Many women are surprised to learn that androgen, which is considered primarily a male hormone, is also a female hormone. It is secreted by the ovaries as testosterone and androstenedione. Aging ovaries produce less androgen as well as less estrogen, although the decline is not so steep as with estrogen. Conditions that accelerate the decline of internal androgen levels include surgical removal of one or both ovaries prior to menopause, pituitary and adrenal insufficiency, corticosteroid therapy, and some chronic illnesses. Because of the lack of androgen, some women suffer a decline in sex drive. Androgen therapy may help. Some women have also reported an increase in energy while taking androgen. However, androgen therapy is appropriate only when a woman is also using estrogen - never androgen alone.
There have been many studies in which androgen was added to estrogen therapy for menopausal women. Currently, the only androgen-containing product that is FDA-approved for use in women is Estratest, a prescription oral tablet containing an androgen (methyltestosterone) and an estrogen (esterified estrogens). However, no product, including Estratest, is FDA-approved for boosting sex drive in women. Estratest is approved for the treatment of hot flashes that are unresponsive to ET alone. Some women, however, find that sex drive is improved by taking this product.
A skin patch product containing another androgen (testosterone) is being developed. Testosterone products also can be custom-made by a compounding pharmacist following a healthcare provider's prescription. One popular form contains 1% to 2% micronized testosterone USP in a water-soluble base; this topical product can be absorbed by rubbing it on the skin. Other custom forms of testosterone include tablets, injections, or pellets implanted under the skin. As with all custom formulations that are not FDA approved, therapy should be used with caution.
Dosage is very important. Too much androgen may not provide the desired improvement in sex drive and can cause feelings of agitation, aggression, and/or depression. Higher dosages can also cause facial and body hair growth, acne, an enlarged clitoris, a lowered voice, and muscle weight gain. These side effects may not go away after therapy stops. Androgen may adversely affect some of estrogen's heart health benefits, even more so
than progestin. Caution is recommended when considering this type of hormone treatment because the safety of taking androgen for extended periods of time has not been established.
Women must not use the androgen products FDA approved for men, as these contain very high doses that would be harmful to women. However, several new products are being studied for use in women, and will, hopefully, be on the market in the near fixture.

Treatments for menopause can be aimed at menopause disturbances or targeted to prevent the potential long-term effects of lowered estrogen levels. An array of remedies is available today, and more are under study for future use.
Although not FDA-approved for this use, low-dose oral contraceptives containing estrogen and progestin are prescribed to help regulate periods, reduce hot flashes, improve sleep, and level out mood swings. Oral contraceptives, even those with very low hormone doses, provide significantly more hormone than standard HT regimens. Since the lowest effective dose of any drug should always be used to reduce exposure to risk, women who need to continue with HT are switched from oral contraceptives to HT after menopause is reached. However, a woman taking birth control pills will continue to have uterine bleeding even after menopause, making it difficult to determine that menopause has occurred. Thus, many clinicians make the switch automatically at age 51 to 55 - the average age of menopause.
Several other prescription drugs are available as options to ET/HT in treating hot flashes, but they are not FDA-approved for this use.

Therapies considered by some to differ from traditional medical treatments are referred to as complementary and alternative medicine (CAM) therapies. These nonprescription treatments are promoted for a range of menopause symptoms, and the remedy usually depends on the specific complaint. The effect, if any, of CAM therapies may take several weeks. In contrast, prescription hormones usually begin to take effect within a few days. Some CAM therapies are expensive and many are untested. CAM therapies include foods, herbs and other botanicals (plant sources), and supplements. Often, a pharmacist or herbalist can offer advice on their use. CAM therapies can also include naturopathy, homeopathy, and acupuncture, each practiced by specialists in the field.
Many CAM therapies are advertised as "natural." This marketing word is used because many consumers believe it suggests that a product that's natural is better or safer. However, this may not be the case. CAM therapies may actually be more dangerous than prescription drugs because less is known about them, and their purity, dosage, and advertising claims are not regulated by the FDA.
These products are marketed as dietary supplements. Women need to use the same caution with CAM therapies as with all other therapies. As more research findings accumulate to support their effectiveness, some therapies now listed as CAM therapies will undoubtedly be moved from the CAM category to mainstream. Some CAM therapies may be proven to be ineffective or too risky, and they will not be included anywhere in a listing of menopause treatment options. Still others will remain classified as CAM, since not all therapies can be adequately tested, often because of lack of financial backing for studies since many CAM products are not patent-protected and, thus, do not allow marketers to recoup their research investment.

