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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. 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 to treat menopause-related symptoms. The most common drug used for menopause is estrogen. This hormone 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 outweigh the benefits for many women. Therefore, you need to discuss the pros and cons of treatment with your doctor.

Prescription Medications

Estrogen Replacement Therapy:

  • Conjugated Equine Estrogens
  • Synthetic Conjugated Estrogens
  • Esterified Estrogens
  • Estropipate
  • Micronized 17-Beta Estradiol
  • Estradiol Hemihydrate
  • Estradiol Transdermal Spray

Progestogen:

  • Progestin Oral Tablet
  • Progestin Injectable
  • Progestin Intrauterine Device (IUD)
  • Progesterone Oral Capsule
  • Progesterone: Vaginal Gel
  • Progesterone IUD

Estrogen Plus Progestogen (Hormone Replacement Therapy–HRT):

  • Oral, Continuous Cycle
  • Oral, Continuous-Combined
  • Oral, Intermittent-Combined
  • Skin Patch, Continuous Cycle
  • Skin Patch, Continuous Combined

Androgen:

  • Androgen Oral Tablet

Bisphosphonates:

  • Alendronate
  • Risedronate
  • Pamidronate
  • Etidronate

RANKL Inhibitor

  • Denosumab

Selective Estrogen Receptor Modulators (SERMs):

  • Raloxifene

Nonhormonal Medications:

Prescription Medications
Estrogen Replacement Therapy (ERT)

Common names include:

  • Conjugated Equine Estrogens
  • Synthetic Conjugated Estrogens
  • Esterified Estrogens
  • Estropipate
  • Micronized 17-beta Estradiol
  • Estradiol Hemihydrate
  • Estradiol Transdermal Spray

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. Even low doses of estradiol (given as a skin patch) may help with vaginal dryness and pain during sexual activity. It may also reduce your risk of osteoporosis. Evamist, which is a spray, is another type of low-dose estradiol that may help reduce hot flashes.

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 blood clotting disorders. You should also avoid long-term use of ERT. 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
  • Lightheadedness
  • 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, a synthetic progesterone, is available as replacement therapy. If you have had your uterus removed, a hysterectomy , you are not at risk for uterine cancer and usually do not need to take progesterone with ERT.

Progestin Oral Tablet:

  • Medroxyprogesterone Acetate
  • Norethindrone
  • Norethindrone Acetate
  • Norgestrel
  • Levonorgestrel
  • Megestrol Acetate

Progestin Injectable:

  • Medroxyprogesterone Acetate

Progestin IUD:

  • Levonorgestrel

Progesterone Oral Capsule:

  • Progesterone USP

Progesterone: Vaginal Gel:

  • Progesterone

Progesterone IUD:

  • Progesterone

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
  • Oral, Continuous-Combined:
    • Conjugated Equine Estrogens and Medroxyprogesterone Acetate
    • Ethinyl Estradiol and Norethindrone Acetate
    • 17-Beta Estradiol and Norethindrone Acetate
  • Oral, Intermittent-Combined:
    • 17-Beta Estradiol and Norgestimate
  • Skin Patch, Continuous Cycle:
    • 17-Beta Estradiol and Norethindrone Acetate
  • Skin Patch, Continuous Combined:
    • 17-Beta Estradiol and Norethindrone Acetate

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)
Androgen

Androgen Oral Tablet:

  • Methyltestosterone and Esterified Estrogens

Androgen is a hormone produced by both males and females. In women, the ovaries secrete androgen as testosterone and androstenedione, which are then converted into estrogen and progesterone. As you get older, your ovaries produce less androgen and 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
  • Risedronate
  • Pamidronate
  • Etidronate
  • Zoledronate

These non-hormonal 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.

RANKL Inhibitor

Common names include denosumab.

Denosumab is used to prevent bone fractures in postmenopausal women with osteoporosis. Side effects may include allergic reaction, low blood calcium, infection, skin problems, and unusual fractures.

Selective Estrogen Receptor Modulators (SERMs)

Common names include:

  • Raloxifene

SERMs are used to treat or prevent osteoporosis in postmenopausal women. They have some of the beneficial effects of estrogen, especially improved bone strength. They do not increase your risk of breast cancer or uterine bleeding. However, these medications tend to cause, rather than relieve, hot flashes. They also 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:

  • Clonidine—a blood pressure lowering medicine
  • Gabapentin—an antiseizure medicine
  • Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
    • Common names: fluoxetine, paroxetine, venlafaxine, desvenlafaxine
    • 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

If you are taking medications, follow these general guidelines:

  • Take your medications as directed. Do not change the amount or the schedule.
  • Know what side effects could occur. Discuss them with your doctor.
  • Drugs can be dangerous when mixed. Talk to your doctor if you are taking more than one drug, including over-the-counter products and supplements.

References:

The 2012 hormone therapy position statement of: The North American Menopause Society. Menopause. 2012 Mar;19(3):257-71.

Menopause. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 3, 2014. Accessed February 27, 2014.

Menopause. National Institute on Aging website. Available at: http://www.nia.nih.gov/health/publication/menopause. Updated February 13, 2014. Accessed February 27, 2014.

Menopause. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq047.pdf?dmc=1&ts=20130416T1306377302. Updated February 2013. Accessed February 27, 2014.

Osteoporosis. EBSCO DynaMed website. http://www.ebscohost.com/dynamed. Updated February 13, 2014. Accessed February 27, 2014.

9/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Huang A, Yaffe K, et al. The effect of ultralow-dose transdermal estradiol on sexual function in postmenopausal women. Am J Obstet Gynecol. 2008;198:265.e1-7.

9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jacobson BC, Moy B, et al. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168:1798-1804.

11/19/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Buster JE, Koltun WD, et al. Low-dose estradiol spray to treat vasomotor symptoms: a randomized controlled trial. Obstet Gynecol. 2008;111:1343-1351.

4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Archer DF, Dupont CM, et al; 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.

7/15/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: FDA approves the first non-hormonal treatment for hot flashes associated with menopause. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm359030.htm. Accessed July 15, 2013.



Last reviewed March 2014 by Kim Carmichael, MD

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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