Every woman deals with menopause differently but figures show that 1 in 4 women will experience severe symptoms. According to a 2017 survey by Nuffield Health, around two thirds of women in the UK say there is a lack of support and understanding around menopause. The survey also found that just 38 per cent of women sought help from a GP. Of those, a third were not made aware of the possibility of hormone replacement therapy.
Some authorities consider the menopause as a hormone deficiency that always requires treatment unless there are medical reasons why you can’t be prescribed it. These articles are intended to help you take the approach that suits you best, based on the evidence.
Of course you don’t have to seek medical help for menopause and many women choose to make lifestyle changes and try alternative remedies and therapies for menopause first. But your GP should help so don’t be afraid to ask.
NICE, that’s the National Institute for Clinical Excellence, has set out clear guidelines which aim to improve the consistency of support and information given to women in menopause. Your GP will be aware of these, but the next sections should give you an overview of what care and treatment you can expect.
If menopausal symptoms are affecting your day-to-day life, you should see your GP.
Menopause diagnosis
If you’re worried about menopause, your GP will be able to give you support and advice including information about the stages of the menopause, the symptoms you can expect, what to do about contraception and offer advice about lifestyle changes you could make. They should also explain the risks and benefits of the treatments available for symptoms including hormone replacement therapy (HRT) and explain how menopause might affect your future health. NICE has a useful set of questions that you can ask your GP, which you might find useful to refer to at your appointment. Menopause UK also has information about getting the most out of your doctor’s appointment.
Your GP should be able to tell if you are in perimenopause or menopause based on your age, symptoms and how often you have periods, so you are unlikely to need tests. If you are taking any hormonal treatments, (for example, to treat heavy periods and including the contraceptive pill) it can be more difficult to know when you have reached menopause.
Your GP may offer you a blood test but only if you’re under 45 and have menopausal symptoms, including changes in your menstrual cycle (how often you have periods). This could mean you are in premature or early menopause. You can read more about this in our article on premature and early menopause.
The blood test measures a hormone called FSH (follicle‑stimulating hormone). FSH is found in higher levels in menopause. You should not be offered this test if you are taking a contraceptive containing oestrogen and progestogen or high‑dose progestogen because the contraceptive changes your natural FSH levels.
Treatment and symptom control for menopause
Your GP can give you information about all the available treatments that might help your menopausal symptoms but it’s worth taking time to understand a little more about your options before you go. Having information may mean that you don’t need to see your GP. When or if you speak to your GP, as well as prescribed medication, there are many different treatments for menopausal symptoms that you can buy at the chemist. There are also lifestyle changes you can try. Let’s take a look at all the different options available in more detail.
Lifestyle changes
There are a number of lifestyle changes that may help alleviate symptoms.
- Reduce or avoid alcohol. Research shows that alcohol can exacerbate hot flushes. Alcohol can also lead to trouble sleeping and increase anxiety. Try to manage how much you’re drinking.
- Cut caffeine. Studies show caffeine is linked hot flushes. It can also interfere with getting a good nights sleep so consider reducing your intake.
- Stop smoking. Smoking can increase hot flushes. Smokers also reach menopause earlier than non smokers. So if you do smoke try to give up.
- Kegel exercises. Kegel or pelvic floor exercises can help alleviate bladder control problems and you can do them at any time! They strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. You can find out about them here.
- General exercise. While there is no evidence that exercise has a direct effect on menopausal symptoms themselves, exercise can help boost mood, energy levels and reduce stress. Combined with a healthy diet it can also help maintain a healthy weight.
- Diet. Many women find they put on weight during menopause so eat a healthy balanced diet to help manage your weight and give you more energy. There’s also some evidence that a diet rich in oily fish and fresh legumes can help delay menopause.
- Practice mindfulness. Coping with symptoms can be hard so you could consider things to reduce your stress, such as practising yoga and mindfulness.
- Try to sleep. It can be hard to sleep when you’re dealing with menopausal symptoms but not getting enough of it can make things even worse! Try to practise good sleep routines. Our six steps to better sleep might help.
- Moisturise. Use moisturisers and lubricants to help with vaginal dryness.
Complementary remedies and medicines available without prescription
If you wish to try any of these over the counter therapies, your GP should explain that their quality and ingredients may be unknown. These are unlikely to be prescribed so will cost you money.
St John’s wort
Some women have found St John’s wort can reduce their hot flushes and night sweats during menopause. It’s also used to alleviate symptoms of anxiety and low mood. However, the ingredients of products containing St John’s wort will vary and therefore so will the effects. These products can also interfere with and cause side effects when taken with other drugs, including those used to treat breast cancer (for example, tamoxifen).
Black cohosh
Black Cohosh is a herb that has been found to help with hot flushes and night sweats. However, data on it’s effectiveness is mixed. Furthermore, the ingredients of these products may vary and they may interfere with any other medicines you are taking.
