Menopause symptoms: Mayo Clinic expert outlines hormone and nonhormonal therapies
Menopause, the end of menstrual cycles, can produce symptoms such as hot flashes, night sweats, insomnia and mood changes. Women do not need to suffer in silence: Many treatment options are available. Jewel Kling, M.D., chair of the Division of Women’s Health at Mayo Clinic in Scottsdale, Arizona, describes hormonal and nonhormonal therapies.
Among benefits:
- Many studies have shown that systemic hormone therapy such as a pill, patch, gel or spray, helps with hot flashes, night sweats, and vulva vaginal symptoms, Dr. Kling says.
There’s also strong evidence that long-term treatment with estrogen therapy or estrogen plus progestogen therapy reduces the risk of fractures after menopause.
Among risks:
- With oral systemic estrogen therapy or estrogen plus progestogen therapy, risks include blood clots in the legs and lungs, and stroke.
- Use of estrogen alone by women who have a uterus carries a risk of uterine cancer; that risk can be lowered by including progestogen or an estrogen selective estrogen receptor modulator, also known as the SERM (selective estrogen receptor modulator) combination.
- Breast cancer risks should also be considered, and appear slightly higher, particularly in women with a uterus who use estrogen plus a progestogen.
Hormone therapy generally isn’t an option for women with breast cancer, other hormonally mediated cancers or blood clot issues, and other women may simply wish to avoid hormone therapy, Dr. Kling says. There are many nonhormonal therapies ranging from mind-body techniques to medication that can bring relief with few or no side effects:
- There is some evidence that losing weight may reduce hot flashes and night sweats.
- Among medications, low-dose paroxetine has been shown to help some women with symptoms such as hot flashes. At low doses, it doesn't appear to cause weight gain or have adverse sexual effects.
- In some cases, antidepressants may be appropriate, and the health care practitioner and patient will weigh benefits and risks, Dr. Kling says.
- Mind-body techniques include cognitive behavioral therapy and clinical hypnosis, both of which depend on expert guidance for success, Dr. Kling says. Some patients have found relief from acupuncture, yoga and meditation.
