Menopause: An Overview of Conventional and Alternative Approaches to Symptom Management

Written by Chrystal Moulton, Science Writer. A summary of common medical and alternative approaches to treatment of menopausal symptoms.

Portrait of an elderly woman with blonde hairMenopause is a natural part of the female reproductive lifecycle signaling the end of fertility. Most women experience this between their 40s-50s1,2. However, various factors including socio-economics, lifestyle, overall health and genetics play a factor in the onset of menopause3,4. It is estimated that approximately 1.3 million women in the US will transition to menopause each year and 1.3 billion women globally by 20302,3. In this paper, we will cover the phases of menopause, symptoms, standard treatment and effects, as well as alternative therapies and supplements used to support peri-menopausal and menopausal women.

So, What is Menopause?

During a woman’s reproductive lifecycle, the lining of the uterus thickens with blood which is shed on a 28-day cycle also known as the menstrual cycle. This cycle is essential to reproduction as the lining serves as a nutrient rich foundation for a fertilized egg during coitus. As a woman enters the end of her reproductive life cycle, the menstrual cycle becomes inconsistent, in-frequent, and eventually ceases2,4. The key hormones affecting the reproductive cycle are estrogen, progesterone, luteinizing hormone [LH], follicle stimulation hormone [FSH], anti-mullerian hormone [AMH], and testosterone2. During the menstrual cycle, LH, FSH, estrogen, and progesterone increases and decreases in phases to produce the typical thickening and shedding of the lining within the uterus on a 28-day cycle2,4. The onset of menopause changes the behavior of these hormones with ovaries producing less estrogen (specifically estradiol or E2) and progesterone and increased levels of  FSH, LH, and estrone (E1, a different form of estrogen)2. This change in hormonal behavior creates symptoms commonly associated with menopause in a gradually increasing manner. There are 3 stages of menopause: peri-menopause, menopause and post-menopause2,4.

As estradiol production decreases and estrone levels rise, the first set of symptoms which generally occur are: changes in duration and consistency of periods, blood clots in menstrual blood, hot flashes, and night sweats. This is the peri-menopausal stage2,4. As a woman becomes peri-menopausal, she will begin to experience a gradual increase in symptoms which include issues listed in Table 1.

 

Table 1. Symptoms associated with menopause1,2,4,5

Mental Health Depression Memory loss
Mood changes Anxiety
Irritability Difficulty concentrating
Neurological Brain fog Fibromyalgia
Headaches Vertigo
Tinnitus Tingling extremities/ electric shock sensation
Dizzy spells Chronic fatigue
Sleep disturbances Sleep Apnea
Migraines Burning sensation in mouth/tongue
Genitourinary Incontinence Vaginal dryness
Dyspareunia Reduced lubrication/ vaginal discharge
UTI Dysuria
Decreased libido, arousal, desire, and orgasm Vaginal/urethral prolapse
Irritation/burning/itching Decreased labial / vulva thickness
Menstrual irregularity
Muscular/Skeletal Bone loss Joint pain
Arthritis Sarcopenia
TMJ Muscle aches
Breast tenderness/ soreness
Hair/Skin/Nails Brittle nails Acne
Dry skin/ Eczema Unwanted hair growth
Hair loss Thinning skin / Wrinkles
Itchy ears/skin Thinning hair
Gastro/Cardio/Metabolic Bloating IBS
Non-acoholic fatty liver disease Kidney stones
Insulin resistance Weight gain
Increased visceral fat Lipid changes
Heart palpitations Acid reflux/ GERD
Vasomotor Hot flashes Night sweats
Other Dental problems Asthma

The symptoms detailed in Table 1 represent some of the symptoms experienced by menopausal women and may not occur in all women. Women experience this transition uniquely as some women function normally with little affect to daily life activities while others have severe symptoms that affect all aspects of daily life. The likelihood of pregnancy is also still evident during this phase, however, not without the risk of complications during pregnancy and at birth for both mother and child2. Perimenopausal symptoms can last between 4-8 years as women transition to menopause2,4.

Menopause is the day when a woman has her last period. Medically, this is diagnosed only after a full year has passed since her last period. Once verified, a woman is now said to be in the post-menopausal phase which continues until the end of life2,4.

