U.S. DEPARTMENT 

OF HEALTH AND 

HUMAN SERVICES 

National Institute 

on Aging 

Menopause: Treatment for Symptoms 

Tips from the National Institute on Aging
 

Larissa is 52. She’s excited to be starting a new 

phase of her life as her children leave home and she 

has more time for her other interests. She’s looking 

forward to traveling and taking a computer class. 

But, recent health changes have been getting in 

the way of her plans. Larissa has been having 

irregular periods for the past few months. Now, 

she’s getting hot flashes and having trouble 

sleeping. The hot flashes, which cause her body 

and face to heat up quickly and uncomfortably, 

are waking her up several times a night. Larissa 

is tired and irritable from lack of sleep and fed up 

with the hot flashes. She is ready to talk with her 

doctor about finding some relief. 

Larissa is experiencing the menopausal transition, a 

normal part of aging. It is not a disease or disorder. 

After the menopausal transition, many women feel 

relieved they no longer have to worry about painful 

periods, cramps, or getting pregnant. 

Some women don’t have any trouble with menopausal

symptoms. For others, the menopausal transition 

can bring hot flashes, trouble sleeping, moodiness 

and irritability, pain during sex, or depression. 

Some may decide to talk with their doctor about 

treatments for their symptoms. 

There are many factors to consider when thinking 

about treating menopausal symptoms. 

What Is Menopause? 

The menopausal transition most often begins 

between ages 45 and 55. It usually lasts about 

7 years but can last as long as 14 years. During the 

menopausal transition, the body’s production of 

estrogen and progesterone, two hormones made 

by the ovaries, varies greatly. Bones also become 

less dense, making women more vulnerable to 

fractures. During this period, too, the body begins 

to use energy differently, fat cells change, and 

women may gain weight more easily. 

This time in a woman’s life is often full of other 

transitions—not just physical ones. Women may 

be caring for aging parents or relatives, supporting 

their children as they move into adulthood, or 

taking on new responsibilities at work. 

Is It Menopause? 

If you are having symptoms commonly associated 

with the menopausal transition, your doctor may

ask questions about your age, symptoms, and family 

history to determine if it really is the menopausal

transition causing your symptoms. In some cases, 

your doctor may suggest a blood test to check your 

FSH (follicle-stimulating hormone) and estradiol 

(E2) levels to rule out any other causes for the 

changes you’re experiencing. 

The menopausal transition, sometimes called 

perimenopause, begins several years before a 
MENOPAUSE: TREATMENT FOR SYMPTOMS

woman’s last period. During this time, women may 

experience spotty menstrual cycles, hot flashes, 

and other changes. While this time is commonly 

referred to as “menopause,” menopause doesn’t 

happen until 1 year after the final menstrual period. 

After menopause, women enter post-menopause. 

Post-menopausal women are more vulnerable 

to heart disease and osteoporosis. At this time, it 

is important to eat a healthy diet and make sure 

you get lots of calcium to keep your bones strong. 

A woman who doesn’t want to get pregnant 

should continue to use birth control for at least 

a full 12 months after her last period. 

What Are the Symptoms of Menopause? 

Many women experience very mild symptoms that 

are easily treated by lifestyle changes, like avoiding 

caffeine or carrying a portable fan to use when a 

hot flash strikes. Some women don’t require any 

treatment at all. Other symptoms can be more 

problematic. Common symptoms include: 

▪	 Hot flashes 

▪	 Disturbed sleep 

▪	 Mood swings, depression, or anxiety 

▪	 Vaginal dryness and pain during sex 

In addition, in some women, symptoms may 

include aches and pains, headaches, and heart 

palpitations. Since menopausal symptoms may 

be caused by changing hormone levels, it is 

unpredictable how often women will have hot 

flashes and other symptoms and how severe they 

will be. Talk with your doctor if these symptoms 

are interfering with your everyday life. The 

severity of symptoms varies greatly around the 

world and by race and ethnicity. 

This tip sheet explores treatment options for 

common symptoms of the menopausal transition. 

Hot Flashes: What Can I Do? 

Hot flashes are uncomfortable and can last for 

many years. When they happen at night, hot 

flashes are called night sweats. Some women find 

that hot flashes interrupt their daily lives. The 

earlier in life hot flashes begin, the longer you may 

experience them. Research has found that African 

American and Hispanic women get hot flashes for 

more years than white and Asian women. 