Currently, intensive research is focused on phytoestrogens (plant estrogens), such as isoflavones. These are naturally occurring compounds found in rich supply in soybeans, soy products, and red clover. They are similar in chemical structure to estrogen and can produce weak estrogen-like effects. There is some evidence that eating soy foods (such as tofu, tempeh, soy milk, or roasted soy nuts) may be helpful in reducing hot flashes and other menopause effects. The most convincing beneficial health effects have been attributed to the actions of soy foods on fats in the blood, stimulating the FDA to recommend eating a daily serving of soy foods (25 grams of "soy protein"), as part of a diet low in saturated fat and cholesterol, to help lower the risk of heart disease. There are inadequate data to evaluate the effect of soy/isoflavones on vaginal dryness, bone mass, and breast cancer.
Commercial preparations containing isoflavones - including over-the-counter supplements, additives to "multi" supplements, and fortified foods (such as candy bars) - are marketed to provide similar health benefits. It is not clear, however, whether the observed health benefits sometimes seen with soy foods are caused from the isoflavones alone or from isoflavones plus other components in whole foods. Until the effectiveness and long-term safety of isoflavone supplements have been clearly established, eating reasonable amounts of soy food is probably a better choice. Foods have widely different amounts of isoflavone , and there is great variability within the same food type, depending on many factors, such as growing conditions.

A number of botanical (plant-based) products, including herbs and multi-herb products, have been used to treat acute menopause-related conditions, such as hot flashes. They are not meant to be considered for prevention of serious diseases, such as osteoporosis. There is limited research information documenting effectiveness and safety of these products. All are regulated as dietary supplements, not as drugs. None are regulated for purity, dose, or health claims.
The most widely used products include the following:

Black cohosh (Cimicifuga racemosa), also known as black snakeroot and bugbane, is available in several forms. The most studied form is an extract used in Germany. The typical dose is 160 mg/day. The most well-known brand is Remifemin.
Pros: There are reports of effectiveness with hot flashes, vaginal dryness, and depression, and some clinical studies support these reports, although critics contend the studies are poorly designed. Results are evident within two to four weeks. Side effects are rare and include gastrointestinal upset, typically with first-time use.
Cons: Black cohosh should not be used longer than six months. It should not be used in combination with ET/HT or with antihypertensive medications.

Evening primrose oil (Oenethera biennis) comes from seeds rich in linoleic acid. It is used at 1,500 to 3,000 mg/day for relief of hot flashes.
Pros: Some women report effectiveness.
Cons: There is no scientific evidence that effectiveness is better than placebo. Side effects include inflammation, nausea, diarrhea, blood clots, and lowered immune system. Women with epilepsy or those using phenothiazines or blood thinners (including aspirin and warfarin as well as supplements of vitamin E, feverfew, garlic, or ginger) should not use this product.

Ginkgo (Ginkgo biloba) is an antioxidant used for short-term memory loss.
Pros: Some studies document effectiveness.
Cons: Bleeding is a serious side effect. Women using blood thinners should not use this product. Use must be discontinued for two to three weeks before and after surgery. Use is not recommended for menopause symptoms.

