Treatment and Talking to your Doctor
Talking to Your Doctor
Since we're always learning more about menopause treatment options and hormone therapy, it can be confusing to figure out how to treat or manage menopausal symptoms. It is important for you to have a doctor that you trust, so you can have an open talk about your concerns and your treatment options. Then you can make informed decisions about your health that you feel good about. If you feel that you have talked openly with your doctor and still don't feel satisfied, you should think about getting a second opinion.
Knowing how to talk to your doctor or other members of your health care team can help you get the information you need about menopause. Your doctor will tell you, as you near menopause, that you may have symptoms from the changes your body is making. For some women, their menopause symptoms will go away over time without treatment. Other women will choose treatment for their symptoms.
Talk to your doctor about how to best manage menopause. Talk about your symptoms and whether they bother you. Make sure the doctor knows your medical history and your family medical history. This includes whether you are at risk for heart disease, osteoporosis, and breast cancer. Remember that your decision is never final. You can, and should review it with your doctor during a checkup. Your needs may change, and so might what we know about menopause.
Menopausal Hormone Therapy (MHT)
To help control the symptoms of menopause, some women can take hormones, called menopausal hormone therapy (MHT). MHT used to be called hormone replacement therapy or HRT. The use of MHT has been debated a great deal since the Women's Health Initiative (WHI) Hormone Study findings were released in 2002. Before this study, it was thought that MHT could ward off heart disease, osteoporosis, and cancer, while improving women's quality of life. Findings emerged from clinical trials that showed this was not so. In fact, long-term use of MHT poses some serious risks. New results from the WHI confirmed that using MHT does not protect against coronary heart disease (CHD, called heart disease here). There is good news, however: The results also suggest that short-term use of MHT does not increase heart disease risk in women who begin MHT within 10 years of onset of menopause. But, it appears that the longer a woman waits to begin MHT after the onset of menopause, the greater her risk of developing heart disease. More research is needed to fully understand this issue. Still, a woman has options when it comes to managing the symptoms of menopause.
During perimenopause, some doctors suggest birth control pills to help with very heavy, frequent, or unpredictable menstrual periods. These pills might also help with symptoms like hot flashes, as well as prevent pregnancy. As you get closer to menopause, you might be bothered more by symptoms like hot flashes, night sweats, or vaginal dryness. Your doctor might then suggest
starting MHT. A woman whose uterus has been removed can use estrogen alone to control her symptoms. But a woman who still has a uterus must take progesterone or a progestin (a man-made progesterone) along with the estrogen. These
hormones will probably help with menopause symptoms and prevent the bone loss that can happen at menopause. However, there is a chance your symptoms will come back when you stop MHT.
Once a woman reaches menopause, MHT currently is recommended only as a short-term treatment of moderate to severe symptoms such as hot flashes or night sweats. Women who have problems with vaginal dryness can try lower dose estrogen products, such as vaginal creams, rings, and tablets. Long-term use of MHT is no longer advised, and doctors very rarely prescribe MHT to prevent certain chronic diseases, like osteoporosis. Postmenopausal women should not take MHT as they grow older to prevent problems like heart disease. A woman should talk about the benefits and risks of using MHT with her doctor to decide if MHT is right for her.
MHT can help with menopause by:
- Reducing hot flashes
- Treating vaginal dryness
- Slowing bone loss
- Easing mood swings and mild depressive symptoms—MHT alone is not effective in treating depression
- Improving sleep
For some women, MHT may increase their chance of getting:
- Blood clots
- Heart attacks
- Breast cancer
- Gall bladder disease
Who should NOT use MHT for menopause:
Women who . . .
- Think they are pregnant
- Have problems with vaginal bleeding
- Have had certain kinds of cancers (such as breast and uterine cancer)
- Have had a stroke or heart attack
- Have had blood clots
- Have liver disease
MHT can also cause these side effects:
- Breast tenderness or enlargement
- Mood changes
Natural Treatments/Alternative Therapies
You may want to consider alternatives to menopausal hormone therapy to ease menopausal symptoms. Some women decide to take herbal, natural, or plant-based products to help their symptoms. But there is not enough evidence to know if treatments like these are helpful. Tell your doctor if you are taking any of these treatments. They may have side effects or make another drug not work as well. Some of the most common ones are:
Soy. This contains phytoestrogens (estrogen-like substances from a plant). Some research has shown that soy food products can help with mild hot flashes. Other research suggests that women who have been diagnosed with estrogen-dependent breast cancer should be cautious with their soy intake. Eating large amounts of soy products could be harmful for women with this type of breast cancer.
Other sources of phytoestrogens. The active ingredients in most dietary supplements for menopause are phytoestrogens — chemicals found in plants that may act like the estrogen produced naturally in the body. These include herbs, such as black cohosh, wild yam, dong quai, and valerian root.
