Menopause medical therapy: Difference between revisions
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{{CMG}} {{RA}} | {{CMG}} {{RA}} | ||
==Overview== | ==Overview== | ||
While [[perimenopause]] is a natural stage of life when the [[symptoms]] are severe, this may be alleviated through medical treatments that include [[Hormone therapy]](HT), non-hormonal therapy, and [[complementary]] or [[Alternative medicine|alternative]] therapies.[[ Hormonal therapy]] | While [[perimenopause]] is a natural stage of life when the [[symptoms]] are severe, this may be alleviated through medical treatments that include [[Hormone therapy]](HT), non-hormonal therapy, and [[complementary]] or [[Alternative medicine|alternative]] therapies.[[ Hormonal therapy]] provides the best relief, but [[hormone therapy]] should only be used for a short duration and the lowest [[effective dose]], as it increases the [[relative risk]] of [[uterine cancer]], [[ovarian cancer]], [[breast cancer]], [[thromboembolism]], and [[coronary heart disease]], especially in [[women]] who start [[Hormone replacement therapy|HT]] after [[menopause]]. Some other [[drugs]] afford limited relief from [[hot flashes]]. A woman and her doctor should carefully review her [[symptoms]] and [[relative risk]] before determining whether the benefits of [[Hormone Replacement Therapy|HT]] or other [[Medicine|therapies]] outweigh the [[risks]]. | ||
==Medical therapy== | ==Medical therapy== | ||
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*The most effective [[treatment]] of severe [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopausal symptoms] is [[hormone therapy|hormonal replacement therapy]] ([[TRH]]), it used to treat [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], [[osteoporosis]], prevent [[genitourinary]] [[atrophy]] and [[sleep disturbances]]. The [[Hormone|HRT]] includes [[estrogens]], [[progesterone]] and other [[hormones]] that are administered to compensate for [[hormone]] deficiency in a [[menopausal]] woman's body. | *The most effective [[treatment]] of severe [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopausal symptoms] is [[hormone therapy|hormonal replacement therapy]] ([[TRH]]), it used to treat [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], [[osteoporosis]], prevent [[genitourinary]] [[atrophy]] and [[sleep disturbances]]. The [[Hormone|HRT]] includes [[estrogens]], [[progesterone]] and other [[hormones]] that are administered to compensate for [[hormone]] deficiency in a [[menopausal]] woman's body. | ||
*There are several types of [[Therapy|therapies]] such as [https://www.mayoclinic.org/tests-procedures/combination-birth-control-pills/about/pac-20385282#:~:text=Combination%20birth%20control%20pills%2C%20also,sperm%20from%20joining%20the%20egg. combined oral contraceptives], [https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372#:~:text=Systemic%20estrogen%20%E2%80%94%20which%20comes%20in,Low%2Ddose%20vaginal%20products. systemic estrogen], [https://www.aafp.org/afp/2016/0215/p307.html estrogen-bazedoxifene], [https://medlineplus.gov/druginfo/meds/a601041.html estrogen-progestin], [[progestin]] alone, and [https://www.sciencedirect.com/science/article/abs/pii/S0960076013002045 conjugated equine estrogens]([[Premarin]]). It is should be used for a short duration and the lowest [[effective dose]] and can be given in various forms ([[tablets]], [[Cream (pharmaceutical)|creams]], patches), in different modalities (continuous or cyclic). | *There are several types of [[Therapy|therapies]] such as [https://www.mayoclinic.org/tests-procedures/combination-birth-control-pills/about/pac-20385282#:~:text=Combination%20birth%20control%20pills%2C%20also,sperm%20from%20joining%20the%20egg. combined oral contraceptives], [https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372#:~:text=Systemic%20estrogen%20%E2%80%94%20which%20comes%20in,Low%2Ddose%20vaginal%20products. systemic estrogen], [https://www.aafp.org/afp/2016/0215/p307.html estrogen-bazedoxifene], [https://medlineplus.gov/druginfo/meds/a601041.html estrogen-progestin], [[progestin]] alone, and [https://www.sciencedirect.com/science/article/abs/pii/S0960076013002045 conjugated equine estrogens]([[Premarin]]). It is should be used for a short duration and the lowest [[effective dose]] and can be given in various forms ([[tablets]], [[Cream (pharmaceutical)|creams]], patches), in different modalities (continuous or cyclic).<ref name="pmid26348174">{{cite journal| author=Kaunitz AM, Manson JE| title=Management of Menopausal Symptoms. | journal=Obstet Gynecol | year= 2015 | volume= 126 | issue= 4 | pages= 859-876 | pmid=26348174 | doi=10.1097/AOG.0000000000001058 | pmc=4594172 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26348174 }} </ref><ref name="pmid22367731">{{cite journal| author=North American Menopause Society| title=The 2012 hormone therapy position statement of: The North American Menopause Society. | journal=Menopause | year= 2012 | volume= 19 | issue= 3 | pages= 257-71 | pmid=22367731 | doi=10.1097/gme.0b013e31824b970a | pmc=3443956 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22367731 }} </ref><ref name="pmid15495039">{{cite journal| author=Maclennan AH, Broadbent JL, Lester S, Moore V| title=Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. | journal=Cochrane Database Syst Rev | year= 2004 | volume= | issue= 4 | pages= CD002978 | pmid=15495039 | doi=10.1002/14651858.CD002978.pub2 | pmc=7004247 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15495039 }} </ref> | ||
