Management

Encouraging changes in behaviour and lifestyle

  • regular physical activity
  • balanced diet
  • optimising sleep
  • stopping smoking and reducing or stopping alcohol consumption

Cardiovascular risk is the main health concern for women going through menopause, with a significant prevalence of risk factors such as high blood pressure, diabetes, obesity, metabolic syndrome, an unbalanced diet, high cholesterol, smoking and a sedentary lifestyle. Excessive alcohol consumption can also exacerbate the symptoms of menopause and perimenopause and increase the risk of breast cancer. It is therefore essential to educate women and promote a healthy lifestyle.

Hormone replacement therapy (HRT)

The main benefit of hormone replacement therapy (HRT) is to relieve most symptoms of menopause and perimenopause, including hot flushes, brain fog, joint pain, mood swings and vaginal dryness. It may also help reduce the risk of osteoporosis.

However, use of HRT cannot be recommended for everyone due to potential risks, particularly venous and cardiovascular risks, and risks affecting certain organs such as the breast, ovaries and endometrium.

The initiation of HRT requires a rigorous assessment of the risk-benefit ratio, carried out at the start of treatment and then reassessed at least once a year. This assessment must be individualised and take the patient’s characteristics into account, including age at the time of menopause, the time elapsed since its onset, medical history, and risk factors, particularly cardiovascular (including stroke), venous, and those related to cancer risk.

Non-hormonal treatments

In cases where hormone replacement therapy is contraindicated or refused, non-hormonal alternatives may be offered to relieve symptoms.

  • Certain medicines can help reduce hot flushes and night sweats, notably clonidine and gabapentin.
  • Antidepressants may be used for mood disorders where depression or anxiety has been diagnosed.
  • In cases of vaginal dryness, non-hormonal treatments, such as vaginal moisturisers, may be offered.
  • Cognitive behavioural therapy (CBT) can help manage certain symptoms, such as mood disorders and anxiety, hot flushes, joint pain and sleep disorders.

Follow-up

Regular medical follow-up allows treatment to be adjusted, complications to be prevented, and cardiovascular risk, bone health and quality of life to be assessed.

The limitations of medical support during menopause

A recent systematic review of the literature (2025), examining the barriers to open discussion about menopause, identifies negative experiences with healthcare professionals as a recurring theme.

These experiences manifest themselves in particular as:

  • a lack of trust, with some women reporting an approach perceived as paternalistic and insufficient consideration of their preferences
  • inconsistent care, with varying practices regarding the prescription of HRT, sometimes offered without discussion, or conversely not offered despite symptoms relating to menopause
  • an expressed need for a more holistic approach, taking into account both the physical and psychological aspects of symptoms
  • insufficient personalised information and support at the time of diagnosis
  • gaps in follow-up, leading to a lack of continuity in care
  • questions regarding the knowledge and role of healthcare professionals, which influence women’s trust and comfort in these discussions.

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