Red clover and isoflavones
Isoflavones are plant based chemicals that are thought to produce oestrogen-like effects in the body. These are found in supplements like red clover and also in soy-based products as well as in legumes like chick peas and lentils. There is some evidence these can reduce their hot flushes and night sweats which while encouraging, is not conclusive and more research is needed. Again the ingredients and amounts of these isoflavones can vary products and foods.
Acupuncture
Acupuncture is a Chinese health approach that uses needles put into the skin at specific points on the body that correspond to meridian or energy channels, which are believed to link to internal organs and restore balance.Studies have shown acupuncture may help alleviate some symptoms of menopause like night sweats and hot flushes. Reflexology works in a similar way but focusing on the hands and feet and there is less research about its effectiveness. While these interventions may not work for everyone and results are not conclusive, there is no real harm in trying it to see if it works for you as side effects are very unusual.
Bioidentical hormones
Bioidentical hormones are hormone preparations made from plant sources and are therefore sometimes referred to as a “natural” alternative to conventional hormone replacement therapy. They are not regulated and while these can be bought online or from some pharmacies, there has been concern about these treatments from experts in the UK, as it’s not known how effective they are in reducing menopausal symptoms. In fact, The British Menopause Society issued a statement last year to express their concern about the safety of unregulated bioidentical hormone replacement therapy, prescribed by pharmacists or clinicians without recognised menopause training. They recommend that people shouldn’t use any hormone therapies that aren’t being regulated and haven’t been approved by the MHRA.
Prescribed medications
NICE sets out clear guidance for GPs to help manage symptoms. For women who seek help for their menopausal symptoms, HRT (hormone replacement therapy) is the most commonly prescribed treatment. You can read more about HRT in our guide here.
However, your GP may also give you information about:
- Non-hormonal treatments, for example a drug called Clonidine which helps to reduce the flushing.
- Vaginal oestrogen. This treatment for vaginal dryness is put directly into the vagina as a pessary, cream or a vaginal ring. This replaces hormones which the menopause has reduced and so enables the vagina to lubricate itself again. You can use vaginal oestrogen for as long as you need to, even if you are already using HRT. It’s rare for vaginal oestrogen to cause problems, but if you have any unexpected vaginal bleeding you should tell your GP. Your GP should explain that your symptoms may come back when you stop using it.
- Testosterone supplements. These are sometimes prescribed to help with lack of interest in sex if HRT doesn’t help. Testosterone contributes to libido and arousal by increasing dopamine levels in the nervous system. Testosterone also helps muscle and bone strength, urogenital health, mood and thinking. Testosterone supplements are not licensed for use in women, but they can be prescribed if the reasons are clear and options are discussed. Your doctor should tell you this and explain what it means for you.
- Other types of treatments, such as cognitive behavioural therapy (CBT), a type of psychological therapy that helps people to manage the way they think and feel. CBT is used to address a variety of issues like depression, PMT and other mental health disorders so it makes sense that it could help manage the emotional changes that menopause brings. Studies have shown CBT can help alleviate symptoms in the short term but more research is needed.
- A note on anti depressants. Research shows many women in the UK are being incorrectly diagnosed as depressed and given antidepressants during menopause. It has not been shown that antidepressant drugs can help with low mood during menopause if you haven’t been diagnosed with depression.
Reviewing your care
You may be having different treatments or therapies to help your menopausal symptoms. To see whether treatment is helping you should be offered review appointments every 3 months to start with. If you are not having any problems you should then have appointments once a year. You should be offered an earlier review if you need it, for example if treatment no longer seems to be working or is causing side effects such as irregular bleeding. it is also important to keep going to all your routine health screening appointments (for example, breast and cervical screening).
Specialist help
If treatments haven’t helped your symptoms or have caused side-effects you should be referred to a healthcare professional specialising in menopause. You may also be referred if there is uncertainty about the best treatment for you. Studies have shown that many women are unaware of NHS menopause clinics so do ask your GP if you feel you need more support. The British Menopause society also has a useful clinic finder, both for NHS and private menopause clinics in your area.
Other sources of advice and support
The menopause can mean big changes for women before, during and afterwards. Don’t be afraid to ask for help. Our articles linked below are intended to help you understand more about the menopause and make informed choices about how you want to proceed.
There are also lots of other support groups and information available too.
Menopause Support UK
The Daisy Network
Menopause matters
The Menopause exchange
Fertility friends
Women’s health concern
You can also go to NHS Choices for more information.
Not got the app yet? Download the Evergreen Life app and look out for a notification about your Menopause questionnaire*. Start taking more control of your health and wellbeing.
*Must be 30 or over and female to receive the Menopause Check. If you haven’t told us your age and sex, please first take the GP Check in your Records section.
Reviewed by:
Dr Brian Fisher MBBCh MBE MSc FRSA Medical Expert
Dr James Harmsworth King MBBS MPhil PhD Biotechnology & Medical Expert
Overview | Menopause: diagnosis and management | Guidance | NICE