Ginseng (Panax ginseng) is a term used to describe many different herbs used for preventing age-related cognitive decline, fatigue, and building resistance to viruses.
Pros: Some women report effectiveness.
Cons: There is a lack of scientific evidence to support these claims. Side effects include vaginal bleeding, worsening of menopause symptoms, high blood pressure, headache, aggressive behavior, mental disturbances, and insomnia. Ginseng should not be used with stimulants, diabetic agents, phenelzine, (a potent antidepressant), blood thinners, or diuretics. Use is not recommended because of side effects and lack of efficacy data.

Dong quai (Angelica sinensis), also known as Chinese angelica, tang-kuei, and dang-gui, is used for menstrual cycle regulation, easing cramps, and menopausal symptoms.
Pros: Some women report effectiveness for these conditions.
Cons: One study using 4.5 grams/day for 12 weeks found it to be no more effective than placebo in relieving hot flashes. Dong quai, however, is not meant to be used alone but in an individually tailored herb mixture.

Kava (Piper methysticum), sometimes called kava kava, is used for menstrual cramps, muscle tension, and insomnia.
Pros: Studies with postmenopausal women document efficacy in relieving mild anxiety.
Cons: Kava may be addictive and must be used with caution. Mild gastrointestinal upset has been reported; long-term use can cause yellow, scaly skin. Kava should not be used with any medication taken for psychological problems, antihistamines, or alcohol.

St. John's wort (Hypericum perforatum) is used for mild to moderate depression at a dose of 300 mg taken three times daily.
Pros: Studies show effectiveness.
Cons: Side effects include gastrointestinal upset, fatigue, and increased sensitivity to sunlight. When taking this herb, sunblock, a hat, and wraparound sunglasses should be worn when in the sun and sunbathing must be avoided. St. John's wort should not be used with drugs for psychological problems or HIV, or after organ transplant.

Wild yam (Dioscorea villosa) must be processed chemically in a lab to the hormone progesterone; humans lack the chemicals necessary to make
this change. Some products are marketed with claims of relieving hot flashes, among others.
Pros: None.
Cons: There is no scientific evidence that wild yam is effective.

For most women experiencing natural menopause, the decision to seek treatment is based on the severity of short-term complaints, risk of disease
in later years, and personal attitudes about menopause and medication. Regardless of the severity of health complaints, women in perimenopause should consult a healthcare provider.
Some women in perimenopause find adequate help from nonprescription remedies, such as vitamins and herbs. Others choose prescription hormones, either ET/HT or oral contraceptives, during this transition. Following perimenopause, some women choose ET/HT or more targeted prescription therapies to protect against osteoporosis and, possibly, heart disease.
Prescription ET/HT appears to be the treatment of choice for women who experience premature menopause (either natural or induced) because of their increased risk for osteoporosis and heart disease.
However, it is also important to assess and improve overall diet, exercise regimen, and other lifestyle factors. For all women, living a healthy lifestyle
can contribute significantly to improved well-being, not only today but throughout life.

Prior to beginning any treatment or combination of treatments, whether intended to alleviate short-term disturbances or prevent diseases later in life, a woman needs to be assured that the treatment regimen selected is the best for her. This requires an open discussion with her healthcare provider about her health status and concerns and in-depth information on available treatment options. A clinician with expertise in managing menopause can offer optimal care.

For optimal results, treatment takes time. It takes time for effects to manifest fully and for side effects to diminish. For example, the effects of ET/HT usually become stable after six to eight weeks.
Nonprescription and CAM therapies, on the other hand, may take months for the desired effects, if any.
Over time, therapy may need to change because of gradually lowering levels of ovarian hormones and the possible appearance of medical conditions unrelated to menopause or menopause treatments. Also, new research and changing ideas about medicines and health arise that have an impact on health decisions.
Before switching from one therapy to another, a "wash-out" period during which no drugs are used may be required to clear all drugs from the body. If ET/HT is to be discontinued, it should be tapered off in order to avoid severe recurrence of hot flashes.
Treatment should last as long as it is needed. Duration will be different for each woman, depending on her own unique and ongoing health profile, and risks of developing serious diseases later in life. Because of this, regular checkups are important throughout life.
For more info, go to the North American Menopause Society website.

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