====Selective Estrogen Receptor Modulators (SERMs)==== | ====Selective Estrogen Receptor Modulators (SERMs)==== | ||
*[https://www.breastcancer.org/treatment/hormonal/serms Selective estrogen receptor modulators]([https://www.breastcancer.org/treatment/hormonal/serms SERMs]), such as [[raloxifene]], [[bazedoxifene]], and [[ospemifene]] have the ability to modulate [[estrogen]] action, without stimulating [[endometrial hyperplasia]] or increased risk of [[cancer]]. [https://www.breastcancer.org/treatment/hormonal/serms SERMs] have the same outcome as [[hormone therapy]] in the treatment of [[osteoporosis]]. | *[https://www.breastcancer.org/treatment/hormonal/serms Selective estrogen receptor modulators]([https://www.breastcancer.org/treatment/hormonal/serms SERMs]), such as [[raloxifene]], [[bazedoxifene]], and [[ospemifene]] have the ability to modulate [[estrogen]] action, without stimulating [[endometrial hyperplasia]] or increased risk of [[cancer]]. [https://www.breastcancer.org/treatment/hormonal/serms SERMs] have the same outcome as [[hormone therapy]] in the treatment of [[osteoporosis]]. | ||
*[[Raloxifene]] acts as an [[estrogen]] agonist (pro-estrogen) on [[bone]] and [[lipids]], and like an [[estrogen]] [[antagonist]] ([[Anti-estrogen therapy|anti-estrogen]]) on [[uterus]] and [[breast]]. Thus, it is effective in preventing/treating mild [[osteoporosis]] and decreasing [[serum]] [[LDL]], and [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], like [[Hot flash|hot flashes]]. [[Ospemifene]] is a newer [[drug]] of [https://www.breastcancer.org/treatment/hormonal/serms SERM], which is effective in treating [https://www.uspharmacist.com/article/urogenital-symptoms-of-menopause-atrophic-vaginitis-and-atrophic-urethritis urogenital symptoms]. | *[[Raloxifene]] acts as an [[estrogen]] agonist (pro-estrogen) on [[bone]] and [[lipids]], and like an [[estrogen]] [[antagonist]] ([[Anti-estrogen therapy|anti-estrogen]]) on [[uterus]] and [[breast]]. Thus, it is effective in preventing/treating mild [[osteoporosis]] and decreasing [[serum]] [[LDL]], and [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], like [[Hot flash|hot flashes]]. [[Ospemifene]] is a newer [[drug]] of [https://www.breastcancer.org/treatment/hormonal/serms SERM], which is effective in treating [https://www.uspharmacist.com/article/urogenital-symptoms-of-menopause-atrophic-vaginitis-and-atrophic-urethritis urogenital symptoms].<ref name="pmid27559463">{{cite journal| author=An KC| title=Selective Estrogen Receptor Modulators. | journal=Asian Spine J | year= 2016 | volume= 10 | issue= 4 | pages= 787-91 | pmid=27559463 | doi=10.4184/asj.2016.10.4.787 | pmc=4995266 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27559463 }} </ref> | ||
====Other forms of hormone therapy:==== | ====Other forms of hormone therapy:==== | ||
*Due to the controversy about [[Premarin]]-based [[hormone therapy]], a number of doctors are now moving [[patients]] who request [[hormone therapy]] to help them through [[perimenopause]] to [https://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm bioidentical hormone products] such as [[Estrace]], a form of the precursor to [[estrogen]] in the [[human body]] known as [[estradiol]], which have produced fewer [[side effects]] than [https://www.sciencedirect.com/science/article/abs/pii/S0960076013002045 conjugated equine estrogens] | *Due to the controversy about [[Premarin]]-based [[hormone therapy]], a number of doctors are now moving [[patients]] who request [[hormone therapy]] to help them through [[perimenopause]] to [https://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm bioidentical hormone products] such as [[Estrace]], a form of the precursor to [[estrogen]] in the [[human body]] known as [[estradiol]], which have produced fewer [[side effects]] than [https://www.sciencedirect.com/science/article/abs/pii/S0960076013002045 conjugated equine estrogens]<ref name="pmid21531972">{{cite journal| author=Files JA, Ko MG, Pruthi S| title=Bioidentical hormone therapy. | journal=Mayo Clin Proc | year= 2011 | volume= 86 | issue= 7 | pages= 673-80, quiz 680 | pmid=21531972 | doi=10.4065/mcp.2010.0714 | pmc=3127562 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21531972 }} </ref> | ||
====Adverse effects:==== | ====Adverse effects:==== | ||
