Many treatments can relieve menopause symptoms. The right choice depends on your symptoms, health history, and preferences. You and your health care provider decide together.
Hormone therapy
Menopause hormone therapy, often just called hormone therapy, can supplement some of the hormones your ovaries no longer make. The U.S. Food and Drug Administration (FDA) has approved hormone therapies for reducing moderate to severe hot flashes, preventing bone loss and osteoporosis, and relieving vaginal dryness and discomfort.
Hormone therapy has risks as well as benefits. Its labeling describes risks such as blood clots, stroke, heart attack, and certain cancers. Your risks depend on your age, health history, and the type, dose, and form of hormone therapy. Talk with your provider about the benefits and risks for you. Learn about hormone therapy safety.
Whole-body estrogen (systemic estrogen)
Estrogen for the whole body comes as pills, skin patches, gels, sprays, and a vaginal ring. It treats hot flashes and night sweats and helps prevent bone loss.
Certain forms of estrogen may carry increased risk of blood clots. Talk with your provider about your risk and which form of estrogen is right for you.
Whole-body progestogens (progesterone and progestins)
If you have a uterus, you need progesterone or a similar medicine (a progestin) when taking estrogen. It protects the lining of your uterus from cancer. If you do not have a uterus, you can speak to your provider about whether you need progesterone.
Another way to protect your uterus is a pill that combines estrogen with a medicine called bazedoxifene.
Whole-body testosterone (systemic testosterone)
Beginning in your 30s, testosterone levels drop slowly as you age, and they drop suddenly if both ovaries are removed.
The FDA has not approved testosterone for women. Talk with your provider about the possible benefits and risks.
Vaginal hormones
Vaginal estrogen (cream, tablet, insert, or ring) and vaginal dehydroepiandrosterone (DHEA; prasterone) treat vaginal dryness and pain during sex caused by menopause.
If you have or have had breast cancer, talk with your cancer care team before using hormone therapy, including vaginal estrogen.
Vaginal hormones come in several forms. Talk with your provider to choose the product and dose that are right for you.
Hormone therapy at a glance
- Whole-body estrogen: pills, patches, gels, sprays, ring. Treats hot flashes and night sweats and helps prevent bone loss.
- Whole-body progestogens (progesterone and progestins): pills. Protects the uterus when you take estrogen.
- Vaginal hormones: creams, tablets, inserts, rings, and vaginal DHEA. Treat vaginal dryness and pain during sex.
How long can you take hormone therapy?
There is no single time limit. You and your provider review your symptoms, health, and preferences on a regular schedule.
If you have early or premature menopause, talk with your provider about whether hormone therapy is right for you and how long to use it.
Decisions about hormone therapy are shared decisions. You and your provider should talk through your symptoms, your health history, and the benefits and risks for you. Then you can decide together whether to start, continue, or stop treatment, based on what matters most to you.
Nonhormone medicines for hot flashes
If you cannot or do not want to take hormone therapy, other medicines can help.
The FDA has approved three nonhormone medicines for moderate to severe hot flashes: a low-dose form of paroxetine, fezolinetant, and elinzanetant. Fezolinetant and elinzanetant act on a brain pathway that helps control body temperature.
Fezolinetant has an FDA warning about rare, serious liver injury. Ask your provider about monitoring your liver health during treatment. Talk with your provider about the benefits and risks for you.
Your provider may also suggest a Selective Serotonin Reuptake Inhibitor (SSRI), a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI), or gabapentin. The FDA has not approved these for this use.
Talk therapy for hot flashes
Cognitive behavioral therapy (CBT) and clinical hypnosis are options that do not use medicine. Studies show they can reduce how much hot flashes bother you. Ask your provider whether they are right for you.
Treatments for genital and urinary symptoms (GSM)
- Vaginal estrogen and vaginal DHEA: Prescription treatments placed in the vagina. They treat vaginal dryness and pain during sex caused by menopause.
- Ospemifene: A daily prescription pill that acts like estrogen on vaginal tissue.
- Moisturizers and personal lubricants: These products provide temporary relief of vaginal dryness and discomfort. Use a vaginal moisturizer every few days and/or a water-based personal lubricant during sex.
Energy-based (e.g., laser, radiofrequency) vaginal treatments are not recommended for treatment of GSM. They have not been shown to work better than placebo treatment, and they can cause vaginal pain and scarring. The FDA has not authorized energy-based devices for treatment of GSM.
Healthy habits as part of care
Healthy habits support your well-being. They do not replace treatment when symptoms affect your life.
- Be active. Exercise can ease depressive symptoms and help with weight and waist size.
- Keep a regular sleep routine. Go to bed and get up at the same time each day.
- Do not smoke. Quitting is one of the best steps for your health.