Menopause and perimenopause

Medications

• Hormone replacement therapy. Estrogen therapy through a pill, patch, gel, or cream provides the most effective relief for both premenopausal and menopausal symptoms. If you still have your uterus, progestin may also be included in this hormone therapy. When delivered through a pill or patch, the hormones can travel throughout your body. This is referred to as systemic estrogen therapy. Systemic estrogen therapy can help relieve hot flashes and night sweats, as well as prevent bone loss and osteoporosis.
• Vaginal estrogen. Hormone therapy can also be administered directly into the vagina with a tablet, ring, or cream to relieve vaginal dryness. A small amount of estrogen is released directly into the vaginal tissue to relieve the discomfort associated with vaginal dryness and atrophy, as well as some urinary symptoms.
• Antidepressants. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can reduce menopausal symptoms of depression and anxiety. This is especially useful for people who are unable to have estrogen replacement therapy for any health reasons such as recent treatment for breast cancer, or who simply need them to treat a mood disorder.
• Gabapentin (also known as Neurontin). This anti-seizure medication is also shown to reduce hot flashes and migraines. It is especially useful for those who cannot take hormone replacement therapy.

Lifestyle changes and home remedies

Sometimes, lifestyle changes can help manage menopause symptoms. These include:

• Eating a healthy diet. A healthy diet is imperative to help prevent heart disease and osteoporosis that may arise from menopause. Adopt a low-fat, high-fiber diet full of fruits, vegetables, and whole grains. Limiting alcohol and caffeine can also help lessen the effects of hot flashes.
• Keep it cool. Use fans to keep yourself cool whenever you feel a hot flash. Keep your room cool at night and avoid heavy or synthetic blankets to avoid night sweats. Try to wear cotton and linen clothes, since these fabrics are breathable.
• Maintaining good sleep habits. Keeping a consistent sleep schedule, sleeping in a cold environment, and avoiding caffeine and alcohol will help ensure your sleep is not interrupted.
• Practice stress reduction techniques. Paired with good sleep habits, stress reduction techniques can help ease anxiety and depressive symptoms of perimenopause and menopause. Paired with regular exercise, stress reduction techniques such as yoga and meditation can help keep a mental and physical balance and prevent weight gain.
• Strengthen your pelvic floor. Exercises like Kegels can help you maintain the muscle tone of your pelvic floor. This can help with discomfort during sex and urinary incontinence.
• Using lubricants. Over-the-counter, water-based lubricants can help ease sexual discomfort and vaginal dryness. Lubricants paired with continued sexual intercourse may stimulate blood flow to the vagina, which may ease vaginal symptoms.
• Taking Vitamin D. Taking vitamin D supplements can help the body absorb calcium and promote bone growth.

Herbal remedies and supplements

You may find that lifestyle fixes aren’t enough for you, but you don’t want to go on prescription medication. Many menopausal people face this dilemma and turn to herbal remedies or supplements.

Here are some options to consider:

• Herbal supplements. Sage and black cohosh are two common herbal supplements used to manage menopause symptoms. Certain varieties of sage have compounds that resemble estrogen, but evidence about their effectiveness is mixed. Additionally, taking sage herbal supplements is not usually recommended for people with a history of breast cancer, epilepsy, or diabetes. Black cohosh is often used to treat hot flashes, but evidence about its effectiveness is limited. Black cohosh can cause liver problems and, like sage, is not recommended for people with a history of breast cancer. Moreover, herbal supplements are not regulated like normal medications. Always talk to your doctor and pharmacist before taking herbal supplements so that you have a clear picture of the risks and benefits of herbal supplements.
• Plant estrogens (phytoestrogens). Foods like soy, chickpeas, and flaxseeds contain compounds similar to estrogen. While these foods may be part of a healthy diet, there is currently no proof that they are effective for managing menopausal symptoms. Additionally, isoflavone – the plant estrogen compound found in soy – may not be suitable for people who previously had or are at risk for breast cancer. Talk to your doctor about any dietary changes.
• Bioidentical hormones. These hormones biologically match estrogen and progesterone, much like the synthetic hormones in traditional estrogen therapy. The difference is that these hormones come from “natural” plant and animal sources rather than a laboratory.  However, these hormones are not FDA-regulated and there is no evidence that they are safer or more effective than taking traditional hormone therapies.