You may decide you don’t need to change 

your lifestyle or investigate treatment options 

because your symptoms are mild. But, if you are 

bothered by hot flashes, there are some steps 

you can take. Try to take note of what triggers 

your hot flashes and how much they bother you. 

This can help you make better decisions about 

managing your symptoms. 

Lifestyle Changes to Improve Hot Flashes 

Before considering medication, first try making 

changes to your lifestyle. Doctors recommend 

women make changes like these for at least 3 

months before starting any medication. 

▪	 If hot flashes are keeping you up at night, 

keep your bedroom cooler and try drinking 

small amounts of cold water before bed. 

Layer your bedding so it can be adjusted as 

needed. Some women find a device called a 

bed fan helpful. 

▪	 Carry a portable fan to use when a hot flash 

strikes. 

▪	 Avoid alcohol, spicy foods, and caffeine. 

These can make menopausal symptoms 

worse. 

▪	 If you smoke, try to quit, not only for 

menopausal symptoms, but for your overall 

health. 

▪	 Try to maintain a healthy weight. Women 

who are overweight or obese may experience 

more frequent and severe hot flashes. 

▪	 Try mind-body practices like yoga or other 

self-calming techniques. Early-stage research 

has shown that mindfulness meditation, 

yoga, and tai chi may help improve 

menopausal symptoms. 

2
 
TIPS FROM THE NATIONAL INSTITUTE ON AGING 

Medications: Non-Hormone Options for 

Treating Hot Flashes 

If lifestyle changes are not enough to improve your 

symptoms, non-hormone options for managing 

hot flashes may work for you. They may be a good 

choice if you are unable to take hormones or if you 

are worried about their potential risks. 

The U.S. Food and Drug Administration (FDA) has 

approved the use of paroxetine, a low-dose selective 

serotonin reuptake inhibitor (SSRI) antidepressant, 

to treat hot flashes. Researchers are studying the 

effectiveness of other antidepressants in this class. 

Women who use an antidepressant to help manage 

hot flashes generally take a lower dose than those 

who use the medication to treat depression. Side 

effects depend on the type of antidepressant you 

take and can include dizziness, headache, nausea, 

jitteriness, or drowsiness. As with any medication, 

talk with your doctor about whether this is the right 

medication for you and how you can manage any 

possible side effects. 

Medications: Treating Hot Flashes and 

Night Sweats With Hormones 

Some women may choose to take hormones to treat 

their hot flashes. A hormone is a chemical substance 

made by an organ like the thyroid gland or ovary. 

During the menopausal transition, the ovaries begin 

to work less and less well, and the production of 

hormones like estrogen and progesterone declines 

over time. It is believed that such changes cause hot 

flashes and other menopausal symptoms. 

Hormone therapy steadies the levels of estrogen 

and progesterone in the body. It is a very effective 

treatment for hot flashes in women who are able 

to use it. There are risks associated with taking 

hormones, including increased risk of heart attack, 

stroke, blood clots, breast cancer, gallbladder 

disease, and dementia. The risks vary by a woman’s 

age and whether she has had a hysterectomy. 

Women are encouraged to discuss the risks with 

their healthcare provider. 

Women who still have a uterus should take 

estrogen combined with progesterone or another 

therapy to protect the uterus. Progesterone is added 

to estrogen to protect the uterus against cancer, 

but it also seems to increase the risk of blood 

clots and stroke. Hormones should be used at the 

lowest dose that is effective for the shortest period 

of time possible. (See What Are the Risks of Using 

Hormones for Hot Flashes? on page 4.) 

Some women should not use hormones for their 

hot flashes. You should not take hormones for 

menopausal symptoms if: 

▪	 You have had certain kinds of cancers, like 

breast cancer or uterine cancer 

▪	 You have had a stroke or heart attack, or 

you have a strong family history of stroke or 

heart disease 

▪	 You have had blood clots 

▪	 You have had problems with vaginal 

bleeding or have a bleeding disorder 

▪	 You have liver disease 

▪	 You think you are pregnant or may become 

pregnant 

▪	 You have had allergic reactions to hormone 

medications 

Talk with your doctor to find out if taking 

hormones to treat your symptoms is right for you. 

Should I Take Hormones for My Hot 

Flashes? 

Hormones can be very effective at reducing the 

number and severity of hot flashes. They are also 

effective in reducing vaginal dryness and bone loss. 