- Bioidentical hormone therapy. Bioidentical hormones are custom-mixed formulas containing various hormones that are chemically identical to those naturally made by your body. These over-the-counter products are marketed as being tailored to a woman's individual hormone needs. There are two main types of Bioidentical hormones:
- Those that are FDA-approved and commercially available with a prescription
- Those that are mixed on an individual basis for women in compounding pharmacies, which are NOT FDA-approved
It is important to know that alternative therapies can affect medical care by introducing personal belief systems that are not typically a part of the doctor-patient relationship.
Additional Resources on Treatments:
Bio-Identicals: Sorting Myths from Facts - This brochure from the FDA alerts consumers and health care professionals to false and misleading claims of bio-identical hormone replacement therapies.
Black Cohosh - This fact sheet provides an overview of the use of Black Cohosh for menopausal symptoms. It includes information on how effective it is, how it works, and what the possible risks are.
Facts About Menopausal Hormone Therapy - This brochure summarizes the risks and benefits of postmenopausal hormone therapy. It is designed to provide patients with information to help them communicate more effectively with their doctor or nurse and determine the best course of treatment on an individual basis.
Frequently Asked Questions - Menopause and Menopause Treatments - This fact sheet discusses menopause symptoms and treatments, including postmenopausal hormone therapy (HT) and the practical steps women can take to alleviate symptoms and prevent diseases like osteoporosis and heart disease.
Hormones and Menopause: Tips from the National Institute on Aging - This easy-to-read publication presents information and guidelines for women who are troubled by menopausal symptoms.
Menopausal Hormone Replacement Therapy Use and Cancer: Questions and Answers - This publication discusses the benefits and the risks of using menopausal hormone therapy and how its use affects breast cancer risk and survival. The information comes from the Women’s Health Initiative Hormone Program, which was sponsored by the National Heart, Lung, and Blood Institute and the National Cancer Institute.
Menopausal Hormone Therapy Information - New findings from the Women's Health Initiative and other studies offer important information about the risks and benefits of long-term menopausal hormone therapy. The links on this web site point to information resources, including the most current from the NIH, on both long-term and short-term hormone use, and other concerns related to women's health during and after menopause.
Menopausal Symptoms and CAM - Many women and their health care providers have become interested in complementary and alternative medicine (CAM) for menopausal symptoms. This fact sheet is based on findings from a 2005 National Institutes of Health (NIH) State-of-the-Science (SoS) conference on the management of menopause-related symptoms. It answers some frequently asked questions and lists resources for more information.
Menopause and Hormone Replacement - In recent months and years, there has been a great deal of confusion concerning menopause and hormone replacement therapy (HRT). The FDA regulates the drugs that make up different kinds of HRT, and has changed information on drug labels as new scientific information becomes available. This internet site links to information about menopausal hormone therapy from the FDA.
Menopause: Medicines to Help You - This fact sheet lists different kinds and brands of medicines you can take for symptoms of menopause, their warnings, side effects, and brand names.
Bioidentical Hormones (Copyright © NAMS) - This on-line publication briefly explains what bioidentical hormones are and how they are made. It also includes information on hormone testing.
Herbal Products for Menopause (Copyright © ACOG) - This publication provides information on the benefits and risks of using herbal products for the relief of menopause symptoms. It also discusses the importance of talking to your doctor before using any alternative remedies.
Hormone Therapy for Menopausal Symptoms: The First Few Years (Copyright © The Hormone Foundation) - The publication explains menopausal hormone therapy. It discusses recent research, treatment alternatives for menopause symptoms, and it includes a list of questions to ask your doctor.
Menopause Guidebook (Copyright © NAMS) - This guidebook explains the emotional and physical changes that often accompany menopause. It also explains what to expect and how to take care of yourself after menopause.
Menopause Resource Center (Copyright © ARHP) - The Association of Reproductive Health Professionals (ARHP) created this web site to guide health care providers, the media, and the general public through the vast array of hormone therapy resources on the web.
Perimenopausal Women and the Use of Very-Low-Dose Birth Control Pills (Copyright © AAFP) - This publication provides information on very-low dose birth control pills, why someone would use these during perimenopause, who shouldn't take these pills, and how to know when menopause starts.
Pros and Cons for Treatment of Menopause Symptoms (Copyright © The Hormone Foundation) - This publication lists the pros and cons of the different treatments used to relieve menopause symptoms.
Ten Questions a Woman Should Ask Her Healthcare Provider (Copyright © AHA) - This publication explains why you should talk to your doctor about heart disease, stroke, cholesterol, high blood pressure, menopause, nutrition and physical activity.
Food and Drug Administration, HHS
National Institute on Aging, NIH, HHS
Womenshealth.gov, OWH, HHS
American Menopause Foundation
American Society for Reproductive Medicine (ASRM)
The Hormone Foundation
The North American Menopause Society (NAMS)
= Indicates Federal Resources
Content last updated May 29, 2008.