The post-menopausal phase signifies an end to the reproductive cycle. Women in this phase can continue to experience menopausal symptoms for up to 9.5 years4. However, as symptom frequency decreases, most women are usually able to conduct daily life activities with ease. Management of overall health during a women’s lifetime and in her adulthood will determine her experience post-menopause. It is imperative to develop and maintain lifestyle and dietary habits that promote good health earlier in life to reap the benefits post menopause1-4.

Standard Treatment for Menopause

The certified standard of care for menopause is hormone replacement therapy2-6. Medical research shows a 70-80% success rate in reducing night sweats and hot flashes using hormone replacement therapy7. Hormone replacement therapy also supports bone and cardiovascular health8-10. Secondarily, women are also given SSRI’s/SNRI’s (to support hot flashes), bisphosphonate (to support bone health), and gabapentin (to support night sweats and hot flashes)2. These secondary treatments have a 30-50% rate of improving vasomotor symptoms and bone health in the case of bisphosphonate11,12. However, these treatments come with obvious risks. In particular, hormone replacement therapy can increase the risk of cancer in women1,2,4. This risk is accentuated in women who carry the gene coding for estrogen-dependent cancers such as breast and ovarian cancer2,4,8-10. Women with breast, ovarian, and other estrogenic cancers are given other conventional therapies to manage menopausal symptoms such as gabapentin or bisphophonate2-4,11,12. In the case of SSRIs/SNRIs and gabapentin, these conventional therapies are not as effective as hormone replacement therapy but they do provide significant relief11,12. Side effects such as dizziness/somnolence are commonly observed with gabapentin use while nausea/dry mouth is commonly associated with SSRIs/SNRIs2,11,12.

Overall, conventional therapies are effective in management of menopause. However, for women who experience unwanted adverse reactions to these therapies, alternative and natural remedies are usually done in place of or concomitantly with conventional medical practice.

Alternative Focus in Management of Menopause

When considering complementary or alternative treatment for menopause, it is important to consider one’s diet, exercise, and lifestyle. Furthermore, comprehensive and extensive research on any particular therapy specific to menopause is limited. Therefore, one must understand which approach best meets one’s individual goals and needs. Among various alternative therapies used to ameliorate symptoms of menopause, acupressure, acupuncture, and Chinese herbal medicine has some positive results. In a systematic review of alternative and complementary approaches to symptom management, researchers found13:

  • Acupressure provides some improvement in menopausal symptoms compared to sham or no treatment; however, statistical certainty was deemed as low14,15. Acupressure combined with conventional therapy such as moxibustion was more effective in improving anxiety and depression in menopausal women compared with moxibustion alone16.
  • Acupuncture, like studies of acupressure, had statistically low certainty. The low certainty, however, was due to inconsistent results across studies. For example, in one study in menopausal women with breast cancer, acupuncture was better than “sham” for menopausal symptoms and depression17. However, another study found no difference between acupuncture and sham for menopausal symptoms and depression18. Combined with Chinese herbal medicine, acupuncture was more effective in improving menopausal symptoms compared with western medicine19. In other study combination of Chinese herbal medicine and acupuncture improved depressive symptoms but not menopausal symptoms20.
  • Chinese herbal medicine was efficacious in improving bone mineral density in menopausal women as well as improving menopausal symptoms compared to sedative-hypnotic medication21-23. Researchers also reported benefits in menopausal symptoms, quality of life, and bone mineral density with ayurvedic medicine24,25.

Adequate nutrition is crucial for good health. In menopausal women especially, vitamin D, calcium, and magnesium are commonly deficient and supplementation of these nutrients either through nutritional supplements or diet is essential2,4. Research suggests that women over 40 who are likely to enter menopause should increase intake of vitamin D, vitamin K, calcium, magnesium, and supplement iron to maintain overall health2,4,26. The combination of these vitamins support bone health, which is crucial for menopausal women who are at high risk for developing osteoporosis2,4. See Table 2 to see the effective doses of vitamins and minerals needed to improve or maintain good health during menopause.

Table 2. Effective doses of selected nutrients for menopausal women2,4,26

Nutrient Dose
Vitamin D 4000 IU/ d
Calcium 1200 mg/d
Magnesium 320 mg/d
Omega-3 fatty acids 2 g/d
Fiber >25 g/d
Iron 18mg/d (age 31-50); 8mg (age: 50+)
Vitamin K 90mcg

 

Herbal medicines such as Black Cohosh extract have also been shown, historically, to improve symptoms of menopause13,27,28. In a study published in 2023, researchers found that across 22 randomized control trials, black cohosh reduced occurrence of vasomotor symptoms and improved overall somatic symptoms in menopausal women27. Support for vasomotor symptoms were observed between 20-40mg dosage taken twice daily particularly in standardized extracts containing 1mg of triterpenes per tablet28. Due to safety concerns, most studies limit consumption to 6 months. Individuals are also advised to be cautious if taking anti-hypertensives supplements or medicines while using black cohosh28. Studies involving phytoestrogens alone did not show changes in menopausal symptoms28,29. Furthermore, long-term use of phytoestrogens has been linked to endometrial hyperplasia—a possible precursor to cancer28.