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*All [[Hormone replacement therapy|hormone replacement therapies]] probably do carry some health risks, including [[high blood pressure]], [[blood clots]], and increased risks of [[breast]] and [https://www.mdanderson.org/cancer-types/uterine-cancer.html uterine cancers]. The use of [[estrogen]] alone should be avoided in [[women]] with having a [[uterus]], it is may cause of [https://innovativegyn.com/conditions/endometrial-hyperplasia uterine hyperplasia] and [[uterine cancer]], so the use of combination [https://www.mayoclinic.org/drugs-supplements/estrogen-and-progestin-combination-ovarian-hormone-therapy-oral-route/description/drg-20070172 estrogen-progestin therapy] is recommended for women with having a [[uterus]]. | *All [[Hormone replacement therapy|hormone replacement therapies]] probably do carry some health risks, including [[high blood pressure]], [[blood clots]], and increased risks of [[breast]] and [https://www.mdanderson.org/cancer-types/uterine-cancer.html uterine cancers]. The use of [[estrogen]] alone should be avoided in [[women]] with having a [[uterus]], it is may cause of [https://innovativegyn.com/conditions/endometrial-hyperplasia uterine hyperplasia] and [[uterine cancer]], so the use of combination [https://www.mayoclinic.org/drugs-supplements/estrogen-and-progestin-combination-ovarian-hormone-therapy-oral-route/description/drg-20070172 estrogen-progestin therapy] is recommended for women with having a [[uterus]]. | ||
*[[Hormone therapy|Hormone replacement therapy]] is [[Contraindication|contraindicated]] in women with a positive history of [[breast cancer]], [[endometrial cancer]], [[deep vein thrombosis]], [[pulmonary embolism]], [[Liver diseases|liver disease]], [https://www.healthline.com/health/dysfunctional-uterine-bleeding-dub dysfunction uterine bleeding], and [[coronary heart disease]] due to an increased risk of developing [[cancer]] after 3 to 7 years of using [[hormone therapy]]. | *[[Hormone therapy|Hormone replacement therapy]] is [[Contraindication|contraindicated]] in women with a positive history of [[breast cancer]], [[endometrial cancer]], [[deep vein thrombosis]], [[pulmonary embolism]], [[Liver diseases|liver disease]], [https://www.healthline.com/health/dysfunctional-uterine-bleeding-dub dysfunction uterine bleeding], and [[coronary heart disease]] due to an increased risk of developing [[cancer]] after 3 to 7 years of using [[hormone therapy]]. | ||
*Women who have had a [[hysterectomy]] seem to tolerate [[estrogen]]-only therapy better than mixed-[[hormone therapy]], and reduce the [[breast cancer]] risk brought on by [[progestin]] supplementation. The use of localized [[estrogen]] therapy ([https://www.webmd.com/menopause/qa/what-are-estrogen-replacement-therapy-vaginal-suppositories-rings-and-creams vaginal rings, creams, or tablets]), | *Women who have had a [[hysterectomy]] seem to tolerate [[estrogen]]-only therapy better than mixed-[[hormone therapy]], and reduce the [[breast cancer]] risk brought on by [[progestin]] supplementation. The use of localized [[estrogen]] therapy ([https://www.webmd.com/menopause/qa/what-are-estrogen-replacement-therapy-vaginal-suppositories-rings-and-creams vaginal rings, creams, or tablets]), has been shown to enhance [[blood flow]] and reverse [[vaginal atrophy]] and carries a small risk of [[venous thromboembolism]]. | ||
*[[Women]] had been advised for many years that [[hormone therapy]] after [[menopause]] might reduce their risk of [[heart disease]] and prevent various aspects of aging. However, a large, randomized, controlled trial (the [[Women's Health Initiative]]) found that women undergoing [[Hormone Replacement Therapy|HT]] with [https://www.sciencedirect.com/science/article/abs/pii/S0960076013002045 conjugated equine estrogens] ([[Premarin]]), whether or not used in combination with a [[progestin]] ([[Premarin]] plus [[Provera]]), had a slightly increased risk of [[breast cancer]], [[heart disease]], [[cerebrovascular accident|stroke]], and [[Alzheimer's disease]]. | *[[Women]] had been advised for many years that [[hormone therapy]] after [[menopause]] might reduce their risk of [[heart disease]] and prevent various aspects of aging. However, a large, randomized, controlled trial (the [[Women's Health Initiative]]) found that women undergoing [[Hormone Replacement Therapy|HT]] with [https://www.sciencedirect.com/science/article/abs/pii/S0960076013002045 conjugated equine estrogens] ([[Premarin]]), whether or not used in combination with a [[progestin]] ([[Premarin]] plus [[Provera]]), had a slightly increased risk of [[breast cancer]], [[heart disease]], [[cerebrovascular accident|stroke]], and [[Alzheimer's disease]]. | ||
