In short
Overview
There is more than one way to treat menopausal symptoms, and a surprising number of popular options have been tested and found not to work.
Direct Answer
The main options are hormone therapy, which is the most effective, and non hormonal medication, which works and is used where hormones are not appropriate.
Hormone therapy clears hot flushes completely in about 80 per cent of women and cuts them by around 75 per cent on average across 24 trials.
The Menopause Society does not recommend supplements, soy, acupuncture, cannabinoids, paced breathing, trigger avoidance or clonidine.
Who This Applies To
Which route fits which situation
| Healthy, under 60 or within 10 years of last period | Hormone therapy. Benefits outweigh risks |
| Contraindication present | Non hormonal medication |
| High cardiovascular or breast cancer risk | Non hormonal suggested |
| Vaginal dryness and pain only | Low dose vaginal oestrogen, not systemic treatment |
| Still cycling and needing contraception | A low dose pill or a hormonal coil, which cover both |
Option Comparison / Decision Criteria
is first choice for most women. It avoids the liver first pass and carries lower clot and stroke risk than tablets
is reasonable for many, but avoided with high triglycerides, active gallbladder disease, migraine or a known lower risk clotting tendency
if you have a uterus. 200 mg for 12 days a month, or 100 mg daily. Taken at bedtime, since some of its breakdown products cause drowsiness
as the progestogen component, useful if oral progesterone affects your mood
SSRIs, which also help perimenopausal mood
Gabapentin
Neurokinin 3 receptor antagonists, fezolinetant and elinzanetant, which are the newest option
Why an In-Person Physician Review Matters
The choice depends on risk, not preference alone Cardiovascular and breast cancer risk are calculated before starting.
Moderate cardiovascular risk means transdermal rather than oral and micronised progesterone rather than a synthetic progestin. High risk means non hormonal instead. Cyclical or continuous Perimenopause or early postmenopause: cyclical progesterone, which produces a monthly bleed in 80 to 90 per cent of women More than two to three years past the last period: continuous progesterone, which produces no bleed in most women Most women eventually switch to continuous to stop the bleeding, which is a common reason for giving up on treatment otherwise. The symptoms that are not menopause Sleep is the trap. Restless legs and sleep apnoea often start in the same decade, and in women investigated for sleep disturbance around menopause, 53 per cent had one or both. Those need their own treatment and do not respond to hormones. Mood, which is treated on its own terms The risk of new depression during the transition is around 30 per cent, and around 60 per cent with a previous history. Oestrogen improves mood during the transition but not after menopause. Where mood and flushes are both severe, both hormone therapy and an SSRI are often needed.
Frequently Asked Questions
The Menopause Society does not recommend them, along with soy, acupuncture, cannabinoids, paced breathing, trigger avoidance and clonidine. That is a specific recommendation against, not an absence of opinion.
There are effective non hormonal options: SSRIs, gabapentin, and the newer neurokinin 3 receptor antagonists fezolinetant and elinzanetant. Vaginal symptoms can still be treated locally with low dose vaginal oestrogen.
On a cyclical regimen, most likely, and 80 to 90 per cent of women do. Once you are more than two to three years past your last period, a continuous regimen produces no bleed in most women, and most women switch.
Only if night time flushes are the cause. Restless legs and sleep apnoea often begin in the same decade, and 53 per cent of women investigated for sleep disturbance around menopause had one or both. Those need their own treatment.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.