Management of Menopause Symptoms

Treatment choices for menopause depend on which symptoms are most bothersome, how severe they are, stage of menopause, hysterectomy, surgical menopause, other health conditions, and personal preference. Options for managing menopausal symptoms include menopausal hormone therapy (MHT), non-hormonal prescription medications, lifestyle and complementary therapy.¹⁰

MHT is the most effective treatment for hot flashes and night sweats. It can also improve sleep, mood and overall well-being, vaginal symptoms, and help prevent bone loss and fractures.^{8, 10}

Most women need a combination of estrogen and progesterone. Estrogen treats symptoms, while progesterone protects the uterus lining. Women with a uterus also need progesterone in addition to the systemic estrogen, while women without a uterus may use estrogen alone. Other forms of hormone therapy include tibolone and combinations of estrogen with bazedoxifene.  For vaginal symptoms, vaginal estrogen therapy is often effective, and lubricants or moisturizers may be added for comfort.

Although concerns about MHT have received a lot of attention, when prescribed appropriately it is considered relatively safe. Current guidelines recommend systemic MHT for women under 60 or within 10 years of menopause who do not have contraindications.^{10, 11} Risks with MHT include cardiovascular disease, blood clots, or breast cancer are rare. Side effects such as breast tenderness, headaches, fluid retention, or irregular bleeding can occur early on but usually settle over time.¹⁰

In women with existing heart disease or a history of blood clots, MHT should be avoided. In those with risk factors such as high blood pressure, diabetes, or smoking, transdermal low-dose products (patches or gels) may be safer as they bypass the liver.¹²

Concerns about breast cancer are common with, but the actual risk is low, less than 0.1% per year with estrogen and progestogen together.¹³  Women with a history of breast cancer should avoid MHT.  For women with a strong family history of breast cancer, it is best to discuss with your primary care provider of what options may be best for you.

For those who cannot or prefer not to use MHT, non-hormonal medicines are available. These include certain antidepressants, gabapentin, oxybutynin, and the newest options which are called NK receptor antagonists, fezolinetant and elinzanetant, which have recently been approved in Canada.^{10, 14}

Lifestyle approaches like staying cool, avoiding triggers, exercising regularly, yoga, and maintaining a healthy weight may also help with symptoms and support overall health. Some complementary therapies can be useful as well. Cognitive behavioural therapy (CBT) and clinical hypnosis have been shown to help, while treatments such as soy products or acupuncture show mixed results. Many natural products are popular but don’t have strong evidence of benefit.¹⁰