Menopause – Diagnosis and Treatment

Diagnosis

Doctors usually recognize menopause by changes in a woman’s menstrual cycle and the start of symptoms like hot flashes, night sweats, and vaginal dryness.

These signs can also appear during the menopausal transition, called perimenopause.

Many women experience dryness and discomfort in the vaginal area, often linked to genitourinary syndrome of menopause. Doctors often do not need extra tests to confirm menopause.

They ask about medical history, recent symptoms, and menstrual patterns. If the diagnosis is unclear, doctors may order certain blood tests:

Test	Purpose
Follicle-stimulating hormone (FSH)	Checks if FSH is high, which happens during menopause
Estrogen (Estradiol)	Looks for low estrogen, another sign of menopause
Thyroid-stimulating hormone (TSH)	Rules out thyroid problems that may cause similar symptoms

You can find home tests for FSH, but these tests do not always give clear answers because hormone levels change during perimenopause.

Doctors diagnose premature menopause if symptoms appear before age 40 and usually check ovarian function.

Treatment

People can ease menopausal symptoms with medical treatments and lifestyle changes. Treatment options depend on each person’s health, symptoms, and risk factors.

Hormone-Based Approaches

Estrogen Therapy

Estrogen helps many people control hot flashes and night sweats. Doctors use estrogen alone if a person has had their uterus removed.

If the uterus is still present, doctors pair estrogen with progestin to lower the risk of endometrial cancer.

Doctors often recommend menopausal hormone therapy for those under 60 or within ten years of menopause starting. They use the lowest effective dose for the shortest necessary time to lower risks.

Combined Estrogen and Progestin

Hormone replacement therapy (HRT) combines estrogen and progestin. This therapy may help with hot flashes, night sweats, and prevent bone thinning.

Long-term use may increase risks for some health issues, including blood clots, breast cancer, and heart disease. Each person should discuss the benefits and possible risks with their healthcare provider.

Vaginal Estrogen

Doctors may prescribe estrogen as a cream, ring, or tablet in the vagina to help with dryness, painful intercourse, and urinary symptoms. This method uses a lower dose and mainly treats local symptoms.

Non-Hormonal Treatments

• Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): These low-dose antidepressants can reduce hot flashes. They are helpful for people who cannot or do not want to use estrogen and can also help with mood problems.
• Anticonvulsants: This seizure medicine can relieve hot flashes, especially night sweats. It provides a non-hormonal option for those who cannot use hormone therapy.
• Alpha-2 Adrenergic Agonists: Usually used for high blood pressure, this type of medicine can help with hot flashes. However, strong side effects like sleepiness, headache, or constipation limit its use for menopause.
• Neurokinin 3 Receptor Antagonists: This medication blocks a nerve pathway in the brain that causes hot flashes. It does not contain hormones and is FDA approved but can cause side effects such as abdominal pain or sleep problems.
• Anticholinergic Agents: Used to manage urgency and overactive bladder, this medicine may also help with menopausal symptoms. Older adults need to use it carefully as it can affect thinking and memory.

Medicines to Protect Bones

Menopause speeds up bone loss. Some people may need medicine to reduce bone loss or prevent fractures. Doctors may prescribe bisphosphonates or selective estrogen receptor modulators.

Vitamin D supplements often support these treatments to help keep bones strong.

A selective estrogen receptor modulator (SERM) taken by mouth helps with pain during intercourse caused by thin vaginal tissue. Doctors do not advise it for people who have had, or are at high risk for, breast cancer.

Considerations and Cautions

People should talk with a healthcare professional before starting any treatment. They need to discuss symptoms, age, medical history, and risks. Reviewing the treatment plan every year is important because needs can change.

Everyday Habits and Simple Solutions

Lifestyle changes can help people manage menopause symptoms. Wearing layers, choosing light fabrics like cotton, and using fans or cooling packs can reduce hot flashes.

Lowering room temperature and avoiding triggers such as spicy foods, caffeine, and alcohol may also help. For vaginal discomfort, water-based or silicone-based lubricants and moisturizers are good choices.

Remaining sexually active, if possible, may help increase blood flow to the area. Quality sleep matters. Avoiding caffeine and alcohol, especially in the evening, can improve sleep.

Exercising during the day—not right before bed—may help with falling asleep and staying asleep.

People bothered by night sweats or hot flashes should try different cooling techniques for better rest. Relaxation techniques can benefit overall health and help with mood changes.

Deep breathing, muscle relaxation, and guided imagery are easy to learn from books or online resources.

