Menopause and Perimenopause - Medications
Research has changed how doctors use
hormone therapy after menopause. For a long time, hormone replacement therapy
(HRT) was thought to protect against certain health problems, such as heart disease and dementia. But the
Women's Health Initiative (WHI) study has shown that HRT
does not protect against heart disease. In fact, in a small number of women who
are 10 or more years past menopause, it causes heart disease, including
heart attacks.7 In the WHI
study, short-term use of HRT was also linked to an
increase in the numbers of
blood clots. Using HRT for several years was linked to
increased cases of
breast cancer and
dementia. Overall, most women using HRT in the WHI
study had no serious side effects, but they also had no long-term
Experts do not yet know whether
hormone therapy risks are the same for older and younger postmenopausal women.
Researchers are now exploring HRT use by women who use short-term, low-dose
hormone therapy starting at menopause.
Average HRT- and
ERT-related risks are low among the general population of women.
Your personal risks that hormone therapy may stimulate
breast cancer, heart problems, blood clots, or neurological changes
may be lower or higher, depending on your risk factors.
Prescription medicine without hormones
doctors now suggest trying nonhormonal treatment for bothersome
menopause symptoms before considering hormone therapy
(birth control pills, estrogen alone [ERT], or estrogen-progestin [HRT]). There
are several nonhormonal prescription treatments that can relieve or reduce hot
flashes and other menopause symptoms.
Prescription medicine with hormones
Birth control pills (estrogen and
progestin) regulate menstrual bleeding and can relieve symptoms until
menopause. Birth control pills are not used after menopause. You should not use
birth control pills if you smoke or have
diabetes, untreated high blood pressure,
cardiovascular disease, or a history of breast cancer. Low-dose formulations
are recommended for women older than 35. Some women have side
Progestin pills or the
levonorgestrel IUD, which releases a form of
progesterone into the uterus, reduce heavy, irregular menstrual periods during
perimenopause. Some women have side effects.
Low-dose vaginal estrogen (cream, tablet, or ring) reduces vaginal and urethral dryness and
weakening without introducing high levels of estrogen into the body.
Hormone replacement therapy (estrogen and progestin),
in pill, patch, vaginal ring, gel, or cream form, can be used to treat
menopause symptoms. Because studies have found that HRT increases some health
risks for some women, doctors have changed the way HRT is used. For menopause
symptom relief, experts now recommend that HRT only be used at the lowest
effective dose for the shortest possible period of time.6
Bioidentical hormone replacement therapy is made from plants and is thought to be more similar to
human-produced hormones than synthetic HRT. But bioidentical HRT is not well
researched and may carry the same health risks that traditional HRT
does.6 Any form of hormone therapy is best taken for
as short a period as possible.
Menopause: Should I Use Hormone Replacement Therapy (HRT)?