Menopause is not a medical problem in and of itself and so it does not always require treatment. However, for some people the symptoms associated with the transition to menopause are debilitating and in these cases, treatment may be appropriate. There are several approaches to treatment so it is important to talk with your doctor about the options that are available. No treatment works for every woman so it is important to work with your doctor to determine a treatment strategy that is right for you. Menopause symptoms will go away with time, but there is no way of knowing how long that will take; in some cases it may be several years.

Hot flashes and night sweats are some of the most bothersome symptoms of the transition to menopause. Here are some ways that may help relieve the discomfort when they occur:

• Keep a diary of your hot flashes to see if you can determine what triggers them.
• When a hot flash starts, try to go somewhere cool.
• Sleep in a cool room or with a fan on.
• Dress in layers that you can remove if you get too warm.
• Use sheets and clothing that let your skin “breathe.”
• Have a cold drink (water or juice) when you feel a hot flash starting.

Some other non-medical ways to help relieve the symptoms of menopause include:

• Vaginal dryness: Use a water-based lubricant (such as KY Jelly) or a vaginal moisturizer.
• Problems sleeping: Practice good sleep hygiene (e.g. going to bed at the same time each night, using the bed only for sleeping, not reading or watching TV).
• Mood swings: Getting enough exercise and eating right may actually stabilize mood.

The most effective and also the most controversial treatment for menopause symptoms is hormone replacement therapy (HT or HRT). HT involves taking supplemental estrogen with or without progesterone to increase the levels of these hormones in the body. HT is very effective at preventing hot flashes and improving vaginal lubrication as well as some of the other symptoms that may accompany menopause. Another benefit of HT is that it helps prevent the bone loss that can occur after menopause and it may also help prevent heart disease.

However, HT also comes with many risks. HT increases your risk of suffering blood clots, stroke, heart attacks, and breast cancer. Because of these risks certain people should not use HT including women who think they may be pregnant, those with vaginal bleeding, women with a history of breast or uterine cancer, women who have had a stroke, heart attack, or blood clots, women with liver or heart disease, and women who smoke. These serious risks mean that the decision to take HT should not be taken lightly. The FDA recommends that HT for post-menopausal women be given the lowest doses for the shortest amount of time to reach treatment goals. Other side effects of HT include vaginal bleeding, bloating, breast tenderness, headaches, and mood changes.

It is important to note that for women without other risk factors, the increase in risk of cardiovascular problems and breast cancer is relatively small. So, while HT is not right for every woman, if you are suffering from severe menopausal symptoms that are making life unbearable, HT may be a good choice for you. See the resources at the end of this article for more information about HT and making a personal choice about its use.

Other medications that may help alleviate menopause symptoms include:

• Low-dose antidepressants: Small doses of antidepressants from the SSRI class may decrease menopausal hot flashes.
• Gabapentin (Neurontin): This anti-seizure drug may also significantly reduce hot flashes.
• Clonidine (Catapres): This medication is normally used to treat high blood pressure, but it may also significantly reduce the frequency of hot flashes.
• Bisphosphonates: This class of drugs, which includes alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva), can help prevent or treat osteoporosis.
• Selective estrogen receptor modulators (SERMs): These drugs, such as raloxifene (Evista) help increase bone density in postmenopausal women.
• Local estrogen: Estrogen administered locally to the vagina using a vaginal tablet, ring, or cream can help relieve vaginal dryness.

Before deciding on any form of treatment, talk with your doctor about all your options and the risks and benefits involved with each.