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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
There are a number of prescription therapies available for treating menopause-related symptoms. The most common drug used for menopause is the hormone estrogen, which helps make up for the lower levels secreted by your ovaries at menopause.
Since each person is unique, a number of factors need to be considered before you make the decision to use hormone therapies, including your family and medical history. The results of recent studies on estrogen replacement therapy (ERT) and estrogen plus progestin (hormone replacement therapy or HRT) suggest that the risks of long-term hormone replacement therapy (> 3 years) outweigh the benefits for many women. Therefore, you need to discuss the pros and cons of treatment with your doctor.
Estrogen Plus Progestogen (Hormone Replacement Therapy–HRT)
Selective Estrogen Receptor Modulators (SERMs)
Common names include:
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:
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
Progestin Injectable
Progestin IUD
Progesterone Oral Capsule
Progesterone: Vaginal Gel
Progesterone IUD
Possible side effects include:
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:
Androgen Oral Tablet
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:
*These side effects often occur as the result of improper dosages of androgen.
Common names include:
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.
Common names include:
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.
Your doctor may prescribe other types of medication to relieve hot flashes. . Examples include:
Whenever you are taking a prescription medication, take the following precautions:
References:
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed February 15, 2006.
National Women's Health Resource Center website. Available at: http://www.healthywomen.org/content.cfm?L1=3&L2=52&L3=2.0&SS=0 . Access date unknown.
North American Menopause Society website. Available at: http://www.menopause.org/default.htm . Accessed February 15, 2006.
Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 2008. Accessed September 23, 2008.
USP DI . 21st ed. Micromedex; 2001.
*¹9/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Huang A, Yaffe K, Vittinghoff E, et al. The effect of ultralow-dose transdermal estradiol on sexual function in postmenopausal women. Am J Obstet Gynecol. 2008;198:265.e1-7.
*²9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Jacobson BC, Moy B, Colditz GA, Fuchs CS. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168:1798-1804.
*³11/19/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Buster JE, Koltun WD, Pascual ML, Day WW, Peterson C. Low-dose estradiol spray to treat vasomotor symptoms: a randomized controlled trial. Obstet Gynecol. 2008;111:1343-1351.
*44/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Archer DF, Dupont CM, Constantine GD, Pickar JH, Olivier S; Study 319 Investigators. Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: a double-blind, randomized, placebo-controlled trial of efficacy and safety. Am J Obstet Gynecol. 2009;200:238.e1-238.e10. Epub 2009 Jan 24.
Last reviewed November 2008 by Jeff Andrews, MD, FRCSC, FACOG
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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