There are many products available without a prescription ("over-the-counter") that may help with specific menopause-related complaints. Healthcare professionals can provide information about these products, including vitamin and mineral supplements, other nutritional supplements, and vaginal lubricants and moisturizers. A woman's healthcare provider should be involved in the decision to use nonprescription products because no therapy is without potential risk.

Probably every woman could benefit from a good quality, daily multivitamin and mineral supplement. After menopause, the chosen supplement typically should not contain iron, because a woman no longer loses iron through menstrual bleeding. During perimenopause, when periods may be quite heavy, the clinician may recommend that a woman take extra iron to avoid anemia. Most daily supplements contain 400 IU of vitamin D, providing the amount that most women need. For those who are never in the sun, 600 IU is recommended.
A "multi" preparation may not contain the daily requirement of calcium, however, because the tablet would be too large. If adequate calcium cannot be obtained from the diet, a separate calcium supplement may be required to reach the recommended level of 1,200 to 1,500 mg elemental calcium daily. Several types of calcium are available, such as calcium carbonate (eg, Tums) and calcium citrate (eg, Citracal). Calcium-fortified foods provide another source.

In early 2000, the FDA began allowing dietary supplement marketers to make health claims for certain conditions without providing documentation for efficacy or safety. These conditions include hot flashes and age-related memory loss, for example, but not prevention of diseases, such as osteoporosis and heart disease. The marketer, not the FDA, is responsible for ensuring that labels are truthful and not misleading, that they contain enough information for consumers to make an informed choice, and that all dietary ingredients are accurately listed.
Some women choose a combination supplement of calcium and vitamin D (eg, Oscal). Calcium is best absorbed when taken with meals in 250 to 500 mg doses throughout the day. Calcium should not be taken with fiber or iron supplements. Up to 1,500 mg of calcium per day does not increase the risk of kidney stones, but drinking plenty of water is advised.
Some women find vitamin E (daily doses of 400 IU or more) helpful in reducing hot flashes, although studies do not support this benefit. For easiest digestion, this supplement should be taken along with a meal that contains fats. It may take two to six weeks before feeling the optimum effects, if any. Vitamin E supplements thin the blood, so these supplements should not be used by women using blood-thinning prescription drugs or aspirin.
Other vitamins and minerals are available over-the-counter. A woman's healthcare provider can provide guidance regarding her needs for these products.

Also available without a prescription are products containing hormones such as topical progesterone and DHEA, marketed under the dietary supplement regulations (see box). None of these products is FDA-approved to treat a menopause related condition.

Topical progesterone creams. These come in strengths ranging from 2 to 400 mg per ounce and are marketed for a variety of claims, including relief of hot flashes and protection against osteoporosis and breast cancer. These claims have not been confirmed through clinical studies.
Studies with one topical progesterone cream have shown that after applying the cream on the skin's surface, progesterone is absorbed into the bloodstream, but studies show that the products are not consistent in delivering levels high enough to protect the uterus when using estrogen replacement therapy. Some topical progesterone products have been found to contain no progesterone at all. A prescription progestogen is a better choice to provide the needed protection. Because of these concerns, NAMS does not recommend the use of over-the-counter progesterone creams.

DHEA (dehydroepiandrosterone) is an androgen hormone made by the human adrenal gland. It can be synthesized from wild yams. DHEA is marketed with a wide range of claims, such as improving immune function, slowing the aging process, increasing energy, improving cholesterol levels, causing weight loss, improving mood, and increasing sex drive. However, very few clinical trials have been conducted regarding its use in humans, and more are needed to support not only its effectiveness but also its safety. Because of these reasons, NAMS does not recommend its use. High doses can produce side effects, such as liver damage and depressed mood. DHEA is contraindicated in women who have a history of hormone-sensitive tumors or who might become pregnant (because of possible masculinization of a female fetus).

Vaginal Lubricants & Moisturizers.  Minor vaginal moisture problems can often be solved by using one of many water-soluble vaginal products designed for this use. A wide selection of lubricants (eg, Astroglide, Lubrin, Moist Again) and moisturizers (eg, Replens, K-Y Long-Lasting) are available. Unlike lubricants, moisturizers act directly on tissue to make it less dry. Moisturizers have the extra advantage of a low pH that helps keep the vagina acidic and less inviting for infection. Only products designed for vaginal dryness are recommended. Hand lotion contains ingredients such as alcohol and perfume that can irritate vaginal tissue. Oil-based products such as Vaseline petroleum jelly and baby oil can also cause irritation, damage condoms and diaphragms, and cling to vaginal tissue, providing a habitat for infection. One exception may be vitamin E oil, which some women have found to provide lubrication and relieve itching and irritation. Vinegar douches and vaginally applied cultures of lactobacilli or yogurt are not effective for vaginal dryness and are not recommended. Antihistamine pills taken for allergies have a drying effect on all mucous membranes, including those in the nose and in the vaginal wall. It is also advisable to limit the use of soap, bubble baths, and bath oils as well as to avoid talcum powder in the vaginal area because of a possible link with ovarian cancer. No vaginal lubricant or moisturizer treats the cause of menopause-related vaginal dryness and atrophy. Since the cause is a lack of estrogen, vaginal tissue can best be restored with prescription estrogen therapy. Estrogen is FDA-approved for treating vaginal atrophy.

Several prescription drugs are available to help with menopause-related changes. By far, the most often used drug for these conditions is the
hormone estrogen, which is prescribed to replace the lowered levels secreted by the ovaries at menopause. Estrogen is FDA-approved for the treatment of hot flashes and vaginal atrophy as well as the prevention of osteoporosis. A number of factors need to be considered when a woman, with the guidance of her healthcare provider, decides whether therapy with estrogen is right for her. There is no "one size fits all" when it comes to menopause therapy. Each woman is unique and must make her own decision after totally understanding her personal situation.

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