Hormone Therapy in the Menopause Transition

Hormone Therapy in the Menopause Transition

Menopause is when menstrual periods stop permanently and women are no longer able to bear children. It typically occurs between 49 and 52 years of age and medical professionals often define menopause as having occurred when a woman has not had any vaginal bleeding for a year.

While menopause causes both an increase and decrease in the production of certain hormones. There is no conclusive scientific evidence of consistent benefits from long-term hormone therapy for menopausal symptoms, despite their popularity. While this may surprise many women, according to the Mayo Clinic, menopause requires no specific medical treatment. Instead, treatments focus on relieving signs and symptoms and preventing or managing chronic conditions that may occur with aging.

Treatments may include:

Hormone therapy
Estrogen therapy is the most effective short-term treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose and the shortest time frame needed to provide symptom relief for you. If you still have your uterus, you’ll need progestin in addition to estrogen. Estrogen also helps prevent bone loss. However, long-term use of hormone therapy may have some cardiovascular and breast cancer risks, but starting hormones around the time of menopause has shown benefits for some women. Talk to your doctor about the benefits and risks of hormone therapy and whether it’s a safe choice for you.

To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissues. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.

Low-dose antidepressants
Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. A low-dose antidepressant for management of hot flashes may be useful for women who can’t take estrogen for health reasons or for women who need an antidepressant for a mood disorder.

Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can’t use estrogen therapy and in those who also have nighttime hot flashes.

Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes.

Osteoporosis Medications
Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. Your doctor might prescribe vitamin D supplements to help strengthen bones.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.