*After these results were reported in 2002, the number of [[prescriptions]] written for [[Premarin]] in the United States dropped almost in half, as many [[women]] discontinued [[Hormone Replacement Therapy|HT]] altogether. The sharp drop in [[Prescription|prescriptions]] for [[Premarin]] and PremPro following the mid-2002 announcement of their dangers was followed by large and successively greater drops in new [[breast cancer]] diagnoses at six months, one year, and 18 months after that announcement, for a cumulative 15% drop by the end of 2003. And the studies still continue to determine if the drop is related to the reduced use of [[HRT]]. | *After these results were reported in 2002, the number of [[prescriptions]] written for [[Premarin]] in the United States dropped almost in half, as many [[women]] discontinued [[Hormone Replacement Therapy|HT]] altogether. The sharp drop in [[Prescription|prescriptions]] for [[Premarin]] and PremPro following the mid-2002 announcement of their dangers was followed by large and successively greater drops in new [[breast cancer]] diagnoses at six months, one year, and 18 months after that announcement, for a cumulative 15% drop by the end of 2003. And the studies still continue to determine if the drop is related to the reduced use of [[HRT]].<ref name="pmid14519708">{{cite journal| author=Anderson GL, Judd HL, Kaunitz AM, Barad DH, Beresford SA, Pettinger M | display-authors=etal| title=Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial. | journal=JAMA | year= 2003 | volume= 290 | issue= 13 | pages= 1739-48 | pmid=14519708 | doi=10.1001/jama.290.13.1739 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14519708 }} </ref><ref name="pmid7824251">{{cite journal| author=Grady D, Gebretsadik T, Kerlikowske K, Ernster V, Petitti D| title=Hormone replacement therapy and endometrial cancer risk: a meta-analysis. | journal=Obstet Gynecol | year= 1995 | volume= 85 | issue= 2 | pages= 304-13 | pmid=7824251 | doi=10.1016/0029-7844(94)00383-O | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7824251 }} </ref><ref name="pmid24084921">{{cite journal| author=Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL | display-authors=etal| title=Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. | journal=JAMA | year= 2013 | volume= 310 | issue= 13 | pages= 1353-68 | pmid=24084921 | doi=10.1001/jama.2013.278040 | pmc=3963523 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24084921 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=24492931 Review in: Evid Based Med. 2014 Jun;19(3):105] </ref> | ||
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*[[SSRIs]] and [[SNRIs]] such as [[paroxetine]] ([[Paxil]]), [[Fluoxetine hydrochloride ]] ([[Prozac]]), and [[Venlafaxine hydrochloride]] ([[Effexor]]) are [[antidepressants]] that treat [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], such as [[hot flashes]], improving [[sleep]], [[mood]], and quality of life. These [[treatments]] can be used for a few months for [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopause symptoms]. | *[[SSRIs]] and [[SNRIs]] such as [[paroxetine]] ([[Paxil]]), [[Fluoxetine hydrochloride ]] ([[Prozac]]), and [[Venlafaxine hydrochloride]] ([[Effexor]]) are [[antidepressants]] that treat [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], such as [[hot flashes]], improving [[sleep]], [[mood]], and quality of life. These [[treatments]] can be used for a few months for [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopause symptoms]. | ||
*[[paroxetine]] ([[Paxil]]), in particular, is the only [[FDA]]-approved [[drug]] for this indication, and [[symptoms]] diminish within a week of initiating [[treatment]]. There is a theoretical reason why [[SSRI]] [[antidepressants]] might help with [[memory]] problems, they increase circulating levels of the [[neurotransmitter]] [[serotonin]] in the [[brain]] and restore [[hippocampal]] function. [[Prozac]] has been repackaged as [[Sarafem]] and is approved and prescribed for [[premenstrual dysphoric disorder]] ([[PMDD]]), a [[mood disorder]] often exacerbated during [[perimenopause]] and early [[menopause]]. [[PMDD]] has been found by [[PET scan|PET scans]] to be accompanied by a sharp drop in [[serotonin]] in the [[brain]] and to respond quickly and powerfully to [[SSRIs]]. | *[[paroxetine]] ([[Paxil]]), in particular, is the only [[FDA]]-approved [[drug]] for this indication, and [[symptoms]] diminish within a week of initiating [[treatment]]. There is a theoretical reason why [[SSRI]] [[antidepressants]] might help with [[memory]] problems, they increase circulating levels of the [[neurotransmitter]] [[serotonin]] in the [[brain]] and restore [[hippocampal]] function. [[Prozac]] has been repackaged as [[Sarafem]] and is approved and prescribed for [[premenstrual dysphoric disorder]] ([[PMDD]]), a [[mood disorder]] often exacerbated during [[perimenopause]] and early [[menopause]]. [[PMDD]] has been found by [[PET scan|PET scans]] to be accompanied by a sharp drop in [[serotonin]] in the [[brain]] and to respond quickly and powerfully to [[SSRIs]]. | ||
