Menopause And Perimenopause

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Medication Therapy

A number of medications are used to treat the symptoms of menopause. The type of medication needed is a complicated decision and each woman should discuss the issue with her doctor. The treatment will depend on what symptoms are most bothersome and how bothersome they are.

Estrogen taken as a pill or applied to the skin as a patch can reduce hot flashes, sleep disturbances, mood changes and vaginal dryness. Estrogen can be prescribed alone when a woman no longer has her uterus. A combination of estrogen and progesterone is used when a woman still has her uterus. Progesterone is necessary to balance estrogen's effect on the uterus and prevent changes that can lead to uterine cancer.

However, recent evidence has shown that there are some risks associated with the use of these medicines. Estrogen therapy can increase the risk of heart disease, stroke, breast cancer and blood clots in a small number of women. On the other hand, it prevents fractures and can decrease the risk of colon cancer. Therefore, the decision to use hormone replacement therapy to treat symptoms of menopause is an individual decision. A woman should talk to her doctor about the risks and benefits of hormone replacement therapy for her.

There are several other medications that can be used to treat the symptoms of menopause:

Hot flashes
- Antidepressants - Medications such as venlafaxine (Effexor) and paroxetine (Paxil) are often the first choice for women with hot flashes who are not on hormone replacement therapy. They relieve the symptoms of hot flashes in 60% of women.
- Gabapentin (Neurontin) - This medicine is moderately effective in treating hot flashes. Gabapentin's main side effect is drowsiness. Taking it at bedtime may help improve sleep while decreasing hot flashes.
- Clonidine - This is a blood pressure medication that can relieve hot flashes in some women.

Osteoporosis

Calcium and vitamin D supplements - All postmenopausal women who have osteoporosis or are at risk of osteoporosis should take calcium and vitamin D supplements. The usual recommended supplemental dose is 1,000 milligrams of calcium carbonate (taken with meals) or calcium citrate daily. It is best to take this as 500 milligrams twice a day. Women also need 800 international units of vitamin D daily.
Bisphosphonates - Etidronate (Didronel), alendronate (Fosamax) and other similar drugs are the most effective medicines that can be used to both prevent and treat osteoporosis. They increase bone density and decrease the risk of fractures.
Raloxifene (Evista) - This drug has some of the beneficial effects of estrogen without the increased risk of breast cancer. It is effective in building bone strength and preventing fractures.
Parathyroid hormone - This is a synthetic form of a naturally occurring hormone produced by the parathyroid glands. It increases bone density and decreases the risk of fracture.
Calcitonin - This hormone is produced by the thyroid gland and helps the body keep and use calcium. A nasal spray form of this drug is used to help prevent bone loss in women at risk. Doctors may prescribe calcitonin to help relieve pain from fractures due to osteoporosis.

Several alternative treatments have been proposed to treat the symptoms of menopause. Many of these treatments have not been studied in large clinical trials. Although black cohosh has been previously promoted as a treatment for hot flashes, a study reported in the December 2006 Annals of Internal Medicine found that the root was no better than a placebo. Some women have found St. John's wort to be effective in treating mood disorders related to menopause.

The use of soy products in the diet such as tofu is controversial. While it may improve symptoms for some women., the phytoestrogens (plant estrogens) that may help relieve hot flashes may also increase the risk of breast cancer.

Scientific studies have found no benefit to the use of vitamin E or primrose oil. No evidence has been found to support the use of acupuncture or homeopathy, but few studies of these therapies have been done.