Unpleasant or uncomfortable menopause symptoms can be managed in a variety of ways ranging from changes in lifestyle and diet to prescription medication and psychological treatments.
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Reducing your stress levels, increasing your physical activity and avoiding triggers for hot flushes can help to ease menopause symptoms. Some of these changes can address several menopause symptoms at once, as well as increasing your general health and improving sleep, mood and sexual desire.
- Use meditation and relaxation techniques or take up yoga.
- Have regular massages.
- Make time for play, catching up with friends, daily exercise and nutritious meals.
Easing night sweats
- Wear light cotton nightclothes.
- Use sheets and blankets instead of doonas so you can adjust your sleeping temperature easily.
- Have a small fan in your bedroom.
- Keep a frozen cold pack under your pillow at night so you always have a fresh cool side for your head.
Avoiding hot flush triggers
Try to identify and avoid your personal hot flush triggers. These may include:
- spicy food and hot food or drinks
- using a hair dryer
- hot baths
- cigarettes, caffeine and alcohol
- weight gain.
Cooling gels containing menthol may provide relief and refreshment, as may washing your hands in cold water or putting a cold compress on the back of your neck. In hot weather, try to keep your household temperature cool.
Increased physical activity
- Take the stairs.
- Get off the tram or bus a stop early and walk.
- Have a swim.
- Do some gardening.
- Take a walk or enrol in an exercise class.
The importance of sleep
Sleeping well will improve your mood, memory and concentration. Sticking to a regular sleep schedule, with a consistent bedtime and rising time, is a good start.
- Keep your bedroom quiet, dark and cool.
- Only use your bedroom for sleep and sexual activity.
- Get up if you can't fall asleep within fifteen to thirty minutes, leave the room and do something relaxing.
- Return to bed only when you become drowsy.
- Ensure you get enough vitamin D. Ask your GP to check your vitamin D blood levels, especially if you are dark-skinned (pale-skinned women don’t need as much sun exposure), spend a lot of time indoors or wear clothing to cover your skin for religious or cultural reasons.
- Exercise daily (for example, walk at least 30 minutes a day); regular weight-bearing exercises are essential to prevent osteoporosis.
- Eat a healthy diet that is high in vegetables, fruit, nuts, seeds, fish, low-fat dairy food, proteins and wholegrains. Eat lean meat for iron and protein, and avoid saturated fats, salt and caffeine. Drink more water and herbal teas.
- Consume more phytoestrogenic foods such as soybeans, soy grits, tofu, soy yoghurt, soy milk, soybean sprouts, sesame seeds (tahini), multigrain bread, hummus, garlic, mung bean sprouts, alfalfa sprouts, dried apricots, pistachio nuts, dried dates, sunflower seeds, chestnuts, dried prunes, fennel, yams.
- Increase your intake of calcium-rich foods such as nuts, seeds, low-fat dairy products, tofu, broccoli, bok choy and fish with bones (salmon and sardines).
Non-prescription natural remedies, as well as changing to a healthier diet, can help some women manage their menopausal symptoms. Healthy diet, regular meals and regular exercise can help balance mood; the jury is out about whether the omega 3 oils from oily fish can help improve mood and depression.
Soy extracts and soy foods
Soy foods, foods enriched in isoflavones (plant-derived oestrogen-like substances) and isoflavone supplements have not been consistently shown to reduce hot flushes. These compounds may have oestrogen-like effects, so discuss with your doctor whether they are safe for you.
- Black cohosh may have a mild effect on menopause symptoms, but studies have been inconsistent.
- St John's wort; combined herbal products that include St John's wort have been found to ease hot flushes and improve mood. It can interact with other medication such as the oral contraceptive pill and should never be taken with other antidepressants, as this can be lethal. Check with your doctor before taking it.
- Red clover contains high levels of phytoestrogens. Studies have shown mixed and relatively small benefits for menopausal symptoms. You should avoid using it if you have oestrogenic-related health problems such as breast and endometrial cancers.
- Evening primrose oil, dong quai, ginseng, licorice and sage, have not been shown effective in reducing menopause symptoms in clinical trials.
Phytoestrogens in food
Plant oestrogens (phytoestrogens) may be able to replace some of the oestrogen lost at menopause and help reduce menopause symptoms. Evidence from trials has been conflicting and it is not certain whether they work any better than placebo.
If you want to try phytoestrogens from food, aim for 40 to 50 mg of phytoestrogen per day (the amount found in the traditional Asian diet).
The following list is a guide only. Each of the foods in the list contains approximately 45 mg of phytoestrogens:
- 100 to 150g (½ to 1 cup) soybeans, tofu or tempeh
- 35g soy flour
- ½ to 1 litre soy milk
- 45g linseeds
- 4 to 5 slices soy and linseed bread.
Large amounts of phytoestrogens are not recommended in people with oestrogen-positive breast cancer or other oestrogen-dependent cancers, as they may stimulate growth of cancer cells.
Herbal medicines have traditionally been used for the management of menopause symptoms. Clinical trials have shown mixed benefits related to the use of these.
Psychological treatments such as cognitive behaviour therapy may be effective in reducing the discomfort of hot flushes and night sweats.
There are a number of prescription medications that are effective for hot flushes and night sweats. Some of these may also improve mood and sleep.
- low-dose antidepressants such as venlafaxine, desvenlafaxine, escitalopram, citalopram and paroxetine
- clonidine (generally used to treat high blood pressure, but can be used to reduce menopause-related hot flushes after breast cancer)
- gabapentin (used to treat epilepsy and chronic pain, but can also be effective in reducing hot flushes).
Non-hormonal treatments for hot flushes appear to be effective in one to two weeks. If there is no improvement over this period, talk to your doctor about modifying your treatment. Let your doctor know if you are also taking tamoxifen, as this may interact with some of these non-hormonal treatments.
Many of the symptoms of menopause are thought to occur because of the change and eventual fall in ovarian production of oestrogen.
Hormone replacement therapy (HRT) works by supplying oestrogen to relieve menopausal symptoms. Combined HRT formulations, also have a second hormone, progesterone. Oestrogen taken without progesterone can increase the risk of cancer of the lining of the uterus (endometrial cancer), so women who still have their uterus need combined HRT, which protects against this type of cancer. Women who have had a hysterectomy (surgical removal of the uterus) can use oestrogen alone.
HRT can only be prescribed by your doctor, who should be aware of your medical history including any instances of breast cancer, uterine cancer, ovarian cancer, abnormal mammograms, blood clots or clotting disorders, high blood pressure, heart disease, stroke, liver problems or migraine.
HRT medication can be administered:
- by mouth
- through skin patches
- in gels and creams applied to the skin or into the vagina
- through devices inserted into the uterus.
HRT side effects
While HRT is the most effective treatment currently available for hot flushes and night sweats, all formulations of HRT have side effects.
These may include:
- breast tenderness
- vaginal bleeding.
HRT should be avoided in women who already have heart disease. Combined HRT is also associated with a slightly higher than average risk of developing and dying from breast cancer.
The risks of heart disease, blood clots, high blood pressure and stroke are higher among women who smoke, so taking HRT may not be safe if you smoke.
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