*Both [[gabapentin]] and [[clonidine]] have been shown to reduce [[Hot flashes|hot flashes]] in [[menopausal]] women. [[Gabapentin]] ([[Neurontin]]) is [https://epilepsyontario.org/about-epilepsy/treatments/medications/anticonvulsantanti-seizure-medication-from-a-to-z/ an anti-seizure medication], reduces [[hot flashes]] by up to 2 [[hot flashes]] per day. [[Clonidine]]([[Catapres]]) is a [https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications blood pressure medicine], this [[drug]] may have special consideration for women suffering from [[high blood pressure]] and [[Hot flash|hot flashes]]. It has most effective in mild [[Hot flash|hot flashes]], but it is less effective than [[SSRIs]]/[[SNRIs]] and [[gabapentin]].<ref name=" | *Both [[gabapentin]] and [[clonidine]] have been shown to reduce [[Hot flashes|hot flashes]] in [[menopausal]] women. [[Gabapentin]] ([[Neurontin]]) is [https://epilepsyontario.org/about-epilepsy/treatments/medications/anticonvulsantanti-seizure-medication-from-a-to-z/ an anti-seizure medication], reduces [[hot flashes]] by up to 2 [[hot flashes]] per day. [[Clonidine]]([[Catapres]]) is a [https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications blood pressure medicine], this [[drug]] may have special consideration for women suffering from [[high blood pressure]] and [[Hot flash|hot flashes]]. It has most effective in mild [[Hot flash|hot flashes]], but it is less effective than [[SSRIs]]/[[SNRIs]] and [[gabapentin]].<ref name="pmid26382310">{{cite journal| author=| title=Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. | journal=Menopause | year= 2015 | volume= 22 | issue= 11 | pages= 1155-72; quiz 1173-4 | pmid=26382310 | doi=10.1097/GME.0000000000000546 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26382310 }} </ref><ref name="pmid28649145">{{cite journal| author=Stubbs C, Mattingly L, Crawford SA, Wickersham EA, Brockhaus JL, McCarthy LH| title=Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women. | journal=J Okla State Med Assoc | year= 2017 | volume= 110 | issue= 5 | pages= 272-274 | pmid=28649145 | doi= | pmc=5482277 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28649145 }} </ref> | ||
==='''Complementary and alternative therapies:'''=== | ==='''Complementary and alternative therapies:'''=== | ||
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*The [[complementary]] and [http://www.alternative-therapies.com/ alternative therapies] include [[acupuncture]] treatment are promising. Some studies indicating positive effects, especially on [[hot flashes]] but also others showing no positive effects of acupuncture regarding [[menopause]]. | *The [[complementary]] and [http://www.alternative-therapies.com/ alternative therapies] include [[acupuncture]] treatment are promising. Some studies indicating positive effects, especially on [[hot flashes]] but also others showing no positive effects of acupuncture regarding [[menopause]]. | ||
*There are claims that soy [[isoflavones]] are beneficial concerning [[menopause]]. However, a study indicated that soy [[isoflavones]] do not improve or appreciably affect [[cognitive]] functioning in [[postmenopausal]] women. | *There are claims that soy [[isoflavones]] are beneficial concerning [[menopause]]. However, a study indicated that soy [[isoflavones]] do not improve or appreciably affect [[cognitive]] functioning in [[postmenopausal]] women. | ||
*Other remedies that have proven no better than a [[Placebo effect|placebo]] at treating [[hot flashes]] and other [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopause symptoms] include red clover [[isoflavone]] extracts and [[black cohosh]]. [[Black cohosh]] has potentially serious [[side effects]] such as the stimulation of [[breast cancer]], therefore prolonged administration is not recommended in any case. | *Other remedies that have proven no better than a [[Placebo effect|placebo]] at treating [[hot flashes]] and other [https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 menopause symptoms] include red clover [[isoflavone]] extracts and [[black cohosh]]. [[Black cohosh]] has potentially serious [[side effects]] such as the stimulation of [[breast cancer]], therefore prolonged administration is not recommended in any case.<ref name="pmid30868921">{{cite journal| author=Johnson A, Roberts L, Elkins G| title=Complementary and Alternative Medicine for Menopause. | journal=J Evid Based Integr Med | year= 2019 | volume= 24 | issue= | pages= 2515690X19829380 | pmid=30868921 | doi=10.1177/2515690X19829380 | pmc=6419242 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30868921 }} </ref><ref name="pmid26046035">{{cite journal| author=Kim MY, Choi SD, Ryu A| title=Is complementary and alternative therapy effective for women in the climacteric period? | journal=J Menopausal Med | year= 2015 | volume= 21 | issue= 1 | pages= 28-35 | pmid=26046035 | doi=10.6118/jmm.2015.21.1.28 | pmc=4452811 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26046035 }} </ref> | ||
==='''Other therapies:'''=== | ==='''Other therapies:'''=== | ||
