Navigating Menopause: A Physician’s Guide to Treatment Options

Menopause is BIG! You can’t scroll through social media, stream a show, or open a magazine without coming across the Great Midlife Awakening. And honestly, it’s about time.   

But with the sudden wave of attention comes a tsunami of information. How do you make sense of it all and figure out what you actually need? With nearly 60% of women reporting that they feel unprepared for menopause, let’s make sure that’s not you. 

  
Perimenopause vs. Menopause: A Quick Refresher 

  
Let’s say you already know the difference between menopause, defined as 12 months without a period, when estrogen, progesterone, and testosterone levels drop to near zero, and perimenopause, the decade or so before menopause when hormones fluctuate wildly. 

What Are the Common Menopause Symptoms?

This hormonal chaos can lead to a confusing mix of symptoms, from irregular periods to mood shifts, brain fog, and disrupted sleep.

 The most common symptoms include:

• hot flashes
  
• mood changes
  
• vaginal dryness
  
• low libido
  
• weight gain
  
• sleep problems
  
• Other, less common symptoms

And let’s say you’re ready for help. Where do you turn? Google? TikTok? Your doctor? Let’s break it down by menopause treatment options into four easy-to-navigate boxes.   

Box 1: Over-the-Counter and Online Options   

This first box is a broad one: complementary and alternative treatments. These are non-prescription options that you can find online or at the store, and they include everything from sleepwear to supplements.   

Helpful OTC options may include:  

• Moisture-wicking bedding and sleepwear for more comfortable nights 
• Wearable devices that use cooling technology on the wrist to reduce hot flashes and improve sleep
• Supplements—some with better research than others. Equelle, for example, contains S-equol (a plant-derived compound) which provides multi-symptom menopause relief for hot flashes1,4, poor sleep quality2||⁋, and muscle aches1,4†. Melatonin can also help with sleep.   
• Vitamins and minerals, such as calcium and vitamin D for bone health, Magnesium for relaxation and sleep support† 

Just a note: while some supplements are safe and well-studied, others aren’t. Always check the research and talk to a healthcare provider if you’re unsure.

Box 2: Prescription (Non-Hormonal) Medications   

Next up are prescription medications that are not hormone-based but can still be very effective for treating menopause symptoms. Only one is currently FDA-approved specifically for vasomotor symptoms (like hot flashes), but others are used “off-label.”   

Here are some common options:   

• SSRIs and SNRIs: These antidepressants help reduce hot flashes by targeting the brain’s temperature regulation system. Estrogen fluctuations affect serotonin and norepinephrine, so these medications can help stabilize mood and body temperature. Downsides? Sleepiness and reduced libido can be side effects.   
• Oxybutynin: Typically used for overactive bladder, but may also help with hot flashes. Dry mouth and eyes can be a trade-off.
• Gabapentin: Originally used for chronic pain, it can reduce hot flashes, though drowsiness may be an issue.   
  
• Fezolinetant: A newer FDA-approved medication that works directly on the brain center responsible for hot flashes. It’s highly effective but may not be covered by all insurance plans. 

Box 3: Hormonal Therapies 

Hormone therapy (HT) is often the most effective option, but also the most misunderstood. When used appropriately and under medical supervision, HT is safe and highly beneficial for many women.   

HT options include:   

• Oral contraceptives: For perimenopausal women, these can ease symptoms and provide needed contraception. They contain both estrogen and progesterone.   
• Menopausal hormone therapy (MHT): Low doses of estrogen (with or without progesterone, depending on whether you still have a uterus) can relieve symptoms quickly and effectively—and safely. It can also provide long-term benefits, like protecting bone density and possibly reducing heart disease risk.   
    
  

Types of hormones:   

• Estradiol: The body’s main estrogen. Available in gel, patch, mist, pill, and vaginal cream for genitourinary symptoms.   
• Progesterone: Taken nightly with estradiol (if you have a uterus) to protect against endometrial buildup. Bonus: it often helps with sleep.   
• Testosterone: Also made in the ovaries, it affects libido, energy, and muscle mass. While there’s no FDA-approved testosterone for women in the U.S., some clinicians prescribe low doses or compounded formulations in accordance with guidelines.   
• DHEA: A hormone that helps produce other hormones like estrogen and testosterone. Available OTC, but use with caution. It may interact with other medications and isn’t recommended alongside estrogen or testosterone.   

Box 4: Lifestyle Changes

Before you dive into pills, patches, or prescriptions, don’t overlook the power of everyday habits. Lifestyle tweaks can play a major role in how you experience—and manage—menopause. While they might not replace treatment, they can absolutely support it.

Here’s what that can look like:

• Nutrition with intention. A balanced diet rich in protein, healthy fats, and fiber supports hormone metabolism and helps regulate energy, mood, and weight. Think: leafy greens, fatty fish, whole grains, and a little dark chocolate for good measure.
• Movement that feels good. Whether it’s strength training, walking, yoga, or dancing in your kitchen—regular physical activity helps ease stress, support bone health, and improve sleep quality. Bonus: it boosts endorphins and combats brain fog.
• Mind-body practices. Meditation, deep breathing, acupuncture, and even cognitive behavioral therapy (CBT) have been shown to help with hot flashes, anxiety, and mood swings. Small practices, big difference.
• Sleep hygiene. Good sleep isn’t a luxury—it’s essential. Create a wind-down routine, cut back on caffeine and alcohol, and set up your room for optimal comfort (hello, moisture-wicking sheets).

While lifestyle changes won’t “fix” menopause, they can make everything else work better. Think of them as the foundation for whatever treatment path you choose.

The Bottom Line   

There are more options than ever for managing the symptoms of menopause—but only if you know what to look for. If you need guidance, find a clinician who specializes in menopause care at menopause.org. A trained provider can help you navigate your options and make sure you’re choosing safe, effective treatments tailored to your needs.   

Don’t let hot flashes, night sweats, or mood swings take over your life. Relief is out there—and it starts with knowing what’s available.  

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