You wake up soaked from another bout of night sweats. By morning, your social media feed has an answer: a supplement bundle, a custom hormone prescription, or a test that promises to tell you exactly what’s wrong just by analyzing your saliva.

When you need relief, how do you decide what deserves your time and money?

For years, many women were warned away from hormone therapy to address common symptoms of menopause. As understanding of the benefits and risks of hormone therapy has evolved, menopause has also become a more open topic of conversation, with businesses ranging from content creators to medspas offering solutions.

Dr. James Meek, an ob-gyn at Novant Health Pelvic Health & Menopause Care – SouthPark, welcomes the interest in better care.

However, not every available menopause treatment is supported by research, and not every solution on the market will effectively address menopause symptoms. Before spending money on supplements, saliva tests, custom hormone compounds or online programs, Meek recommends asking some key questions.

Here, Meek explains how to separate evidence-based menopause care from the growing number of treatments on the market, find options that fit your needs and budget, and work with your gynecologist to manage symptoms and protect your long-term health.

We now see menopause treatments offered far beyond the doctor’s office. How can we evaluate these treatments that aren’t always reviewed or recommended by medical experts?

I would advise everyone to ask three questions:

For supplements, the evidence for relieving specific menopause symptoms is often limited. (Editor’s note: Healthy Headlines has a closer look at menopause supplements and what to ask before starting one.)

2. What exactly am I being prescribed? Terms like “bioidentical hormones” and “compounded medications” can be confusing. “Bioidentical” means a hormone is chemically similar to one your body produces — not necessarily safer or more natural. Some FDA-approved hormone medications are bioidentical.

A custom-compounded medication, on the other hand, is not FDA-approved, and the FDA does not review each compounded drug for safety, effectiveness or quality before it is sold. Ask why a custom preparation is needed if an approved option exists.

3. Is anyone looking at how this menopause treatment fits into the broader picture of my health? Online visits and prescribing can make care more accessible. However, they can also skip from symptoms to prescriptions without enough discussion of your personal and family history.

The other thing I’ll say about buying menopause treatments outside of your doctor’s office is to exercise caution when the same clinic diagnoses you and sells you its preferred product. That is a conflict of interest.

Are there menopause treatments you commonly hear about that are sold outside of the doctor’s office?

The most common ones are supplements. A few supplements are very common, like black cohosh. Over-the-counter topical creams that have weak estrogen-derived compounds are also very common. And so are compounded versions of estrogen or estrogen-progesterone.

Most, if not all, of the unregulated treatments I hear about aren't harmful. They simply aren’t as helpful as hormone therapy, or the other options offered by an ob-gyn, so it’s important to talk to a clinician before trying any of them.

What if I’d prefer to take an FDA-approved menopause treatment, but the option my gynecologist offers me is too expensive?

Definitely speak up and say so. Medication coverage and out-of-pocket costs can be significant. Ask whether an FDA-approved generic, another formulation, a pharmacy price comparison or a virtual follow-up could lower the cost. Programs like GoodRx may also work for certain drug brands.

When and how should I seek treatment for menopause symptoms?

It’s important to remember that perimenopause is actually the first hormone shift that can bring changes in periods, sleep, mood, sex drive and temperature regulation. That means you may see these symptoms as early as your mid-30s, if you have early-onset perimenopause. The average age is the mid-40s.

Some changes may be manageable without treatment; others can disrupt your life. No matter what age or stage you’re at, if it’s bothering you, or you have questions about it, it’s time to address it with your gynecologist.

Make an appointment with your gynecologist to describe what changed, when it began and how it’s affecting your daily life. That gives a clinician a starting point to consider menopause alongside other possible causes and to match care to your symptoms. For example:

• Hot flashes and night sweats: Hormone therapy is the most effective treatment. If it is not suitable for you, or you prefer to avoid it, ask about evidence-based nonhormonal options.
• Vaginal dryness or pain: Ask about treatments aimed at these symptoms, including low-dose vaginal estrogen. A localized treatment is different from hormone therapy that circulates throughout the body.
• Poor sleep, low mood or fatigue: Ask what else may be contributing. Hormone therapy alone may not address every cause, although it may help.

I also use menopause visits to discuss longer-term health, including blood pressure, cholesterol, bone health and mental health. The goal is to plan for you to live a long, healthy life, whether or not it includes hormone therapy.

Are there any people who should not use hormone replacement therapy?

There are patients who we will have a more in-depth discussion about hormone therapy due to their medical history. The question of whether or not it is appropriate, however, is not as simple as yes or no. We make an effort to explain benefits and potential downsides to every patient in relation to their specific health history. There are patients for whom hormone therapy would not be my first choice, including anyone with a history of breast cancer, blood clots, heart health issues or unexplained bleeding. However, it is always a choice, and one we make with the patient.

Are there nonhormonal treatment options for menopause symptoms?

Yes, you still have options. Depending on the symptom, they may include prescription medication, targeted treatment for vaginal symptoms or other approaches. Ask which option has evidence for the problem you want to solve and what side effects or follow-up it requires.

What’s one thing women going through menopause can do today to ensure they live the healthiest, longest life possible?

Three things:

• Start or keep exercising.
• Eat a healthy diet.
• Go to your annual exams with both your primary care provider and your gynecologist.

And if you’re having untreated symptoms that may be due to perimenopause or menopause, write down your most disruptive symptoms, what you’ve tried, if anything, and your ideal outcome. Make an appointment with your gynecologist and bring that list. We’re here to help you not only manage symptoms, but also live a long, healthy life.