There are many prescription medications available for the symptoms of menopause and they have different delivery options. They include: Oral pills, patches, creams, gels, rings, vaginal tablets and sprays. The most bothersome symptoms of menopause seem to be hot flashes, night sweats, vaginal dryness, and painful sex. The medications I will be discussing will be primarily for those symptoms.
Whatever medication your doctor prescribes you, you will want to use the lowest amount of medication that works for the shortest amount of time possible to help ease your symptoms. Usually, doctors don’t want you on medication indefinitely because there may be risks involved. Your healthcare provider may also refuse to put you on a medication because of the risk factors. Please understand that your doctor is doing what the guidelines say and they are concerned for your safety.
Hormone replacement therapy HRT – It is a treatment used to augment the body’s natural hormone levels either in estrogen alone or as estrogen and progesterone combination therapy. These are the most widely used products to treat menopause. HRT’s are used to treat hot flashes, night sweats and vaginal symptoms such as dryness and discomfort with intercourse. Basically, the medicine is replacing the hormones your body is losing in menopause. Some of these medications have been around since the 1940’s.
Estrogen Only Choices – for women without a uterus
Pills – Premarin, Estrace, Cenestin
Creams – Estrasorb
Gels – Divigel, Estrogel
Patches – Vivelle-dot, Climara, Minivelle
Rings – Femring
Spray – Evamist
*Vagifem (vaginal tablet) can also be used for hot flashes and vaginal dryness.
There are also oral Progestin’s. If you still have your uterus, you have to take your medicine with another hormone called progestin to lower your risk of uterine cancer. Progestin’s are commonly used as a component of menopausal hormone therapy in women to prevent endometrial hyperplasia (thickening of the inner lining of the uterus) and increased risk of endometrial cancer from estrogen alone therapy. Progestins include Provera and Prometrium. They both come in pill form.
Combination Estrogen and Progesterone – If you still have a uterus.
Pills Patches
Prempro Climara Pro
Femhrt Combipatch
Antidepressants – These drugs have been approved in the last 5 years for the treatment of hot flashes. Some women want another choice other than HRT and antidepressants could help.
- Brisdelle (Paroxetine) is the only SSRI that has been approved by the FDA for hot flashes. (It’s basically a low dose Paxil).
- Duavee – Is an estrogen agonist/antagonist. It treats hot flashes and helps prevent postmenopausal bone loss.
Vaginal dryness
VVA – Vulvavaginal atrophy – the lining of the vagina becomes thinner and drier. It can lead to vaginal and urinary tract problems. It can cause itching and/or burning feelings in your vagina. Vaginal atrophy is a chronic condition. If a woman doesn’t have sex regularly, her vagina may become shorter and narrower. Use it or lose it!
Vaginal estrogen
Cream Vaginal Tablet Ring
Estrace Vagifem Estring
Prem VC Femring
You can also treat VVA with some HRT’s, however, if you’re only treating vaginal dryness, you should only use vaginal estrogen.
Painful intercourse – (Dyspareunia) – Persistent or recurrent genital pain that occurs just before, during, or after sexual intercourse. Pain can range from moderate to severe.
- Osphena – An estrogen agonist/antagonist with tissue selective effects. It increases superficial cells and significantly reduces parabasal cells. Significantly improves moderate to severe VVA (vulvar and vaginal atrophy) due to menopause. It is an oral tablet.
- Intrarosa – Is a steroid for the treatment of dyspareunia. This medication is delivered by inserting a capsule inside the vagina daily at bedtime.
- Premarin vaginal cream -can also be used for dyspareunia. It is a cream inserted into the vagina, usually at bedtime..
- Bioidenticals – Are hormones that were designed to mimic the hormones made by the body. Bioidenticals are compounded formulations which are NOT approved by the FDA. They are compounded in pharmacies, where your doctor decides the amount you need. They come in patches, topical gels, tablet, pellets and liquid drops. These became popular by celebrities like Suzanne Somers and Oprah Winfrey. Some doctors love bioidenticals and use them in their practices, however, others feel that there’s no credible scientific evidence that demonstrates that they are safer or more effective than HRT. Bioidenticals are not covered by insurance, so you will have to pay cash for them.
This is not a complete list of all medications available for each category. Your doctor will let you know about all your options. Prescription medications for menopause are voluntary, so again discuss with your doctor all your options before beginning any medication.