Pelvic Floor Strengthening Activities

Pelvic floor muscle exercises, called Kegels, can help improve some types of urinary incontinence during menopause.

Diet and Weight Management Table

Healthy Practices	Benefits
Eat fruits, veggies, grains	Supports bone and heart health.
Limit saturated fats and sugars	Helps maintain a healthy weight.
Consider calcium and vitamin D	Maintains strong bones.
Stay hydrated	Improves energy and body functions.

Maintaining a healthy weight is important. People with obesity are more likely to have severe or frequent hot flashes.

Healthy eating and regular physical activity support weight loss and maintenance. Quitting smoking brings many health benefits. Smoking increases the risk of heart disease, stroke, and osteoporosis.

It can also make hot flashes worse and may speed up menopause. Regular exercise supports bone health and helps protect against heart disease, diabetes, and osteoporosis.

Alternative medicine

People often seek other ways to manage menopause symptoms. Popular options include plant-based remedies, herbal treatments, and mind-body therapies.

These choices can be appealing, but their effects vary. Phytoestrogens are plant chemicals that act like estrogen in the body. They are found in foods like soybeans, lentils, chickpeas, flaxseed, whole grains, and some fruits and vegetables.

Eating these foods as part of a balanced diet is usually safe. Anyone with a history of breast cancer should talk to a doctor before taking isoflavone supplements.

Scientific studies have not proven that plant estrogens relieve hot flashes or other menopause problems. Bioidentical hormones come from plants and claim to be chemically identical to human hormones.

Some versions are regulated and approved, while others are custom-mixed by pharmacies and not strictly checked for quality or safety.

There is no strong evidence that bioidentical hormones work better or have fewer risks than other hormone therapies. Herbal treatments like black cohosh are used to manage symptoms such as hot flashes and mood swings.

Science does not strongly support black cohosh for menopause. It may harm the liver and may not be safe for people who have had breast cancer.

Other herbs, such as red clover, dong quai, evening primrose oil, wild yam, and kava, are also used by some people.

No reliable evidence shows that these treatments help with menopause symptoms. Some herbal supplements can cause side effects or interact with other medicines.

Here is a simple overview of some common alternative therapies:

Treatment	What it is	Evidence of benefit	Safety concerns
Soy and isoflavones	Plant estrogens from legumes	Limited	May affect hormones
Black cohosh	Herbal extract	Weak / Not proven	Possible liver damage
Bioidentical hormones	Plant-based, hormone-like drugs	Not superior to standard hormone therapy	Quality varies
Red clover	Herbal supplement	Weak / Not proven	Can affect other medicines
Flaxseed	High in lignans	Not proven	Usually safe in foods
Dong quai, kava, wild yam	Herbal remedies	Not proven	Possible side effects

Mind-body practices offer another option. Yoga and tai chi help improve strength and balance. Some people find these activities make symptoms easier to handle. Cognitive behavioral therapy can help people feel less bothered by symptoms.

Acupuncture and hypnotherapy have also been tested. Acupuncture may help reduce hot flashes for a short time. Hypnosis may lower how many hot flashes someone has and how severe they feel them.

Anyone considering alternative medicine should talk with a healthcare provider before starting.

Getting Ready for Your Health Visit

Steps You Can Take Ahead of Time

To make your visit easier and more helpful, try these tips:

• Write Down Your Symptoms
  • Note how often certain symptoms happen, like hot flashes.
  • Describe how strong these symptoms feel.
• List Every Medication and Supplement
  • Record all prescription medicines, over-the-counter drugs, herbs, and vitamins.
  • Include the amount and how many times you take each one.
• Bring Support if Needed
  • Ask a friend or family member to join you if you think they can help you remember details.
• Prepare Your Questions
  • Put your most important questions at the top of your list.
  • Example questions to ask your health care provider:
    • What tests could be useful for me?
    • Which treatments work for my symptoms?
    • Are there any other ways to manage these symptoms?
    • Can I try any alternative therapies?
    • Do you have any reading materials or brochures?

Tip: Bring your notes and your list of questions to the visit. This helps you remember everything you want to discuss.

What Your Provider May Ask or Do

During the appointment, your health care provider will likely ask:

• If you still have your periods and when your last one was.
• How often you notice symptoms and how bothersome they are.

Your provider will also ask what helps your symptoms feel better and what makes them worse.

They may suggest certain tests or discuss different treatment options based on your answers. Bring your information and questions to the visit. This helps you get the support you need.