*Individual counseling or support groups may be helpful to handle sad, [[Depression|depressed]], or confusing feelings [[women]] may be having as their [[Human body|bodies]] change. | *Individual counseling or support groups may be helpful to handle sad, [[Depression|depressed]], or confusing feelings [[women]] may be having as their [[Human body|bodies]] change. | ||
*Vaginal moisturizers such as [https://www.singlecare.com/blog/vagisil-vs-monistat/ Vagisil] or [http://www.replens.com/Why-Try-Replens/#:~:text=Replens%20is%20a%20vaginal%20moisturizer,cells%20for%20long%20lasting%20hydration. Replens] and lubricants, such as [[K-Y Jelly]] or [https://astroglide.com/faqs/personal-lubricants#:~:text=Let's%20face%20it%2C%20when%20it,flavor%20to%20your%20sex%20life. Astroglide] can help women with thinning [[vaginal]] tissue, [[Vaginal dryness|dryness]], and decrease the pain that may be present during [[intercourse]]. | *Vaginal moisturizers such as [https://www.singlecare.com/blog/vagisil-vs-monistat/ Vagisil] or [http://www.replens.com/Why-Try-Replens/#:~:text=Replens%20is%20a%20vaginal%20moisturizer,cells%20for%20long%20lasting%20hydration. Replens] and lubricants, such as [[K-Y Jelly]] or [https://astroglide.com/faqs/personal-lubricants#:~:text=Let's%20face%20it%2C%20when%20it,flavor%20to%20your%20sex%20life. Astroglide] can help women with thinning [[vaginal]] tissue, [[Vaginal dryness|dryness]], and decrease the pain that may be present during [[intercourse]]. | ||
*Moisturizers and lubricants are different products for different types of issues. Some women feel dry apart from [[Sex (activity)|sex]] and they may do better with moisturizers all the time. Those who just need lubricants are fine just using the lubrication products during [[intercourse]]. Low-dose [https://medlineplus.gov/druginfo/meds/a606005.html#:~:text=Vaginal%20estrogen%20is%20used%20to,end%20of%20monthly%20menstrual%20periods). vaginal estrogen] is generally a safe way to take [[estrogen]] to solve [[vaginal]] thinning and [[Vaginal dryness|dryness]] problems while only minimally increasing the levels of [[estrogen]] in the [[blood]]. | *Moisturizers and lubricants are different products for different types of issues. Some women feel dry apart from [[Sex (activity)|sex]] and they may do better with moisturizers all the time. Those who just need lubricants are fine just using the lubrication products during [[intercourse]].<ref name="pmid32990054">{{cite journal| author=Potter N, Panay N| title=Vaginal lubricants and moisturizers: a review into use, efficacy, and safety. | journal=Climacteric | year= 2021 | volume= 24 | issue= 1 | pages= 19-24 | pmid=32990054 | doi=10.1080/13697137.2020.1820478 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32990054 }} </ref> | ||
*Low-dose [https://medlineplus.gov/druginfo/meds/a606005.html#:~:text=Vaginal%20estrogen%20is%20used%20to,end%20of%20monthly%20menstrual%20periods). vaginal estrogen] is generally a safe way to take [[estrogen]] to solve [[vaginal]] thinning and [[Vaginal dryness|dryness]] problems while only minimally increasing the levels of [[estrogen]] in the [[blood]].<ref name="pmid19117185">{{cite journal| author=Al-Baghdadi O, Ewies AA| title=Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview. | journal=Climacteric | year= 2009 | volume= 12 | issue= 2 | pages= 91-105 | pmid=19117185 | doi=10.1080/13697130802585576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19117185 }} </ref> | |||
*Drinking cold liquids and removing excess clothing layers when [[hot flashes]] strike, and avoiding [[Hot flashes|hot flash]] triggers such as spicy foods maybe relieve some [[symptoms]] for some [[women]]. | *Drinking cold liquids and removing excess clothing layers when [[hot flashes]] strike, and avoiding [[Hot flashes|hot flash]] triggers such as spicy foods maybe relieve some [[symptoms]] for some [[women]]. | ||
Latest revision as of 06:57, 18 February 2021
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Menopause Microchapters |
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Menopause medical therapy On the Web |
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American Roentgen Ray Society Images of Menopause medical therapy |
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Risk calculators and risk factors for Menopause medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Rahmah Al-Edresi, M.D.[2]
Overview
While perimenopause is a natural stage of life when the symptoms are severe, this may be alleviated through medical treatments that include Hormone therapy(HT), non-hormonal therapy, and complementary or alternative therapies.Hormonal therapy provides the best relief, but hormone therapy should only be used for a short duration and the lowest effective dose, as it increases the relative risk of uterine cancer, ovarian cancer, breast cancer, thromboembolism, and coronary heart disease, especially in women who start HT after menopause. Some other drugs afford limited relief from hot flashes. A woman and her doctor should carefully review her symptoms and relative risk before determining whether the benefits of HT or other therapies outweigh the risks.
