Symptoms of Menopause
| Treatment | Pros and Cons of Treatment |
| Hot flashes | Vitamin E | Pros: May reduce number and severity of hot flashes Cons: No toxicity of vitamin E; some people get headaches; scientific support for its effectiveness is very weak |
| Megestrol acetate/ Medroxyprogesterone acetate | Pros: Effective progestin treatment for hot flashes Cons: Weight gain; not studied well in women who have had breast cancer |
| SSRI drugs | Pros: Shown to be effective for hot flashes and also for depression Cons: Causes mood changes; can affect sex drive; paroxetine and sertraline hydrochloride have adverse interactions with tamoxifen |
| Estrogen* | Pros: Hormone therapy is very effective at relieving hot flashes; also helps prevent vaginal thinning; prevents bone loss Cons: Increased risk of breast cancer when combined with a progestin; increased risk of uterine cancer if estrogen is taken without progesterone; increased risk of blood clots |
| Neurontin | Pros: Effective for relieving hot flashes, particularly at night; aids in getting to sleep Cons: Dizziness and lethargy if used during daytime |
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| Dry vagina and painful intercourse | Vaginal moisturizers | Pros: Over-the-counter solution Cons: Some people don't like these products, because of consistency or smell; does not thicken the vaginal lining; not as effective as estrogens |
| Water-soluble lubricants | Pros: Over-the-counter solution (Note: There is difference between lubricant and moisturizer) Cons: Some people don't like these products because of their consistency or smell; does not thicken the vaginal lining |
| Low dose vaginal estrogen ring | Pros: Helps keep vaginal tissue from thinning; local estrogen believed to have fewer risks compared to systemic estrogen pills taken in higher doses Cons: Some absorption of estrogen into the body occurs but this is small. |
| Estrogen* (by mouth) | Pros: Helps keep vaginal tissue from thinning; also helps prevent bone loss; very effective against hot flashes Cons: Increased risk of breast cancer if taken with a progestin; increased risk of uterine cancer if estrogen is taken without progesterone; increased risk of blood clots |
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| Bone loss | Bisphosphonates | Pros: Osteoporosis treatment is very effective against bone loss Cons: Common to have gastrointestinal problems when taking these drugs; can cause injury to esophagus unless taken with lots of water while sitting upright or standing; rarely causes jaw necrosis (death cells in the jaw) |
| Raloxifene | Pros: Very effective against bone loss, lowers risk of breast cancer Cons: Increases risk of blood clots; hot flashes; leg cramps |
| Calcitonin | Pros: Slows bone breakdown Cons: Headaches, dizziness, diarrhea, lack of desire for eating, nose bleeds (with nasal form); much less effective than bisphosphonates |
| Vitamin D | Pros: Helps body absorb calcium Cons: Very large amounts of vitamin D can cause build-up of calcium in blood, which could lead to heart and lung problems and kidney stones |
| Estrogen* | Pros: Helps prevent vaginal tissue from thinning; also helps prevent bone loss; very effective against hot flashes Cons: Increased risk of breast cancer if taken with a progestin; increased risk of uterine cancer if estrogen is taken without progesterone; increased risk of blood clots |
| Tamoxifen | Pros: Lowers risk of breast cancer; reduces risk of fractures Cons: Increases risk of uterine cancer, blood clots; more hot flashes; irregular vaginal bleeding |
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| Depression and mood changes | Counseling | Pros: Can be empowering; leads to increased insight Cons: Can be expensive; may not work as well as medications |
| SSRI drugs | Pros: Shown to be effective for hot flashes and also for depression Cons: Can affect sex drive; some types such as paroxetine or sertraline hydrochloride may interfere with effect of tamoxifen |
| Estrogen* | Pros: Very effective at preventing symptoms of osteoporosis such asbone loss and preventing fractures; very effective at preventing hot flashes; prevents vaginal tissue thinning; may reduce the risk of dementia (in younger menopausal women taking HT for 10 years or more) Cons: Increased risk of breast cancer if taken with a progestin; increased risk of uterine cancer if estrogen is taken without progesterone; increased risk of blood clots; increased risk of dementia (in women 65 years and older taking hormone therapy for five years or less) |
*A note on estrogen
Short-term goals of estrogen treatment are different from the long-term goals. Short-term hormone therapy is designed to relieve symptoms; long-term therapy helps to prevent bone loss. If you take hormones for less than three to five years, the risks are relatively low. If you are concerned about bone loss and are thinking about taking hormone therapy for more than five years, consult with your doctor to see whether hormone therapy or an alternative treatment is best for you.
You should not take estrogen if you have had breast cancer or are at risk for breast cancer. There is an increased risk of breast cancer if taken with progestin, increased risk of uterine cancer if not taken with progesterone and increased risk of blood clots for women taking estrogen.
Editors:
Nanette Santoro, MD
Director, Division of Reproductive Endocrinology
Dept. of OB/GYN and Women's Health
Albert Einstein College of Medicine
Richard J. Santen, MD
Professor of Medicine
University of Virginia Health System
Last Review: January 2008