Other herbs providing support for menopausal symptoms include:

Red clover – a botanical source rich in isoflavones which has been shown to support vasomotor symptoms in menopause. Isoflavones exhibit phytoestrogenic properties but has a lower estrogenic effect compared to estradiol. Noticeable effects may be observed after 13 weeks of use28. There is no standard dose, however, a randomized controlled trial with 80mg red clover isoflavones capsules administered twice daily  significantly improved intensity and frequency of hot flashes compared to placebo30. Other studies utilizing isoflavones showed improvement in menopausal symptoms, however, altogether the studies exhibited high heterogeneity and low certainty13.

Dong quai – a traditional herb used in Chinese medicine, which contains compounds that may be effective in alleviating menopausal symptoms like vaginal dryness and hot flashes31. Dosing is typically administered at 3-4g daily. Women who are taking anticoagulants (like warfarin) should avoid using dong quai due to potential interactions with those medications28.

St. John’s Wort – an herb traditionally used to manage depression is also effective in managing irritability, vasomotor menopausal symptoms, while improving sleep and quality of life, along with depression. St. John’s wort is typically administered at 300mg three times daily and has been shown to modulate serotonin, norepinephrine, and dopamine levels in the brain28. Women taking SSRIs, SNRIs, and benzodiazepines must exercise caution when supplementing with St. John’s wort as severe drug interactions may occur28.

Ashwagandha – an adaptogenic Ayurvedic herb commonly used to improve symptoms of stress with broad applications including cognitive health, immune support, and management of menopausal symptoms. In menopausal women, ashwagandha (W. somnifera) has been clinically shown to reduce frequency of hot flashes, stress, and anxiety while improving sleep, bone health, muscular strength, cognition, and overall quality of life32. Dosing used in clinical trials ranged between 120mg – 600mg daily. Ashwagandha is considered safe and side effects while using this herb are rare. Individuals on medication for anxiety, hypertension, headaches, or any chronic diseases should consult with a health professional before taking this ashwagandha due to risk of potentiation32,33.

Rheum rhaponticum – also referred to as Siberian rhubarb, has a standardized extract [ERr731®] that acts a modulator for the beta estrogen receptor [ER-beta]. The beta estrogen receptor has been linked to improvement in hot flashes, anxiety, and depression. Clinical trials using Rheum rhaponticum demonstrated significant improvement in overall quality of life and decrease in vasomotor symptoms34-36. The standardized EEr731® extract is provided as a 4mg dose taken daily. It is considered safe with no documented contraindications with prescription drugs, currently.

Evening Primrose Oil – is commonly used to treat premenstrual symptoms, breast pain, menopausal symptoms and a wide range of female reproductive disorders. Evening primrose oil is rich in linoleic and gamma-linolenic acid which is also beneficial in treating chronic inflammatory disease like rheumatoid arthritis37. Evidence on the effectiveness of primrose oil, however, is conflicting37,38. A systemic review of clinical research on evening primrose oil showed no significant difference between placebo and primrose oil in reducing vasomotor symptoms in menopausal women37. In a more recent study, which was not included in the aforementioned systemic review, researchers found that supplementation with evening primrose oil did significantly reduce vasomotor symptoms and improved overall menopausal symptoms38. Dosing ranges from 250mg – 1300mg. Mild nausea has been reported while using primrose oil39. It is not recommended to use primrose oil while taking blood thinners2.

Conclusion

Menopause is a natural part of a woman’s reproductive lifecycle signaling a transition from reproductive fertility to reproductive senescence – and for some women – a new lease on life. Although, the process is complicated and fraught with undesirable symptoms, conventional and alternative methods exist to support women during this phase. Ultimately, a comprehensive approach encompassing both alternative and conventional treatments that align with an individual’s needs and goals is most suited to long-term maintenance of a healthy lifestyle.

Posted May 20, 2026.

Chrystal is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Chicago.

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