Menopause and Perimenopause - Medications
Recent studies have changed how health professionals use hormone therapy
after menopause.
For a long time, hormone replacement therapy (HRT) was thought to protect
against heart disease and dementia. However, studies now show that HRT use
can cause serious health problems. One large study done by the Women's
Health Initiative (WHI) has shown that HRT does not protect against heart
disease. In fact, in a small number of women who are 10 or more years past
menopause, it causes heart disease, including heart attacks.11 In the WHI study,
short-term use of HRT was also linked to an increase in the numbers of strokes
and blood clots. Using HRT for several years was linked to increased cases of
breast cancer and dementia. Overall, most women using HRT in the WHI study
had no serious side effects, but they also had no long-term benefits.
ERT may also cause breast cancer in a small number of women.
Experts do not yet know whether hormone therapy risks are the same for older
and younger postmenopausal women. Researchers are now exploring HRT use
by women who use short-term, low-dose hormone therapy starting at
menopause.
Average HRT- and ERT-related risks are low among the general population of
women. Your personal risks that hormone therapy may stimulate breast cancer,
cardiovascular problems, blood clots, or neurological changes may be lower or
higher, depending on your risk factors.
Many health professionals now suggest trying nonhormonal treatment for
bothersome menopause symptoms before considering hormone therapy (birth
control pills, estrogen alone [ERT], or estrogen-progestin [HRT]). There are
several nonhormonal prescription treatments that can relieve or reduce hot
flashes and other menopause symptoms. You can also try using black cohosh
or dietary soy.
Medication Choices
Prescription medication without hormones
Selective serotonin reuptake inhibitors (SSRIs), which are a type of
antidepressant medicine such as Paxil or Prozac, can reduce the number and
severity of hot flashes. Some women have side effects. The safety of very
long-term use has yet to be studied.
Clonidine, a high blood pressure medication, can reduce the number and
severity of hot flashes.13 Some women have side effects related to low blood
pressure.
Gabapentin (Neurontin), an antiseizure medication, can reduce the number and
severity of hot flashes.28 Possible side effects include sleepiness, dizziness,
and swelling.
Prescription medication with hormones
Birth control pills (estrogen and progestin) regulate menstrual bleeding and can
relieve symptoms until menopause. Birth control pills are not used after
menopause. You should not use birth control pills if you smoke or have
diabetes, untreated high blood pressure, cardiovascular disease, or a history of
breast cancer. Low-dose formulations are recommended for women older than
35. Some women have side effects.
Progestin pills or the levonorgestrel IUD, which releases a form of progesterone
into the uterus, reduce heavy, irregular menstrual periods during
perimenopause. Some women have side effects.
Low-dose vaginal estrogen (cream, tablet, or ring) reduces vaginal and urethral
dryness and weakening without introducing high levels of estrogen into the
body.
Hormone replacement therapy (estrogen and progestin), in pill, patch, or vaginal
ring form, can be used to treat menopause symptoms. Because recent studies
have found that HRT increases some health risks for some women, health
professionals have changed the way HRT is used. For menopause symptom
relief, experts now recommend that HRT only be used at the lowest effective
dose for the shortest possible period of time.1
Bioidentical hormone replacement therapy is made from plants and is thought to
be more similar to human-produced hormones than synthetic HRT. However,
bioidentical HRT is not well-researched and may carry the same health risks that
traditional HRT does.1 Any form of hormone therapy is best taken for as short a
period as possible.
PLEASE NOTE
MEDICATION STUDY
BELOW
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MENOPAUSE
THIS INFORMATION COMES
FROM MAYO CLINIC.