Hormone treatments (sometimes called menopausal 

hormone therapy) can take the form of pills, patches, 

rings, implants, gels, or creams. Patches, which stick 

to the skin, may be best for women with cardiac risk 

factors, such as a family history of heart disease. 

There are many types of hormones available for 

women to treat hot flashes. These include estradiol, 

conjugated estrogen, selective estrogen receptor 

3
 
MENOPAUSE: TREATMENT FOR SYMPTOMS

modulators (SERMs), and compounded or synthetic 

hormones. It is a common misconception that 

synthetic (“bioidentical”) hormones mixed by a 

compounding pharmacist are safer and less risky 

than other hormone therapies. This is not the case. 

We must assume they have the same risks as any 

hormone therapy. 

Some of the relatively mild side effects of hormone 

use include breast tenderness, spotting or return 

of monthly periods, cramping, or bloating. By 

changing the type or amount of the hormones, the 

way they are taken, or the timing of the doses, your 

doctor may be able to help control these side effects 

or, over time, they may go away on their own. 

What Are the Risks of Using Hormones 

for Hot Flashes? 

In 2002, a study that was part of the Women’s 

Health Initiative (WHI), funded by the National 

Institutes of Health, was stopped early because 

participants who received a certain kind of 

estrogen with progesterone were found to have a 

significantly higher risk of stroke, heart attacks, 

breast cancer, dementia, urinary incontinence, and 

gallbladder disease. 

This study raised significant concerns at the time and 

left many women wary of using hormones. 

However, research reported since then found that 

younger women may be at less risk and have more 

potential benefits than was suggested by the WHI 

study. The negative effects of the WHI hormone 

treatments mostly affected women who were over 

age 60 and post-menopausal. Newer versions of 

treatments developed since 2002 may reduce the 

risks of using hormones for women experiencing 

the menopausal transition, but studies are needed 

to evaluate the long-term safety of these newer 

treatments. 

If you use hormone therapy, it should be at the 

lowest dose, for the shortest period of time it 

remains effective, and in consultation with a 

doctor. Talk with your doctor about your medical 

and family history and any concerns or questions 

about taking hormones. 

Buyer Beware: Unproven, 

Nonscientific “Treatments” for 

Hot Flashes 

You may have heard about black cohosh, 

DHEA, or soy isoflavones from friends 

who are using them to try to treat their 

hot flashes. These products are not 

proven to be effective, and some carry 

risks like liver damage. At this time, it is 

unknown whether herbs or other “natural” 

products are helpful or safe. The benefits 

and risks are still being studied. Always 

talk with your doctor before taking any 

herb or supplement to improve your hot 

flashes or other menopausal symptoms. 

Sleep Problems and Menopause: What 

Can I Do? 

The years of the menopausal transition are often 

a time when there are other changes in a woman’s 

life. You may be caring for aging parents, supporting children as they move into adulthood, and 

reflecting on your own life journey. Add hot flashes 

on top of all this, and you may find yourself having 

trouble sleeping at night. 

Not getting enough sleep can affect all areas of 

life. Lack of sleep can make you feel irritable or 

depressed, might cause you to be more forgetful 

than normal, and could lead you to have more falls 

or accidents. 

Some women who have trouble sleeping may use 

over-the-counter sleep aids like melatonin. Others 

use prescription medicines to help them sleep, 

which may help when used for a short time. But 

remember, medicines are not a cure for insomnia. 

Developing healthy habits at bedtime can help you 

get a good night’s sleep. 

Getting a Good Night’s Sleep During 

the Menopausal Transition 

To improve your sleep through the menopausal 

transition and beyond: 

4
 
TIPS FROM THE NATIONAL INSTITUTE ON AGING 

▪	 Follow a regular sleep schedule. Go to sleep 

and get up at the same time each day. 

▪	 Avoid napping in the late afternoon or 

evening if you can. It may keep you awake at 

night. 

▪	 Develop a bedtime routine. Some people 

read a book, listen to soothing music, or soak 

in a warm bath. 

▪	 Try not to watch television or use your 

computer or mobile device in the bedroom. 

The light from these devices may make it 

difficult for you to fall asleep. 

▪	 Keep your bedroom at a comfortable 

temperature, not too hot or too cold, and as 

quiet as possible. 

▪	 Exercise at regular times each day but not 

close to bedtime. 

▪	 Avoid eating large meals close to bedtime. 

▪	 Stay away from caffeine (found in some 

coffees, teas, or chocolate) late in the day. 

