Menopause related symptoms can be bothersome and interfering with daily lifestyle and requiring treatment. 60% of women at menopause experience symptoms for five years around the menopause , but the majority of them can have some symptoms for 10 or 20 years after menopause. The most common is hot flashes ( or night sweats ) , which interferes with sleep pattern and can trigger insomnia , anxiety and depression.

The long duration of these symptoms raises treatment challenges for many women. HRT is the most efficient treatment but it also increases the risk of cardiac and vascular events after the age of 60 or in women with previous history of breast cancer or cardiovascular disease.

Current treatment options for menopausal symptoms

• Hormone therapy is the most effective therapy for hot flashes and all menopause related symptoms . Due to safety profile it’s limited in regards to age and previous cardiac or cancer conditions. See article Is hormone replacement therapy safe?

• Non-hormonal prescribed therapy

• Alternative therapy

Promising therapy

Inconsistent evidence of efficacy

Used , but proven to be of no benefit

Non-hormonal prescribed therapies

venlafaxine(Effexor®)

• Proven effectiveness

• Safe for breast cancer women taking tamoxifen

• Main side effect – Elevated blood pressure (at high doses).

• Helps with depression

• No weight gain

desvenlafaxine(Pristiq®)

• Similar to venlafaxine.

fluoxetine (Prozac®)

• Proven efficacy in menopausal symptoms relief

• Should be avoided in women taking tamoxifen.

escitalopram (Lexapro®)

• Additional effectiveness in insomnia

gabapentin (Neurontin®)

• weight gain.

• helps with insomnia

clonidine (Catapres®)

• cardiac drug , lowers blood pressure., less commonly used

Alternative therapy

1. Promising results

●Cognitive behavioral therapy (CBT) – CBT appears to be beneficial for insomnia , but less so for hot flashes

●Hypnosis – may be beneficial for hot flashes, but data are limited

2. Inconsistent evidence of efficacy. Not proven effective but awaiting trials .

• Primrose Oil , can give Nausea, diarrhea, headache.

• Black cohosh: can give stomach upset, liver toxicity

• Soy (plant estrogen). Also referred to as phytoestrogens : not recommended for breast cancer survivors. Foods with high concentration : soybeans, chickpeas, lentils, flaxseed, grains, beans, fruits, red clover and vegetables

3. Used , but proven to be of no benefit

• Acupuncture

Vitamin E