Medications for Menopause

Estrogen Replacement Therapy (ERT)

Common names include:

• Conjugated Equine Estrogens (Premarin, Premarin Vaginal Cream)
• Synthetic Conjugated Estrogens (Cenestin)
• Esterified Estrogens (Estratab, Menest)
• Estropipate (Ortho-Est, Ogen, Ogen Vaginal Cream)
• Micronized 17-beta estradiol (Estrace, Matrix Patch: Alora, Climara, Esclim, Vivelle, Vivelle-Dot; Reservoir Patch: Estraderm; Estrace Vaginal Cream, Estring Vaginal Ring)
• Estradiol Hemihydrate (Vagifem Vaginal Tablet)
• Estradiol Transdermal Spray ( Evamist]]> )

Estrogen replacement therapy (ERT) provides you with a fraction of the amount of estrogen that was produced by your ovaries before menopause. It helps reduce hot flashes and vaginal dryness and may reduce your risk of osteoporosis. Even low doses of estradiol (given as a skin patch) may help with vaginal dryness and pain during sexual activity. ]]>*¹]]> Evamist, which is a spray, is another type of low-dose estradiol that may reduce the number of hot flashes. ]]>*³]]>

Estrogen may be administered as an oral tablet, patch, injection, pellet placed under the skin, vaginal cream, ring, tablet, or spray

Recent scientifically strong studies now show that estrogen replacement therapy increases a woman's risk of heart disease, endometrial cancer, ovarian and breast cancers, blood clots, and stroke.

In general, you should NOT be using ERT if you have cardiac risk factors or known cardiac disease, are or may be pregnant, have a history of breast cancer or other hormone-sensitive cancer, have unexplained bleeding from your uterus, or a history of blot clotting disorders. You should also avoid ERT over the long term (more than one or two years). You should discuss the risks and benefits of ERT with your doctor.

Possible side effects include:

• Uterine bleeding
• Enlargement of benign uterine tumors
• Sore breasts
• Abdominal bloating
• Nausea
• Fluid retention
• Headache, including migraine
• Dizziness
• Corneal changes in the eye
• Increased risk of breast, ovarian, and endometrial cancers
• Increased risk of heart attacks and strokes
• Increased risk of blood clots

Progestogen

If you choose ERT, the progesterone that your ovaries once produced must be replaced to reduce the increased risk of uterine cancer from taking ERT alone. Progesterone or progestin (synthetic progesterone) is available as replacement therapy. If you have had your uterus removed ( hysterectomy]]> ), you are not at risk for uterine cancer and do not need to take progesterone with ERT.

Progestin Oral Tablet

• Medroxyprogesterone acetate (Amen, Cycrin, Provera)
• Norethindrone (Micronor, Nor-QD)
• Norethindrone acetate (Aygestin)
• Norgestrel (Ovrette)
• Levonorgestrel (Norplant)
• Megestrol Acetate (Megace)

Progestin Injectable

• Medroxyprogesterone acetate (Depro-Provera)

Progestin IUD

• Levonorgestrel (Mirena)

Progesterone Oral Capsule

• Progesterone USP (Prometrium)

Progesterone: Vaginal Gel

• Progesterone (Crinone)

Progesterone IUD

• Progesterone (Progestasert)

Possible side effects include:

• Fluid retention
• Weight gain
• Headache
• Mood changes

Estrogen Plus Progestogen (Hormone Replacement Therapy–HRT) Oral, Continuous Cycle:

• Conjugated Equine Estrogens and Medroxyprogesterone Acetate (Premphase)
• Oral, Continuous-Combined:
  • Conjugated Equine Estrogens and Medroxyprogesterone Acetate (Prempro)
  • Ethinyl Estradiol and Norethindrone Acetate (Femhrt)
  • 17-Beta Estradiol and Norethindrone Acetate (Activella)

• Oral, Intermittent-Combined:
  • 17-Beta Estradiol and Norgestimate (Ortho-Prefest)

• Skin Patch, Continuous Cycle:
  • 17-Beta-Estradiol and Norethindrone Acetate (CombiPatch)

• Skin Patch, Continuous Combined:
  • 17-Beta-Estradiol and Norethindrone Acetate (CombiPatch)

When progesterone is taken with estrogen, it is called Hormone Replacement Therapy (HRT). Options for HRT include cyclic, continuous-cyclic, continuous-combined, and intermittent-combined. Long-term HRT increases the risk of strokes, blood clots, heart attacks, ovarian, endometrial, and invasive breast cancers. Therefore, you and your doctor should carefully discuss the risks and benefits.

Possible side effects include:

• Uterine bleeding or “spotting”
• Fluid retention
• Sore breasts
• Headache
• Mood changes
• Increased risk of endometrial, breast, and ovarian cancers
• Increased risk of heart attacks and strokes
• Increased risk of blood clots
• Increased risk of gastroesophageal reflux disease]]> (GERD) ]]>*²]]>

Androgen

Androgen Oral Tablet

• Methyltestosterone and esterified estrogens (Estratest, Menogen)

Androgen is a hormone produced by both males and females. In women, the ovaries secrete androgen as testosterone and androstenedione. As you get older, your ovaries produce less androgen as well as less estrogen. As a result of less androgen, some women notice a decline in their sex drive. Androgen, which must be taken with estrogen, may help improve sex drive in some women.

Possible side effects* include:

• Restlessness
• Depression
• Growth of facial and body hair
• Acne
• An enlarged clitoris
• Increased muscle mass
• A lowered voice
• Increased cardiovascular risks

*These side effects often occur as the result of improper dosages of androgen.

Bisphosphonates

Common names include:

• Alendronate (Fosamax)
• Risedronate (Actonel)
• Pamidronate (Aredia)
• Etidronate (Didronel)

These nonhormonal medications are used to prevent or treat osteoporosis. These agents effectively reduce both bone loss and your risk of fractures. Alendronate may cause gastrointestinal problems and irritation of your esophagus.

Selective Estrogen Receptor Modulators (SERMs)

Common names include:

• Raloxifene (Evista)

SERMs have some of the beneficial effects of estrogen, especially improved bone strength, but no increased risk of breast cancer or uterine bleeding. However, these medications tend to cause, rather than relieve, hot flashes and increase your risk of blood clots and gallstones.

Nonhormonal Medications for Hot Flashes

Your doctor may prescribe other types of medication to relieve hot flashes. . Examples include:

• Certain blood pressure medications (taken in lower doses)
  • Common names: clonidine]]> (Catapres), ]]>methyldopa]]> (Aldomet)
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Common names: ]]>fluoxetine]]> (Prozac), ]]>paroxetine]]> (Paxil), ]]>venlafaxine]]> (Effexor),]]> desvenlafaxine]]> (Pristiq) ]]>*⁴]]>
  • Note: SSRIs and SNRIs should not be used if you are taking ]]>tamoxifen]]>, a medication to reduce the risk of ]]>breast cancer]]> recurrence.

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

• Take them as directed, not more, not less, not at a different time.
• Do not stop taking them without consulting your doctor.
• Don’t share them with anyone else.
• Know what effects and side effects to expect, and report them to your doctor.
• If you are taking more than one drug, even if it is over-the-counter, be sure to check with a doctor or pharmacist about drug interactions.
• Plan ahead for refills so you don’t run out.