Menopause Treatments - A Study on Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy

Menopause is associated with a decline in ovarian hormone production, particularly estrogen, which contributes to a range of symptoms including hot flushes, night sweats, sleep disturbance, mood changes, bone loss, and genitourinary symptoms. A comprehensive review published in Frontiers in Endocrinology outlines current evidence on the benefits, risks, and treatment modalities available for managing menopause, with a strong emphasis on individualised care rather than a one-size-fits-all approach.

The most extensively studied and effective treatment for moderate to severe menopausal
symptoms is menopausal hormone therapy (MHT). MHT works by replacing some of the
estrogen that naturally declines during menopause, helping to stabilise thermoregulation in the brain, reduce vasomotor symptoms (hot flushes and night sweats), improve sleep quality, and slow the rate of bone loss. For women who still have a uterus, estrogen is combined with a progestogen to protect the uterine lining; women who have had a hysterectomy may use estrogen alone. Current evidence indicates that when MHT is initiated in healthy women under the age of 60 or within approximately 10 years of menopause onset, the benefits for symptom relief and bone health generally outweigh potential risks when therapy is appropriately prescribed and reviewed.

Importantly, not all hormone therapies are the same. The route of administration matters.
Transdermal estrogen (delivered via patches, gels, or sprays) bypasses the liver and is
associated with a lower risk of blood clots and less impact on triglycerides compared to oral estrogen. Dose, formulation, and duration are tailored based on individual health history, cardiovascular risk, breast cancer risk, and symptom profile. Modern menopause care focuses on using the lowest effective dose for symptom control, with regular reassessment over time.

For women who cannot use hormone therapy or prefer not to, non-hormonal treatment
options are also supported by evidence. Certain medications, including specific
antidepressants (SSRIs and SNRIs), gabapentin, and clonidine, can reduce the frequency an severity of hot flushes by acting on the central nervous system. While these options may be less effective than estrogen for vasomotor symptoms, they provide meaningful relief for some women and may be appropriate depending on medical history.

Another key area of treatment is genitourinary syndrome of menopause, which includes
vaginal dryness, irritation, pain with intercourse, and urinary symptoms. These changes are
caused by estrogen deficiency in vaginal and urinary tissues. First-line management often
includes non-hormonal vaginal moisturisers and lubricants. If symptoms persist, low-dose
vaginal estrogen therapy can be highly effective, delivering estrogen locally with minimal
systemic absorption and a strong safety profile for many women.

From a training and lifestyle perspective, understanding these treatment options is important because symptom management directly affects exercise tolerance, recovery, sleep quality, and consistency. When menopausal symptoms are well managed, whether through hormone therapy, non-hormonal medications, or supportive lifestyle strategies,  women are better able to engage in regular physical activity, including resistance training, which is essential for preserving muscle mass, bone density, and metabolic health during and after menopause.

 
Conversely, unmanaged symptoms such as poor sleep, chronic fatigue, or joint discomfort can limit training adaptation and increase perceived effort. Overall, this research reinforces that menopause treatment should be evidence-based, individualised, and regularly reviewed, with medical and lifestyle strategies working together.

Effective symptom management supports not only comfort and quality of life, but also long-term health outcomes, particularly when combined with appropriate exercise, nutrition, stress management, and recovery strategies.