There are many different options that patients can try to relieve menopause symptoms. This page will explore the following treatment options:

Systemic Therapies:

Local Therapies

Systemic menopausal hormone therapy is considered to be the most effective treatment currently available for the management of vasomotor symptoms associated with menopause.^1,2

The term hormone therapy includes a wide range of hormonal products and routes of administration, with potentially different benefits and risks (see table below).⁴

Please refer to the individual product SmPC before prescribing

HRT—hormone replacement therapy; SERM—selective estrogen receptor modulator. 
Table adapted from Barber⁴

The duration of treatment with hormonal agents should be reviewed periodically.⁴ There are no mandatory limitations on the duration of menopausal hormone therapy; the decision to continue therapy should be based on the specific goals of treatment and an objective estimation of ongoing individual benefits and risks.⁴

Prescription nonhormone therapies are available to alleviate select menopausal symptoms in women who are unable or unwilling to take local or systemic oestrogen therapy.⁴

For Vasomotor Symptoms
It is possible to treat vasomotor symptoms without use of hormones. This may be the sole option for women with contraindications to oestrogen or progesterone therapy (eg, women with a history of breast cancer).⁴

A variety of nonhormonal pharmacological agents have been shown to decrease the frequency and intensity of hot flushes in clinical trials; however, many of these agents may not be approved for this purpose.³ 

The duration of treatment with nonhormonal agents should be reviewed periodically. Treatment initiation usually requires a step-wise increase in dose to minimize side effects. Similarly, treatment discontinuation usually involves a step-wise taper in dose over ≥ 2 weeks to avoid withdrawal symptoms.⁴

For Vulvovaginal Atrophy (VVA)
• Ospemifene is an oral selective oestrogen receptor modulator (SERM) approved for the systemic treatment of moderate to severe VVA associated with menopause in women who are not candidates for vaginal oestrogen therapy.⁶
• SERMs do not contain hormones, per se, and therefore are not strictly a form of menopausal hormone therapy.^4,6
• Nevertheless, the biologic activity of SERMs is mediated through binding to oestrogen receptors, resulting in activation of some oestrogenic pathways (agonism) and blockade of others (antagonism).⁶

BMD—bone mineral density; SERM—selective estrogen receptor modulator; SC--subcutaneously.

​​​​​Table adapted from Barber⁴

The role of complementary and alternative medicines in managing menopause symptoms remains controversial due to a lack of high-quality data.⁴

Studies and meta-analyses do not consistently support the efficacy of complementary/alternative or over-the-counter medications in reducing the severity or frequency of vasomotor symptoms.⁴
•  Soy and red clover (ie, isoflavone preparations) and traditional Chinese medicines have demonstrated variable efficacy compared to placebo in small randomized, controlled trials and small meta-analyses^.4
• Black cohosh and St John’s wort have been associated with adverse effects and unfavorable drug-drug interactions with medications and should therefore be used with caution.⁴

Further data from larger randomized trials are needed to confirm the efficacy and safety of complementary and alternative medicines for management of menopause symptoms.⁴

Calcium and/or vitamin D supplementation should be considered for patients not meeting daily dietary requirements and those being treated for high fracture risk.⁴

For postmenopausal women, the daily recommended dietary intake is:
• 1000-1500 mg of elemental calcium⁴
•  800-1000 IU of vitamin D1

Genitourinary symptoms respond well to oestrogen therapy (either local or systemic).⁴ Local low-dose oestrogen therapy is preferred for women whose symptoms are limited to the vagina.⁷
• Long-term vaginal treatment is often required since symptoms can recur upon cessation of therapy.⁴
• Low-dose vaginal oestrogen therapy produces minimal systemic absorption.⁹ Risks associated with systemic hormone therapy have not been identified with local low-potency/low-dose oestrogen therapy, although product labels may carry warnings based on studies using systemic therapies.⁴

Please refer to the individual product SmPC before prescribing 

Various local oestrogen preparations are available for treating genitourinary symptoms:⁴

Vaginal moisturisers and lubricants can help alleviate symptoms associated with vaginal atrophy and dryness.⁴
• With regular use, these modalities may be very effective for some women.⁴
• These products can be used on their own or in combination with hormone therapy (systemic or topical).⁸

Moisturisers and/or lubricants, along with regular sexual activity, should be recommended for women wishing to avoid use of hormone therapy.⁴ These products may also benefit women taking hormone therapy who desire additional symptom relief.^4,8

Estring (estradiol hemihydrate) prescribing information can be found here
Premarin (oestrogens, conjugated) prescribing information can be found here
Premique (medroxyprogesterone acetate oestrogens, conjugated) prescribing information can be found here