Menopause - Medications

Research has changed how doctors use hormone therapy after menopause. For a long time, hormone replacement therapy (HRT) was thought to protect against certain health problems, such as heart disease and dementia. But the Women's Health Initiative (WHI) study 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.7 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.

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, heart problems, blood clots, or neurological changes may be lower or higher, depending on your risk factors.

Medication Choices

Prescription medicine without hormones

Many doctors 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.

  • Antidepressant medicines can lower the number and severity of hot flashes. They may also help with irritability, depression, and moodiness.
  • Clonidine, a high blood pressure medicine, can reduce the number and severity of hot flashes.14 Some women have side effects related to low blood pressure.
  • Gabapentin (Neurontin), an antiseizure medicine, can reduce the number and severity of hot flashes.15 Possible side effects include sleepiness, dizziness, and swelling.

Prescription medicine 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, vaginal ring, gel, or cream form, can be used to treat menopause symptoms. Because studies have found that HRT increases some health risks for some women, doctors 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.6
  • Bioidentical hormone replacement therapy is made from plants and is thought to be more similar to human-produced hormones than synthetic HRT. But bioidentical HRT is not well researched and may carry the same health risks that traditional HRT does.6 Any form of hormone therapy is best taken for as short a period as possible.
Click here to view a Decision Point.Menopause: Should I Use Hormone Replacement Therapy (HRT)?

Estrogen replacement therapy (ERT) is used to preventweakening bones and the severe symptoms that come with sudden, early menopause.Early menopause usually happens after surgery to remove the uterus and ovaries(hysterectomy and oophorectomy) or from ovary failureafter cancer treatment. But ERT is known to slightly increase the risks ofstroke and blood clots during the first year of use.16Long-term ERT may slightly increase breast and ovarian cancer risks.17, 12

Taking estrogen byitself (ERT) can lead touterine (endometrial) cancer. Taking progestin withestrogen protects against uterine cancer. This is why ERT is only recommendedif you have no uterus. If you have not had your uterus removed and want hormonetherapy, you take progestin with the estrogen (HRT).

Click here to view a Decision Point.Hysterectomy and Oophorectomy: Should I Use Estrogen Replacement Therapy (ERT)?

Short-term, low-dose HRT or ERT is hoped to offer a balance between HRT benefits and risks. It can be taken for up to 4 to 5 years, with regular checkups. This may work well for many women, who will find that their menopause symptoms have subsided within this period of time. As more women use low-dose hormones for shorter periods of time after menopause, researchers will be able to learn about the actual benefits and risks.

Progesterone creams. "Natural" progesterone creams (available in health food stores or through mail order) or prescription progestin creams, which are made by a compounding pharmacist, are marketed to correct low progesterone levels. While some women report finding relief with progesterone cream, many experts are concerned about whether these products increase the body's progesterone levels. This raises the following concerns about over-the-counter progesterone cream use.

  • If it is absorbing well. Progesterone treatment has risks. It has been linked to breastcancer, headaches, and dangerous blood clots in a small number ofwomen.18 This is why progesterone is usually aprescription hormone and is not safe for women with certain healthrisks.
  • If it is not absorbing well. If youare taking estrogen (and have an intact uterus), you also need to have enoughprogesterone to prevent the estrogen from causinguterine (endometrial) cancer.

Talk to your doctor before using an over-the-counter progesterone cream.

Testosterone.Testosterone-estrogen is sometimes used for menopausal symptoms that don't improve with estrogen therapy. But it is not FDA-approved because its risks are not yet fully known. Testosterone-estrogen carries the same risks as estrogen treatment (blood clots, stroke, breast cancer) as well as testosterone risks and side effects.

Testosterone is sometimes used to increase sexual desire in postmenopausal women who have low testosterone. But, no form of testosterone is approved for women. Studies have not shown a benefit for longer than 12 weeks of use, and long-term testosterone risks for women are not yet known.9 If you have a problem with low sexual desire, see the topic Sexual Problems in Women.

By: Healthwise StaffLast Revised: February 23, 2011
Medical Review: Kathleen Romito, MD - Family Medicine
Carla J. Herman, MD, MPH - Geriatric Medicine

1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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