Medication | Benefits | Disadvantages |
---|---|---|
Treatment: General Menopausal Symptoms (such as hot flashes, mood changes, sleep issues) | ||
Menopausal hormone therapy (previously called hormone replacement therapy) | ||
Estrogen therapy, usually with a progestogen (estrogen is used alone only if a woman has had a hysterectomy [surgical removal of the uterus]*) | Relieves hot flashes, night sweats Usually relieves vaginal dryness and pain during intercourse Helps prevent osteoporosis and reduce the risk of bone fractures | Combination therapy (estrogen plus a progestogen):
Estrogen therapy alone:
|
Progestogen alone, includes synthetic progestins (such as medroxyprogesterone acetate) and natural progesterone (micronized progesterone) | Relieves hot flashes but is not as effective as estrogen therapy Reduces the risk of endometrial cancer (cancer of the lining of the uterus) An option for some women who are at high risk of forming blood clots and cannot use estrogen therapy | Does not relieve vaginal dryness May cause abdominal bloating, breast tenderness, increased breast density, mood disturbances, and/or headache May increase LDL (the unhealthy type of cholesterol) levels May increase the risk of blood clots in the legs and lungs, but probably has less risk than estrogen therapy Micronized progesterone: May have a less negative effect on mood and LDL cholesterol than synthetic progestins May cause drowsiness (and so is usually taken at night) Appears to have fewer side effects (such as moodiness, bloating, or breast tenderness) than synthetic progestins |
Conjugated estrogen plus bazedoxifene | ||
Conjugated estrogen plus bazedoxifene (a SERM) | Relieves hot flashes, night sweats Improves sleep Usually relieves vaginal dryness and pain during intercourse Protects the uterus without the need for a progestogen Helps prevent osteoporosis and reduce the risk of bone fractures | May increase the risk of blood clots in the legs and lungs Does not appear to increase breast density or incidence of breast cancer Less breast tenderness and breakthrough vaginal bleeding than with other types of hormone therapy |
Nonhormonal medications | ||
Antidepressants: SSRIs Selective serotonin reuptake inhibitors (SSRIs) Several types of medications can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine... read more , such as desvenlafaxine, fluoxetine, sertraline, low-dose paroxetine salt, and sustained-release paroxetine salt SNRIs, such as venlafaxine | Relieve depression, anxiety, irritability, and insomnia May be effective for relieving hot flashes | Side effects vary depending on the medication and may include sexual dysfunction, nausea, diarrhea, weight loss, weight gain, drowsiness, dry mouth, confusion, and increased or decreased blood pressure |
Fezolinetant | Reduces hot flash frequency and severity | Side effects include abdominal pain, diarrhea, difficulty sleeping, back pain, hot flushes, and rare reports of liver injury. Liver function tests are needed before starting and every 3 months for first 9 months of treatment |
Gabapentin | May be effective for relieving hot flashes and night sweats | Side effects include drowsiness, dizziness, headache, rash, weight gain, or leg swelling |
Treatment of vaginal and urinary tract symptoms | ||
Low-dose vaginal estrogen therapy | Relieves vaginal dryness and pain during intercourse Decreases incidence of recurrent urinary tract infections Improves stress and urge urinary incontinence | Low-dose vaginal estrogen therapy is unlikely to increase the risk of estrogen sensitive cancers such as breast or uterine cancer. |
Vaginal DHEA | Relieves vaginal dryness and pain during intercourse Decreases incidence of recurrent urinary tract infections Improves urge urinary incontinence | May cause increased vaginal discharge or changes in Pap test results |
Ospemifene (a SERM) | Relieves pain during intercourse Usually used by women who are not able to self-administer vaginal medications, estrogen, or DHEA (eg, if they have severe arthritis) | May worsen hot flashes temporarily May increase the risk of blood clots in the legs and lungs |
* At a dose level used for general menopausal symptoms, estrogen therapy used alone (without a progestogen) can cause cancer of the uterine lining Cancer of the Uterus The most common type of cancer of the uterus develops in the lining of the uterus (endometrium) and is called endometrial cancer. Endometrial cancer usually affects women after menopause. It... read more (endometrial cancer) in women with a uterus (have not had a hysterectomy). † Lower doses of estrogen and estrogen given as a skin patch (transdermal) or vaginal ring have a lower risk of blood clots, stroke, and gallbladder disorders (such as gallstones) than when estrogen is taken as a pill. | ||
DHEA = dehydroepiandrosterone; HDL = high-density lipoprotein; LDL = low-density lipoprotein; SERM = selective estrogen receptor modulator; SNRI = serotonin-norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor. |