Menopause Treatment Options

Treatment for the symptoms of menopause can be approached in two phases:

1. Early in menopause, you and your doctor should discuss your first signs of menopause and whether to treat them as they occur. You should be evaluated for your risk of getting breast cancer or heart disease, as well as osteoporosis, which is severe bone loss that puts you at increased risk for broken bones. If you are not at high risk for breast cancer as determined by your health care provider, you may wish to consider taking estrogen for a limited time. By using the lowest effective dose, you may be able to manage several menopause symptoms at once. If, after weighing the pros and cons of estrogen, you decide it's not for you, other treatments are available.

2. Later in menopause you should focus on effectively preventing diseases such as osteoporosis and heart disease. Your earlier menopause symptoms will probably disappear.

You and your doctor should form a partnership and share information that will help you make the best decisions about your health. There are many things to keep in mind, because menopause and the years that follow it usually cover the second half of a woman's life. Talk to your doctor about all of the treatment choices to decide what is right for you.

Please also see the attached Table - Treating Your Menopausal Symptoms: The Quick Pros and Cons.

Hormone Treatment Options

Many women want to address the hormone imbalance and keep estrogen levels by taking estrogen, because it is often the most effective way to relieve many of the troubling symptoms of menopause. Estrogen increases the risk of uterine cancer, if taken alone, however. For this reason, women who still have a uterus usually take a combination of estrogen with a form of progesterone, called progestin, which helps to protect the uterus. The combination of estrogen and progesterone is called hormone therapy.

If a woman no longer has a uterus, she can take estrogen alone, which is called estrogen therapy.

If you have a family history of breast cancer or have survived breast cancer, you probably should not take either estrogen or hormone therapy. You also should not take estrogen if you have had cancer of the uterus, liver disease, a history of blood clots, heart disease or any unusual bleeding from the vagina.

Estrogen can help to reduce hot flashes, vaginal dryness, and possibly skin changes. It is also an effective way to protect your bones from rapid weakening as you age.

Treating the symptoms of early menopause:

The following are some other ways to treat your symptoms of the hormone imbalance that occurs during menopause without choosing hormones:

• Selective-Serotonin Reuptake Inhibitor (SSRI) drugs and Serotonin Norephinephrine Reuptake Inhibitor (SNRI) drugs are useful both in treating depression and in treating hot flashes.

• Gabapentin may be used to treat hot flashes, particularly for those occurring at night and disturbing sleep.

• Medroxyprogesterone acetate and megestrol acetate, progesterone-type drugs, may be used to treat hot flashes.

• Clonidine is a blood-pressure-lowering drug that is also used to reduce the frequency and severity of hot flashes.

• Individual counseling or support groups can also help you to handle sad, depressed, or confusing feelings you may be having as your body changes.

• Vaginal moisturizers such as Vagisil or Replens, can help women with thinning vaginal tissue or dryness. Lubricants, such as K-Y Jelly or Astroglide, can help with lubrication difficulties that may be present during intercourse.

• Low-dose vaginal estrogen is generally a safe way to take estrogen to solve vaginal thinning and dryness problems while only minimally increasing the levels of estrogen in the blood.

• Lack of desire may be helped with more open communication with your partner. Creating a pleasurable atmosphere at home and making a point to enjoy other activities with your partner may be helpful as well. Counseling can empower you with long lasting benefits if your lack of desire is related to the mood swings and depression that sometimes accompany menopause.

"Designer Estrogens"

Tamoxifen, which is used to prevent breast cancer, and raloxifene, which is used to prevent osteoporosis, are drugs known as "designer estrogens." These medications have been developed to act as beneficially as estrogen on some tissues and to act as estrogen-blockers on other tissues. These drugs also are known by their more technical name - Selective Estrogen Receptor Modulators (SERMs).

Tamoxifen, however, acts like an estrogen on the uterus, increasing the risk of uterine cancer. Raloxifene blocks harmful effects of estrogen on the breast and does not stimulate the lining of the uterus, so women who still have a uterus may want to try this drug. Unfortunately, neither of the "designer estrogens" addresses all the symptoms of menopause in all women, and some women experience hot flashes with raloxifene or tamoxifen.