Menopause treatment: hormone therapy works best. Here's what else does.

Which menopause treatment fits which symptom?

The right menopause treatment is the one matched to the symptom that costs you most, because body-wide symptoms and local ones respond to different things. Menopause symptom treatment works best as a short list of priorities, not one prescription for everything. The table shows where the evidence points, with UK terms beside the US ones.

Weight and supplements sit beside these routes, not inside them. Hormone therapy isn't a weight treatment, and the page on menopause weight gain sets out what is. Whether any menopause supplements earn their place is a separate question, answered one product at a time.

Still getting periods, even erratic ones? The perimenopause pages are for the years before this one. The pages on postmenopause cover the years after it.

Many women ask about holistic treatment for menopause first. CBT is the one the guidance names, and the NHS offers it for hot flushes and night sweats. Plant-based products are a different category, weighed one by one in the guide to herbal menopause supplements. 'Natural' is a label, not evidence.

Three options and the verdict

The evidence favours hormone therapy first for flashes and sweats, and no other option has data behind it for as many symptoms: flashes, sweats, mood, sleep and bone (The Menopause Society, 2022). For dryness, painful sex and urinary symptoms, the evidence favours the low-dose local route. The non-hormonal options are not consolation prizes. They are the NICE-backed answer in the UK (TA1143, 2026) when HRT isn't suitable or wanted. The three routes aren't rivals, and many women end up using more than one.

How safe is hormonal menopause treatment?

Safety comes down to the form you take and when you start, not to a blanket 'dangerous'. Patches, gels and sprays deliver estrogen through the skin and don't raise blood clot or stroke risk, while tablets slightly raise both, according to the NHS (2026). The NHS adds that the absolute risk stays very low, particularly for stroke under 60.

Breast cancer is the risk most women ask about, so here are the numbers. Combined HRT, meaning estrogen plus a progestogen, causes a small rise that grows with years of use, according to the 2019 Lancet analysis by the Collaborative Group on Hormonal Factors in Breast Cancer. The NHS puts it at about 5 extra cases per 1,000 women over 5 years, and the risk falls again after stopping. Estrogen-only HRT, used by women without a womb, causes little or no change.

A womb needs a progestogen alongside estrogen. The NHS lists it as tablets, a combined patch or a hormonal coil (IUS), with micronized progesterone as another option (Utrogestan in the UK). US prescriptions usually say progestin where UK ones say progestogen. The word differs, the job is the same.

The new US labels also add something. They include consideration of starting body-wide therapy for moderate to severe hot flashes and night sweats within that same window (US FDA, 2025). 'Wait it out' is no longer where the label starts.

One group has a firmer recommendation. If periods stop before 45, and especially before 40 (premature ovarian insufficiency), HRT is usually recommended until at least the average age of menopause, to protect bones, heart and brain (NICE NG23, 2024).

What if hormones aren't right for you, or the problem is local?

Local symptoms have their own route, and the guide on how to treat vaginal dryness covers the choices, bladder symptoms included, along with non-hormonal moisturizers and lubricants.

For flashes, the question is what to use when HRT isn't suitable or isn't wanted. In the US, fezolinetant is FDA-approved: a daily tablet that blocks the brain's hot-flash signal. In the UK, NICE has recommended it since 2026 (TA1143) when HRT isn't suitable or wanted. Some SSRIs/SNRIs and gabapentin also reduce flashes, and CBT helps with flashes, sleep and mood.

A vaginal estrogen cream, pessary or ring deserves its own conversation, separate from the HRT one. The FDA's 2025 changes cover local products too: their labels get condensed safety information, and the older advice to use the lowest effective dose for the shortest time has been removed (US FDA, 2025). In the UK, the NHS lists vaginal oestrogen cream or pessary for dryness, soreness and urinary symptoms after menopause.

Next steps

Start with a short list: the symptoms that cost you the most, the date of your last period, and whether you have a womb. Those three details shape most of the options above. Then ask which form of estrogen is being suggested and why, and mention dryness or bladder symptoms even if nobody asks. Anything on the red flag list is worth getting seen promptly, whatever treatment you are using. The decision is yours to make: menopause treatment is not one size fits all.