of phytoestrogens include whole soy, tofu, legumes, oats and linseeds. Interestingly, while phytoestrogen-rich foods are often healthy, Ms Villella says they don’t relieve menopausal symptoms in all women. Rather, she says only about 30% of women have the gut bacteria needed to process these plant oestrogens for them to have a beneficial effect on symptoms.

Where to now?

As you can see, menopause treatments vary in their benefits and risks.

“There is no one-size-fits-all approach at menopause,” says Dr Davison. “It’s about assessing an individual woman carefully, her medical and family medical history, her general health, and her symptoms at menopause. Then, crafting a plan for her based on her wishes and after careful education about the pros and cons of the available strategies.”

Before trying a treatment, speak to a women’s health specialist knowledgeable in menopausal care.

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