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Am Fam Physician. 2016;94(11):online

See related article on hormone therapy and other treatments for symptoms of menopause

What is menopause?

Menopause (MEN-oh-pawz) is when a woman's ovaries make less estrogen and other hormones. It is a normal part of aging. It usually starts around age 50, but it can happen earlier or later. Menopause may happen fairly quickly, or it may take several years for you to feel symptoms.

How do I know if menopause has started?

Your menstrual period will become irregular and eventually stop. You may have hot flashes. This is when you feel a sudden hot or burning sensation that spreads over your face and body. During menopause, you may have a burning feeling in your vagina, or it may feel dry or irritated. This could cause pain during sex. Many women have symptoms during menopause, but some do not.

Your doctor can usually tell if you are in menopause based on your symptoms. A blood test is not usually needed.

Can hormone therapy help with my symptoms?

Hormone therapy is a medicine made out of estrogen. Estrogen can be used as a pill, skin cream or spray, vaginal insert, or skin patch. If you still have your uterus (womb), estrogen should be taken with another hormone called progestogen. Hormone therapy works best for hot flashes. Many women use hormones safely. But, some hormone medicines can increase the risk of breast cancer and heart disease, especially if you use them for more than three to five years. Some women, including those with breast cancer, blood clots, or heart disease, should try nonhormonal treatments first.

All of the types of hormone therapy are effective but have different side effects. Your doctor can help you decide which one is the best for you. Your doctor will want to see you regularly to talk about your treatment. In general, you should use the lowest dose for the shortest period possible to treat your symptoms.

What else can I do to treat hot flashes?

Clinical hypnosis may help hot flashes. Certain medicines that aren't made with hormones, including some that are usually used to treat depression or seizures, can also help.

Compounded hormones are mixtures of certain hormones or supplements. Bioidentical hormones are similar to those your body makes. One example of a bioidentical hormone is estradiol. It is unknown if these therapies are more or less safe than other hormones. But, because they contain hormones, they are likely to have the same side effects as other hormone medicines.

Over-the-counter supplements are not effective for treating menopausal symptoms.

How can I treat vaginal dryness and painful sex?

Over-the-counter vaginal moisturizers (one brand: Replens) may help reduce dryness. Also, prescription hormone creams, vaginal inserts, or a pill called Osphena may help. Many women find that an over-the-counter water-based lubricant may help with pain during sex.

Where can I get more information?

AAFP's Patient Information Resource

National Center for Complementary and Integrative Health

National Institute on Aging

National Library of Medicine

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