Menopause Treatment Options: What Works, What to Weigh Up

30 July

• By: Dr. Anup Dhir

Menopause is not a disease. It's a natural process all women experience, typically between the ages of 45 and 55, as oestrogen and progesterone levels drop and periods stop for good. The experience of that transition is so different from person to person for women.

Others sail through without too much trouble. Some remain in symptoms that impact sleep, mood, attention, sexuality and physical comfort in ways they did not anticipate nor were informed about that last for several years.

Fortunately, treatment options are greater than they have been in the past, both hormonal and non-hormonal. This post provides an overview of the major ones, what the current evidence suggests, and how to think about the selection.

Understands what menopause really entails. Knows what menopause entails.

What Menopause Actually Does

As oestrogen decreases, it affects various systems in the body. Symptoms include:

• Sleep disruption
• Vaginal dryness and pain with sex
• Low mood, anxiety and concentration difficulties
• Reduced libido
• Overall joint pain and muscle aches
• Increased fracture risk over the years (accelerated bone loss)

These are not all experienced by every woman. Severity varies widely. When serious enough to interfere with daily life or relationships, however, it is not something that can be "pushed through" until an effective treatment exists.

Hormone Replacement Therapy

HRT, also known as menopausal hormone therapy (MHT), is the best treatment for vasomotor symptoms. It is a method which replaces the oestrogen no longer produced by the ovaries, bringing it back to adequate levels to lessen hot flashes, enhance sleep, maintain bone density, and treat the vaginal symptoms.

If the woman still has her uterus, a progestogen is also taken with the oestrogen to prevent any damage to the lining of the womb. Those women who have undergone a hysterectomy may use oestrogen only.

The risk of HRT that has long been feared was exaggerated for the majority of women, as a study in 2002 suggested. Later studies have significantly changed the picture. There is current evidence that HRT is appropriate and low risk for most women under 60 or within 10 years of their last period, and is especially safe for women using body-identical hormones (patches or gels) rather than the older oral version in use before. In November 2025, the US FDA revised its HRT label to mark this change by striking out warnings of cardiovascular disease and breast cancer that were previously included in the label.

HRT is not right for everyone. Certain hormone-related breast cancers, abnormal bleeding in the vagina or some clotting issues require careful specialist evaluation prior to beginning.

Non-Hormonal Treatments

There are a number of treatments that can help women without, or prefer not to use, HRT that target certain symptoms.

• Non-hormonal medications: There is a new class of non-hormonal medicine that has proven to be effective for hot flashes called neurokinin receptor antagonists. Fezolinetant and elinzanetant both finished Phase 3 trials with more than 70% decrease in hot flush occurrence. These are not yet common in India but can be where the field is going. Medications that have been used in the past include antidepressants (SSRI's and SNRIs) which have moderate evidence for reducing vasomotor symptoms.
• Vaginal symptoms: Local application of low dose vaginal oestrogen as a cream, pessary or ring is an effective treatment for vaginal dryness, discomfort and urinary symptoms and does not have significant systemic absorption. Vaginal oestrogen is generally safe in women who are not able to take systemic HRT.
• Bone health: Calcium and vitamin D are important at all ages, but become more important from perimenopause onwards. If osteoporosis is diagnosed, women are treated with bisphosphonates.

Lifestyle and Natural Approaches

Lifestyle measures are not as effective as HRT at controlling severe vasomotor symptoms. However, there are several that have real evidence to back up mild to moderate symptoms.

It is important to have weight bearing exercise to prevent bone loss and sleep better. In some women, the frequency of hot flashes is decreased when alcohol, caffeine and spicy foods are limited. There is some moderate evidence that cognitive behavioral therapy can be used to treat the psychological aspects of menopause, especially insomnia and anxiety. The phytoestrogens found in soy and flaxseed have some, though not strong, evidence of mild symptom reduction. The herbal remedies that have the best data supporting their use are ashwagandha and black cohosh, although more large-scale studies are needed.

Menopause and Sexual Health

One of the most common but also least talked-about menopause symptoms are vaginal dryness and a decrease in libido. Low oestrogen causes thinning, loss of lubrication and painful sexual activity (genitourinary syndrome of menopause (GSM)). Unaddressed, it can keep women from enjoying intimacy and have consequences for relationships and enjoyment of life.

The physical aspect is treated with local vaginal oestrogen and non-hormonal lubes. There are several factors that contribute to reduced libido, such as low oestrogen, sleep disturbances and mood swings, which all can be treated. A specialist in sexual medicine, in conjunction with a gynecologists, provides the most comprehensive view.

Getting the Right Assessment

Treatment will depend on your symptoms, the severity, your medical history, and your hormones preference. A consultation in which everything is reviewed appropriately is the beginning.

Dr. Anup Dhir is a Fellow of the European Committee of Sexual Medicine (FECSM) and is an expert in the sexual health aspects of menopause along with his practice in plastic and reconstructive surgery at Indraprastha Apollo Hospital, New Delhi.

• Call: +91 93123 77554
• Clinic: Image Medical Centre, 101 Ansal Tower, 38 Nehru Place, New Delhi
• Consultation fee: Rs. 2,000 (in person or online)

This blog is written for general information purposes and does not constitute medical advice. For concerns about menopausal symptoms or hormone therapy, please consult a qualified healthcare provider.