Medications for Menopause

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 healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.

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 healthcare provider.

Prescription Medications

Estrogen Replacement Therapy

  • 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)

Progestogen

  • 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 Intrauterine Device (IUD)
    • Levonorgestrel
  • Progesterone Oral Capsule
    • Progesterone USP (Prometrium)
  • Progesterone: Vaginal Gel
    • Progesterone (Crinone)
  • Progesterone IUD
    • Progesterone (Progestasert)

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)

Androgen

  • Androgen Oral Tablet
    • Methyltestosterone and esterified estrogens (Estratest, menogen)

Bisphosphonates

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

Selective Estrogen Receptor Modulators (SERMs)

  • Raloxifene (Evista)

Prescription Medications

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)

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.

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

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 healthcare provider.

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 healthcare provider 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

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.

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 healthcare provider.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your healthcare provider.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

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.



Last reviewed October 2005 by Joan Lingen, MD, 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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