Medical therapy
Hormonal replacement therapy(HRT)
- The most effective treatment of severe menopausal symptoms is hormonal replacement therapy (TRH), it used to treat vasomotor symptoms, osteoporosis, prevent genitourinary atrophy and sleep disturbances. The HRT includes estrogens, progesterone and other hormones that are administered to compensate for hormone deficiency in a menopausal woman's body.
- There are several types of therapies such as combined oral contraceptives, systemic estrogen, estrogen-bazedoxifene, estrogen-progestin, progestin alone, and conjugated equine estrogens(Premarin). It is should be used for a short duration and the lowest effective dose and can be given in various forms (tablets, creams, patches), in different modalities (continuous or cyclic).[1][2][3]
Selective Estrogen Receptor Modulators (SERMs)
- Selective estrogen receptor modulators(SERMs), such as raloxifene, bazedoxifene, and ospemifene have the ability to modulate estrogen action, without stimulating endometrial hyperplasia or increased risk of cancer. SERMs have the same outcome as hormone therapy in the treatment of osteoporosis.
- Raloxifene acts as an estrogen agonist (pro-estrogen) on bone and lipids, and like an estrogen antagonist (anti-estrogen) on uterus and breast. Thus, it is effective in preventing/treating mild osteoporosis and decreasing serum LDL, and vasomotor symptoms, like hot flashes. Ospemifene is a newer drug of SERM, which is effective in treating urogenital symptoms.[4]
Other forms of hormone therapy:
- Due to the controversy about Premarin-based hormone therapy, a number of doctors are now moving patients who request hormone therapy to help them through perimenopause to bioidentical hormone products such as Estrace, a form of the precursor to estrogen in the human body known as estradiol, which have produced fewer side effects than conjugated equine estrogens[5]
Adverse effects:
- All hormone replacement therapies probably do carry some health risks, including high blood pressure, blood clots, and increased risks of breast and uterine cancers. The use of estrogen alone should be avoided in women with having a uterus, it is may cause of uterine hyperplasia and uterine cancer, so the use of combination estrogen-progestin therapy is recommended for women with having a uterus.
- Hormone replacement therapy is contraindicated in women with a positive history of breast cancer, endometrial cancer, deep vein thrombosis, pulmonary embolism, liver disease, dysfunction uterine bleeding, and coronary heart disease due to an increased risk of developing cancer after 3 to 7 years of using hormone therapy.
- Women who have had a hysterectomy seem to tolerate estrogen-only therapy better than mixed-hormone therapy, and reduce the breast cancer risk brought on by progestin supplementation. The use of localized estrogen therapy (vaginal rings, creams, or tablets), has been shown to enhance blood flow and reverse vaginal atrophy and carries a small risk of venous thromboembolism.
- Women had been advised for many years that hormone therapy after menopause might reduce their risk of heart disease and prevent various aspects of aging. However, a large, randomized, controlled trial (the Women's Health Initiative) found that women undergoing HT with conjugated equine estrogens (Premarin), whether or not used in combination with a progestin (Premarin plus Provera), had a slightly increased risk of breast cancer, heart disease, stroke, and Alzheimer's disease.
- After these results were reported in 2002, the number of prescriptions written for Premarin in the United States dropped almost in half, as many women discontinued HT altogether. The sharp drop in prescriptions for Premarin and PremPro following the mid-2002 announcement of their dangers was followed by large and successively greater drops in new breast cancer diagnoses at six months, one year, and 18 months after that announcement, for a cumulative 15% drop by the end of 2003. And the studies still continue to determine if the drop is related to the reduced use of HRT.[6][7][8]
Non Hormonal therapy:
Non hormonal therapy includes serotonin-norepinephrine reuptake inhibitors(SNRIs), selective serotonin reuptake inhibitors (SSRIs), clonidine, and gabapentin.
- SSRIs and SNRIs such as paroxetine (Paxil), Fluoxetine hydrochloride (Prozac), and Venlafaxine hydrochloride (Effexor) are antidepressants that treat vasomotor symptoms, such as hot flashes, improving sleep, mood, and quality of life. These treatments can be used for a few months for menopause symptoms.
- paroxetine (Paxil), in particular, is the only FDA-approved drug for this indication, and symptoms diminish within a week of initiating treatment. There is a theoretical reason why SSRI antidepressants might help with memory problems, they increase circulating levels of the neurotransmitter serotonin in the brain and restore hippocampal function. Prozac has been repackaged as Sarafem and is approved and prescribed for premenstrual dysphoric disorder (PMDD), a mood disorder often exacerbated during perimenopause and early menopause. PMDD has been found by PET scans to be accompanied by a sharp drop in serotonin in the brain and to respond quickly and powerfully to SSRIs.
- Both gabapentin and clonidine have been shown to reduce hot flashes in menopausal women. Gabapentin (Neurontin) is an anti-seizure medication, reduces hot flashes by up to 2 hot flashes per day. Clonidine(Catapres) is a blood pressure medicine, this drug may have special consideration for women suffering from high blood pressure and hot flashes. It has most effective in mild hot flashes, but it is less effective than SSRIs/SNRIs and gabapentin.[9][10]
Complementary and alternative therapies:
- Medical non-hormone treatments are less effective for the relief of symptoms than hormone treatments but it has fewer side effects.
