Menopause Treatment: Everything You Need to Know

Anyone who has ever found themselves in the midst of a menopausal hot flash knows the urgent desperation of finding the right menopause treatment. “Forty to fifty percent of the female lifespan is menopausal,” says Dr. Lizellen La Folette, a board-certified ob-gyn and medical adviser for Stripes. “Unfortunately, menopause advice has often been dismissive, belittling, and shaming, leaving women with information based in fear rather than fact.”

Much of the confusion and controversy surrounding menopause treatments centers on hormone therapy (sometimes referred to as hormone replacement therapy, or HRT). This was once the predominant treatment for menopause symptoms, but a 2002 study linking the therapy to increased risks—including breast cancer and stroke—caused a panic. Since then, newer research has proved again and again that hormone therapy is a safe menopause treatment for most women and its benefits outweigh small risks. 

“The leading information about hormones and breast cancer risk has been wrong and out there for over 20 years,” says Dr. La Folette. “Hormones, especially estrogen, have demonstrated a protective effect against cardiovascular disease, which poses a seven-times-greater risk to women than breast cancer.”

Here's everything you need to know about the leading treatments for menopause, including hormone therapy and nonhormonal options. 

What are hormonal treatments for menopause?

According to the official 2022 recommendation of the North American Menopause Society (NAMS), hormone therapy is one of the most effective therapeutic options for the treatment of menopause symptoms. Not only is it the single most effective treatment for hot flashes; it has also been shown to prevent bone loss.

There are two types of hormone therapy: estrogen therapy (typically used only for women who've had a hysterectomy and no longer have a uterus) and combined estrogen plus progesterone therapy, which reduces menopause symptoms while also protecting against the risk of uterine cancer. 

There are two ways to use hormone therapy, according to NAMS:

• Systemic hormone therapy: Typically taken as a patch, pill, or gel, hormones are delivered into the blood stream and circulate throughout the body. 
• Local hormone therapy: Typically used for vaginal symptoms only, it is delivered via a vaginal cream, ring, or suppository. 

“The decision to use hormone therapy is individual specific,” says Dr. Somi Javaid, a fellow of the American Congress of Obstetricians and Gynecologists and founder and chief medical officer of HerMD. Because there is a slightly increased risk of breast cancer, some women who have had breast cancer or have a family history of the disease might not be candidates. “Prior to initiating hormone therapy, we will conduct a thorough review of your personal and family health history, the severity of symptoms you are experiencing, and calculate your specific risk for developing certain medical conditions,” she says. “This approach ensures your clinical outcomes are maximized and any potential risks are minimized.” 

What are nonhormonal treatments for menopause?

If you're not a candidate for hormone therapy, or don't want to use it, there are plenty of other options available. “Relief can also come from nonhormonal treatments and lifestyle modifications,” says Dr. Javaid. Talk to your health care provider about the best plan for you, as well as any potential side effects, but some common treatments for menopausal women include:

If hot flashes are your main concern and menopausal hormone therapy isn't an option, the Food and Drug Administration (FDA) is set to approve a new drug—Fezolinetant—for hot flashes this year. “It's good for hot flashes and sleep,” says Dr. Mary Jane Minkin, a menopause specialist and a clinical professor of obstetrics and gynecology at Yale.

Another powerful frontline treatment for hot flashes: antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have both been proved to safely reduce hot flash symptoms. 

Mood changes, a.k.a. mood swings, are also commonly experienced during menopause, and certain antidepressants and antianxiety medications can help manage those symptoms as well. “If you experience mood disturbances, such as anxiety and depression, there are many FDA-approved treatment options to help manage these symptoms,” says Dr. Javaid. “Bupropion and buspirone are commonly used to help manage depression and anxiety, respectively, in the setting of perimenopause and menopause.” 

Some of the most commonly reported menopause symptoms have to do with your vagina and pelvic floor—vaginal dryness, pain during sex, incontinence—so it's no wonder some of the best menopause treatments target this area. “Lubricants are often a must after menopause,” says Dr. Leah Millheiser, an ob-gyn, NAMS-certified menopause practitioner, and the chief medical officer of Evernow. “The most effective are silicone-based lubricants, which are just as safe as water-based options but last longer and decrease friction better.”

If even the best lubricants aren't cutting it, certain laser treatments can help as well. “During menopause, the vaginal skin becomes thin and friable, and the cellular turnover rate declines,” says Dr. La Folette. “One treatment I offer called the MonaLisa Touch is a nonsurgical laser that uses fractional CO₂ energy to trigger a normal healing response from the dormant vaginal tissue. This dermatologic approach transforms the vaginal skin to be more pliable, elastic, and collagen-rich.” (It can also help improve bladder function.) 

On that note, Dr. Javaid says there is evidence from clinical trials to suggest that vibrators offer users a variety of health benefits, “including improved pelvic floor function, enhanced sexual function, and improvements in vulvar pain”—all symptoms of menopause. She recommends vibrators by Dame (and so do we).  

Chances are if you've ever had a conversation about menopause treatments, someone has brought up herbal remedies. These natural treatments for menopause symptoms can work, but there's a wide range in effectiveness and quality. 

The most convincing herbal treatment is black cohosh, a flowering plant that's been used for centuries in traditional Chinese medicine. Black cohosh works by binding to your body's opioid receptors to reduce pain, according to the Cleveland Clinic, but clinical evidence for its ability to treat hot flashes and other menopause symptoms is mixed. (If you're going to use it, Dr. Minkin recommends a European brand called Remifemin, since herbal supplements in the EU are more heavily regulated than in the US.) 

If you want to explore menopause treatments rooted in Eastern medicine, acupuncture has more data behind it. One 2019 study found that acupuncture treatments over five weeks reduced symptoms of hot flashes, night sweats, sleep disturbances, and mood changes. 

Menopause experts also recommend good old-fashioned exercise for dealing with menopause symptoms. “It's a cure for just about everything in the universe and it does help most menopause symptoms get better,” says Dr. Minkin. Combine that with “getting sufficient sleep, keeping well hydrated, healthful eating, mindfulness, yoga, and stress management techniques which can all help to alleviate symptoms,” adds Dr. Javaid. 

Cutting back on alcohol consumption can also have a big impact and improve your quality of life. Not only is it a common trigger for hot flashes, but alcohol is strongly linked to sleep disruption, says Dr. La Folette. 

Because menopause often includes mental health symptoms, therapy can be a powerful treatment. 

If symptoms of sexual dysfunction are particularly impactful for you, sexual health counseling and couples therapy can be helpful. “For those experiencing insomnia, cognitive behavior therapy for insomnia, or CBT-I, can help,” says Dr. Javaid. “CBT-I is a nonmedication, interventional approach recommended by the American College of Physicians that focuses on the delicate interplay between the mind-body connection in promoting a good night’s sleep.”

Macaela MacKenzie is a writer and editor specializing in wellness. She writes about self-care, mental health, fertility, and women’s equality with a focus on breaking down stigmas in women’s health.