Menopause

Diagnosis

Most people can tell by the symptoms that they've started menopause. If you have worries about irregular periods or hot flashes, talk with your healthcare professional.

Tests most often aren't needed to diagnose menopause. But sometimes, your healthcare professional may suggest blood tests to check your levels of:

• Follicle-stimulating hormone (FSH) and estrogen (estradiol). FSH goes up and estrogen goes down during menopause. Because hormones go up and down during perimenopause, it can be hard to tell from these tests whether you're in menopause.
• Thyroid-stimulating hormone (TSH). Overactive thyroid, called hyperthyroidism, can cause symptoms like those of menopause.

You can get home tests to check FSH levels in your urine without a prescription. The tests show whether you have higher FSH levels. This might mean that you're in perimenopause or menopause.

But FSH levels rise and fall during your menstrual cycle. So home FSH tests can't really tell you whether you're in menopause.

Treatment

Menopause needs no treatment. Treatments aim to ease symptoms and prevent or manage ongoing conditions that may happen with aging. Treatments may include:

• Hormone therapy. Estrogen therapy works best for easing menopausal hot flashes. It also eases other menopause symptoms and slows bone loss.

  Your healthcare professional may suggest estrogen in the lowest dose and for the time needed to relieve your symptoms. It's best used by people who are younger than 60 and within 10 years of the onset of menopause.

  If you still have your uterus, you'll need progestin with estrogen. Estrogen also helps prevent bone loss.

  Long-term use of hormone therapy may have some heart disease and breast cancer risks. But starting hormones around the time of menopause has shown benefits for some people. Talk with your healthcare professional about whether hormone therapy may be safe for you.

• Vaginal estrogen. To relieve vaginal dryness, you can apply estrogen to the vagina using a vaginal cream, tablet or ring. This treatment gives you a small amount of estrogen, which the vaginal tissues take in. It can help ease vaginal dryness, pain with intercourse and some urinary symptoms.
• Prasterone (Intrarosa). You put this human-made hormone dehydroepiandrosterone (DHEA) into the vagina. It helps ease vaginal dryness and pain with intercourse.
• Low-dose medicines to treat depression, called antidepressants. Some antidepressants may ease menopausal hot flashes. These are called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRI). A low-dose antidepressant may help manage hot flashes in people who can't take estrogen for health reasons or for those who need an antidepressant for a mood disorder.
• Gabapentin (Gralise, Neurontin). Gabapentin is approved to treat seizures, but it also has been shown to help reduce hot flashes. This medicine is useful for people who can't use estrogen therapy and for those who also have nighttime hot flashes.
• Clonidine (Catapres-TTS-1, Nexiclon XR). This pill or patch most often treats high blood pressure. It might give some relief from hot flashes. It's not often prescribed for hot flashes because of the possible side effects, such as low blood pressure, headache, sleepiness and constipation.
• Fezolinetant (Veozah). This medicine is free of hormones. It treats menopause hot flashes by blocking a pathway in the brain that helps manage body temperature. It's FDA approved for managing menopause symptoms. It can cause abdominal pain, liver problems and make sleep problems worse.
• Oxybutynin (Oxytrol). This medicine treats overactive bladder and urinary urge incontinence. It's also been shown to relieve menopause symptoms. But in older adults, it may be linked to cognitive decline.
• Medicines to prevent or treat the bone-thinning condition called osteoporosis. Your healthcare professional might suggest medicine to prevent or treat osteoporosis. Several medicines can help reduce bone loss and risk of fractures. Your healthcare professional also might prescribe vitamin D supplements to help strengthen bones.
• Ospemifene (Osphena). Taken by mouth, this selective estrogen receptor modulator (SERM) medicine treats painful intercourse linked to the thinning of vaginal tissue. This medicine isn't for people who have had breast cancer or who are at high risk of breast cancer.

Before deciding on any form of treatment, talk with your healthcare professional about your choices and the risks and benefits of each. Review your choices yearly. Your needs and the treatment choices may change.

Lifestyle and home remedies

Many of the symptoms menopause causes go away on their own in time. In the meantime, the following might help:

• Cool hot flashes. Dress in layers, wear sleeveless tops and wear fabrics that breathe, such as cotton. Lower room temperatures and use hand or room fans. Put cold packs under your pillow and turn the pillow often so your head is on the cool side.

  It might also help to avoid triggers such as caffeine, alcohol and spicy foods.

• Ease vaginal pain. Try a water-based vaginal lubricant (Astroglide, Sliquid, others) or a silicone-based lubricant or moisturizer (Replens, K-Y Liquibeads, others). You can get these without a prescription.

  Stay sexually active by yourself or with a partner. This also can ease vaginal discomfort by increasing blood flow to the vagina.