- The complementary and alternative therapies include acupuncture treatment are promising. Some studies indicating positive effects, especially on hot flashes but also others showing no positive effects of acupuncture regarding menopause.
- There are claims that soy isoflavones are beneficial concerning menopause. However, a study indicated that soy isoflavones do not improve or appreciably affect cognitive functioning in postmenopausal women.
- Other remedies that have proven no better than a placebo at treating hot flashes and other menopause symptoms include red clover isoflavone extracts and black cohosh. Black cohosh has potentially serious side effects such as the stimulation of breast cancer, therefore prolonged administration is not recommended in any case.[11][12]
Other therapies:
- Individual counseling or support groups may be helpful to handle sad, depressed, or confusing feelings women may be having as their bodies change.
- Vaginal moisturizers such as Vagisil or Replens and lubricants, such as K-Y Jelly or Astroglide can help women with thinning vaginal tissue, dryness, and decrease the pain that may be present during intercourse.
- Moisturizers and lubricants are different products for different types of issues. Some women feel dry apart from sex and they may do better with moisturizers all the time. Those who just need lubricants are fine just using the lubrication products during intercourse.[13]
- 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.[14]
- Drinking cold liquids and removing excess clothing layers when hot flashes strike, and avoiding hot flash triggers such as spicy foods maybe relieve some symptoms for some women.
References
- ↑ Kaunitz AM, Manson JE (2015). "Management of Menopausal Symptoms". Obstet Gynecol. 126 (4): 859–876. doi:10.1097/AOG.0000000000001058. PMC 4594172. PMID 26348174.
- ↑ North American Menopause Society (2012). "The 2012 hormone therapy position statement of: The North American Menopause Society". Menopause. 19 (3): 257–71. doi:10.1097/gme.0b013e31824b970a. PMC 3443956. PMID 22367731.
- ↑ Maclennan AH, Broadbent JL, Lester S, Moore V (2004). "Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes". Cochrane Database Syst Rev (4): CD002978. doi:10.1002/14651858.CD002978.pub2. PMC 7004247 Check
|pmc=value (help). PMID 15495039. - ↑ An KC (2016). "Selective Estrogen Receptor Modulators". Asian Spine J. 10 (4): 787–91. doi:10.4184/asj.2016.10.4.787. PMC 4995266. PMID 27559463.
- ↑ Files JA, Ko MG, Pruthi S (2011). "Bioidentical hormone therapy". Mayo Clin Proc. 86 (7): 673–80, quiz 680. doi:10.4065/mcp.2010.0714. PMC 3127562. PMID 21531972.
- ↑ Anderson GL, Judd HL, Kaunitz AM, Barad DH, Beresford SA, Pettinger M; et al. (2003). "Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial". JAMA. 290 (13): 1739–48. doi:10.1001/jama.290.13.1739. PMID 14519708.
- ↑ Grady D, Gebretsadik T, Kerlikowske K, Ernster V, Petitti D (1995). "Hormone replacement therapy and endometrial cancer risk: a meta-analysis". Obstet Gynecol. 85 (2): 304–13. doi:10.1016/0029-7844(94)00383-O. PMID 7824251.
- ↑ Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL; et al. (2013). "Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials". JAMA. 310 (13): 1353–68. doi:10.1001/jama.2013.278040. PMC 3963523. PMID 24084921. Review in: Evid Based Med. 2014 Jun;19(3):105
- ↑ "Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society". Menopause. 22 (11): 1155–72, quiz 1173-4. 2015. doi:10.1097/GME.0000000000000546. PMID 26382310.
- ↑ Stubbs C, Mattingly L, Crawford SA, Wickersham EA, Brockhaus JL, McCarthy LH (2017). "Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women". J Okla State Med Assoc. 110 (5): 272–274. PMC 5482277. PMID 28649145.
- ↑ Johnson A, Roberts L, Elkins G (2019). "Complementary and Alternative Medicine for Menopause". J Evid Based Integr Med. 24: 2515690X19829380. doi:10.1177/2515690X19829380. PMC 6419242. PMID 30868921.
- ↑ Kim MY, Choi SD, Ryu A (2015). "Is complementary and alternative therapy effective for women in the climacteric period?". J Menopausal Med. 21 (1): 28–35. doi:10.6118/jmm.2015.21.1.28. PMC 4452811. PMID 26046035.
- ↑ Potter N, Panay N (2021). "Vaginal lubricants and moisturizers: a review into use, efficacy, and safety". Climacteric. 24 (1): 19–24. doi:10.1080/13697137.2020.1820478. PMID 32990054 Check
|pmid=value (help). - ↑ Al-Baghdadi O, Ewies AA (2009). "Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview". Climacteric. 12 (2): 91–105. doi:10.1080/13697130802585576. PMID 19117185.