▪	 Remember, alcohol won’t help you sleep. Even 

small amounts make it harder to stay asleep. 

If these changes to your bedtime routine don’t help 

as much as you’d like, you may want to consider 

cognitive behavioral therapy. This problem-solving 

approach to therapy has recently been shown to 

help sleep disturbances in women with menopausal 

symptoms. Cognitive behavioral therapy can be 

found through a class or in one-on-one sessions. 

Be sure that your therapy is guided by a trained 

professional with experience working with women 

during their menopausal transition. Your doctor 

may be able to recommend a therapist in your area. 

Having Sex Is Becoming Painful: What 

Can I Do? 

Some women have vaginal dryness when their 

bodies experience the menopausal transition. 

This can make sex painful. Women may also 

experience a tightening of the vaginal opening, 

burning, itching, and dryness (called vaginal 

atrophy). Fortunately, there are options for women 

to address these issues. Talk with your doctor if you 

are having this problem—he or she can suggest 

treatment options. 

Treating Vaginal Dryness and Pain 

During Sex 

Pain during sexual activity is called dyspareunia. 

Like other symptoms of the menopausal transition, 

dyspareunia may be minor and not greatly affect 

a woman’s quality of life. However, some women 

experience severe dyspareunia that prevents them 

from engaging in any sexual activity. 

You may find relief from vaginal dryness using 

water-based lubricants or vaginal moisturizers, 

which can be found at most grocery and drug 

stores. Vaginal moisturizers differ from lubricants. 

They are to be used regularly—not just during 

sex—to replenish vaginal moisture and relieve 

vaginal dryness. Do not use petroleum jelly for this 

purpose; oil-based products can cause irritation. 

If your symptoms are not improved by using waterbased lubricants or vaginal moisturizers, hormones 

may help. Local vaginal treatments (like estrogen 

creams, rings, or tablets) are often used to treat this 

symptom and provide lower hormone doses to the 

rest of the body than a pill or patch. 

Hormones aren’t the only option for treating 

vaginal dryness and dyspareunia. The FDA 

has approved a non-hormone medicine (called 

ospemifene) to treat moderate to severe dyspareunia 

caused by vaginal changes that occur with 

menopause. Your doctor can tell you about the 

risks and benefits of this medicine. 

Other Menopause Symptoms and 

Treatments 

For most women, hot flashes and trouble sleeping 

are the biggest problems associated with menopause. 

But, some women have other symptoms, such as 

irritability and mood swings, anxiety and depression, 

headaches, and even heart palpitations. 

5
 
Many of these problems, like mood swings and 

depression, are often improved by getting a better 

night’s sleep. Discussing mood issues with your 

doctor can help you identify the cause, screen for 

severe depression, and choose the most appropriate 

intervention. For depression, your doctor may 

prescribe an antidepressant medication. 

If you want to change your lifestyle to see if you can 

reduce your symptoms, or if you decide any of your 

symptoms are severe enough to need treatment, 

talk with your doctor. 

Treating Menopause Symptoms: 

What’s Right for Me? 

Deciding whether and how to treat the symptoms 

of the menopausal transition can be very complicated 

and personal. Discuss your symptoms, family and 

medical history, and preferences with your doctor. 

No matter what you decide, see your doctor every 

year to talk about your treatment plan and discuss 

any changes you want to make. 

For More Information About Menopause 

American College of Obstetricians and 

Gynecologists 

1-800-673-8444 (toll-free) 

resources@acog.org (email) 

www.acog.org

National Institutes of Health 

www.nih.gov/PHTindex.htm

National Library of Medicine 

MedlinePlus 

www.medlineplus.gov/menopause.html

North American Menopause Society 

1-440-442-7550 

info@menopause.org (email) 

www.menopause.org

U.S. Food and Drug Administration 

1-888-463-6332 (toll-free) 

druginfo@fda.hhs.gov (email) 

www.fda.gov

For more information on health and aging, contact: 

National Institute on Aging Information Center
 

P.O. Box 8057
 

Gaithersburg, MD 20898-8057
 

1-800-222-2225 (toll-free)

1-800-222-4225 (TTY/toll-free)

niaic@nia.nih.gov (email)

www.nia.nih.gov
 

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information from the NIA, go to www.nia.nih.gov/health.

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OCTOBER 2016
 

NIH PUBLICATION NO. 16-AG-7482