• Get enough sleep. Skip caffeine and alcohol, which can make it harder to sleep. Exercise during the day, but not right before bedtime. If hot flashes disturb your sleep, find a way to help manage them so you can get better rest.
• Find ways to relax. There's little proof that deep breathing, guided imagery, massage and muscle relaxation can ease menopausal symptoms. But finding ways to relax is good for overall health and may help you cope with menopausal symptoms. You can learn how through books and websites.
• Strengthen your pelvic floor. Pelvic floor muscle exercises, called Kegel exercises, can improve some forms of urinary incontinence.
• Eat a balanced diet. Include a variety of fruits, vegetables and whole grains. Limit saturated fats, oils and sugars. Ask your healthcare professional if you need calcium or vitamin D supplements.
• Manage weight. Studies show that being obese is linked to having more and worse hot flashes. Losing weight and keeping it off may help ease them. Talk with your healthcare professional if you need help losing weight.
• Don't smoke. Smoking increases your risk of heart disease, stroke, osteoporosis, cancer and a range of other health problems. It also may increase hot flashes and bring on earlier menopause.
• Exercise regularly. Get regular physical activity or exercise on most days to help protect against heart disease, diabetes, osteoporosis and other conditions associated with aging.

Alternative medicine

There are many alternative medicines that claim to help ease the symptoms of menopause. But few of them have been proved in studies. Some complementary and alternative treatments that have been or are being studied include:

• Plant estrogens, also called phytoestrogens. There are natural estrogens in certain foods. There are two main types of phytoestrogens, called isoflavones and lignans. Soybeans, lentils, chickpeas and other legumes have isoflavones. Flaxseed, whole grains and some fruits and vegetables have lignans.

  It hasn't been proved that the estrogens in these foods can ease hot flashes and other menopausal symptoms. Isoflavones have some weak estrogen-like effects. So if you've had breast cancer, talk with your healthcare provider before taking isoflavone pills.

• Bioidentical hormones. These hormones come from plant sources. The term "bioidentical" implies the hormones in the product are chemically the same as those the body makes.

  The Food and Drug Administration (FDA) has approved some bioidentical hormones. But many are mixed in a pharmacy from a healthcare professional's prescription, called compounded. But the FDA doesn't regulate them, so quality and risks could vary.

  Bioidentical hormones have not been shown to work better or be safer than other hormone therapy.

• Cognitive behavior therapy. This type of therapy can help you change thoughts, feelings and behaviors that aren't healthy. It's been shown to reduce how much menopause symptoms bother you.
• Black cohosh. Black cohosh has been popular among many people with menopause symptoms. But there's little proof that black cohosh works. And it can harm the liver and not be safe for people with a history of breast cancer.
• Yoga. Yoga might ease menopause symptoms at least as well as other forms of exercise. And balance exercises such as yoga or tai chi can improve strength and help you move better. That may help prevent falls that could lead to broken bones.
• Acupuncture. Acupuncture may help to reduce hot flashes in the short term. But research hasn't shown that it helps a lot. More research is needed.
• Hypnosis. This mind-body therapy involves a deeply relaxed state and mental images. Hypnotherapy may lower the number of hot flashes and how bad they are for some menopausal people.

You may have heard of or tried other dietary supplements, such as red clover, kava, dong quai, DHEA, evening primrose oil and wild yam, a natural progesterone cream. There's no scientific proof that they work. Some of these products may be harmful.

Talk with your healthcare professional before taking any herbal or dietary supplements for menopause symptoms. The FDA does not oversee herbal products. Some can be harmful or affect other medicines you take, putting your health at risk.

Preparing for your appointment

Your first appointment will likely be with your primary healthcare professional or a gynecologist.

What you can do

Before your appointment:

• Keep track of your symptoms. For instance, make a list of how many hot flashes you have in a day or week. Note how bad they are.
• Make a list of all medicines, herbs and vitamin supplements you take. Include the doses and how often you take them.
• Ask a family member or friend to go with you, if possible. Someone with you can help you remember what your healthcare team tells you.
• Write down questions to ask your healthcare team. List your most important questions first.

Some basic questions to ask include:

• What tests do I need, if any?
• What treatments are there to ease my symptoms?
• What else can I do to ease my symptoms?
• Are there alternative therapies I might try?
• Are there any printed materials or brochures I can have?
• What websites do you suggest?

Be sure to ask all the questions you have.

What to expect from your doctor

Some questions your healthcare team might ask include:

• Are you still having periods?
• When was your last period?
• How often do you have symptoms that bother you?
• How bad are your symptoms?
• Does anything seem to make your symptoms better?
• Does anything make your symptoms worse?