Menopause related symptoms can be bothersome and interfering with daily lifestyle and requiring treatment. 60% of women at menopause experience symptoms for five years around the menopause, but most of them can have some symptoms for 10 or 20 years after menopause. The most common is hot flashes (or night sweats), which interferes with sleep pattern and can trigger insomnia, anxiety and depression.

The long duration of these symptoms raises treatment challenges for many women. HRT is the most efficient treatment, but it also increases the risk of cardiac and vascular events after the age of 60 or in women with previous history of breast cancer or cardiovascular disease

Current treatment options for menopausal symptoms

  • Hormone therapy is the most effective therapy for hot flashes and all menopause related symptoms. Due to safety profile it’s limited regarding age and previous cardiac or cancer conditions. See article Is hormone replacement therapy safe?
  • Non-hormonal prescribed therapy
  • Alternative therapyPromising therapy. Inconsistent evidence of efficacy Used, but proven to be of no benefit

Non-hormonal prescribed therapies

venlafaxine (Effexor®)

  • Proven effectiveness
  • Safe for breast cancer women taking tamoxifen
  • Main side effect – Elevated blood pressure (at high doses).
  • Helps with depression
  • No weight gains

desvenlafaxine (Pristiq®)

  • Like venlafaxine.

fluoxetine (Prozac®)

  • Proven efficacy in menopausal symptoms relief
  • Should be avoided in women taking tamoxifen.

escitalopram (Lexapro®)

  • Additional effectiveness in insomnia

gabapentin (Neurontin®)

  • weight gain.
  • helps with insomnia

clonidine (Catapres®)

  • cardiac drug, lowers blood pressure., less commonly used

Alternative therapy

  1. Promising results
  • Cognitive behavioral therapy (CBT) – CBT appears to be beneficial for insomnia, but less so for hot flashes
  • Hypnosis – may be beneficial for hot flashes, but data are limited
  1. Inconsistent evidence of efficacy. Not proven effective but awaiting trials.
  • Primrose Oil can give Nausea, diarrhea, headache.
  • Black cohosh: can give stomach upset, liver toxicity
  • Soy (plant estrogen). Also referred to as phytoestrogens: not recommended for breast cancer survivors. Foods with high concentration: soybeans, chickpeas, lentils, flaxseed, grains, beans, fruits, red clover and vegetables


  1. Used, but proven to be of no benefit
  • Acupuncture

Vitamin E


Estrogen offers protection from cardiac DISEASE; with menopause and lack of estrogen, the risk of cardiac events and stroke rise SUBSTANTIALLY. Hormone replacement therapy (HRT) acts differently than natural estrogen.

The biggest controversy about Hormone replacement therapy (HRT) is whether its risks outweigh its benefits. Over the last 10 years several studies showed that HRT may increase the risk of breast cancer, heart disease, stroke, and blood clots. 

This data comes from a large study – The Women’s Health Initiative (WHI) 10 years ago, directing women away from using HRT ALTOGETHER. 

American College of cardiology in 2017 presented new data that the HRT it’s not harmful but maybe beneficial in improving heart health and overall survival in some women, based on age and presence or absence of certain medical conditions. 

Where do we stand with HRT in 2019?

Who should avoid HRT?

  1. Women of any age, who have or previously had:
  • breast cancer,
  • ovarian cancer,
  • endometrial cancer,
  • heart attacks or heart failure
  • blood clots in the legs or lungs,
  • stroke
  1. Women over 60 or thosewho want to start HRT more than 10 years from the onset of menopause. 

Who should consider HRT?

For women with premature menopause the protective benefits of hormone therapy usually outweigh the RISK. Menopause before age 45 requires HRT to prevent an increase risk OF:

  • Osteoporosis
  • Heart disease
  • Earlier death
  • Parkinson’s-like symptoms (parkinsonism)
  • Anxiety or depression


HRT are not “all good or all bad” but require risk and benefit assessment based on age and previous medical history of cancer and heart disease

  • If HRT is started before the age of 60 or in women with premature menopause (due to cancer, surgery), the benefits appear to outweigh the risks. 
  • However, if your menopause started after age 45 and you don’t have bothersome menopausal SYMPTOMS, you do not need HRT to stay healthy. No clear cardiac protection was found in women after age 45. 
  • Premature menopause (before age of 45) benefits from HRT. 



ACC 2017 Hormone Replacement Therapy Associated with Lower Mortality

The Women’s Health Initiative Postmenopausal Hormone Trials: Overview