Hormone replacement therapy

Hormone replacement therapy (HRT) is the main treatment used to manage the symptoms of the menopause.

Over the years, concerns have been raised about a link with breast cancer, but in guidance published at the end of 2015, the National Institute for Health and Care Excellence (NICE) stated that HRT should be offered to most women experiencing menopausal symptoms. Nevertheless, the benefits (including the fact that it is very effective at relieving night sweats, hot flushes and other symptoms) and risks (side effects including breast tenderness, headaches and vaginal bleeding, plus an increased risk of blood clots and breast cancer in certain groups) of HRT should be carefully explained beforehand.

The right type of HRT should be prescribed – a combined oestrogen and progestogen product for women who still have their womb, and an oestrogen-only variety for those who have had a hysterectomy – in a formulation (patches, tablets, gel or implant) that suits the individual.

Other drugs that are sometimes used include selective serotonin reuptake inhibitors (SSRIs), clonidine, testosterone and gabapentin.

Did you know?

Around one in 100 women experience the menopause before 40 years of age. This is known as premature menopause.

Complementary remedies

Complementary and alternative products are popular with women going through the menopause, but care needs to be taken as there is some uncertainty over how safe and effective they are. The most widely available include:

• Black cohosh – a herbal remedy that studies have found can help with night sweats and hot flushes, although not as much as prescription treatments.
• St John’s wort – another herbal remedy that has been shown to help relieve symptoms, such as hot flushes.
• Phytoestrogens – hormones that naturally occur in plants such as red clover and can help reduce anxiety, albeit on a temporary basis only. They are also known as isoflavones.

All of the above can interact with other medicines, in some cases very significantly, so anyone wanting to buy such a product who is taking other medication (OTC or prescribed) may need to be referred to the pharmacist.