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==Medical therapy==
==Medical therapy==


*'''Hormonal replacement therapy(HRT)'''
=== '''Hormonal replacement therapy(HRT)''' ===


[[Hormone therapy]] used to treat [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], [[osteoporosis]], prevent [[genitourinary]] [[atrophy]] and [[sleep disturbances]]. [[Hormone therapy]] (HT) remains an effective [[treatment]] for [[osteoporosis]]. In [[Hormone|HT]], [[estrogens]], [[progesterone]] or other [[hormone]]<nowiki/>s are administered to compensate for the [[body]]'s own insufficiency to produce them. And "should only be used for the shortest duration of time and at its lowest [[effective dose]], It can be given in various forms (i.e., [[tablets]], creams, patches), in different modalities (i.e., continuous, versus, cyclic)."<ref>https://www.ncbi.nlm.nih.gov/books/NBK507826/#article-24984.s8</ref>There are several types of therapies such as combined [[oral contraceptives]], 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]]) contain [[estrogen]] molecules conjugated to [[hydrophilic]] side groups (e.g. [[sulfate]]) and are produced from [https://www.newworldencyclopedia.org/entry/Equidae Equidae-animals (horses)]. 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]] 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]]. 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]), it has been shown to enhance [[blood flow]] and reverse [[vaginal atrophy]] and carries a small risk of [[venous thromboembolism]].
* [[Hormone therapy]] used to treat [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], [[osteoporosis]], prevent [[genitourinary]] [[atrophy]] and [[sleep disturbances]]. [[Hormone therapy]] (HT) remains an effective [[treatment]] for [[osteoporosis]]. In [[Hormone|HT]], [[estrogens]], [[progesterone]] or other [[hormone]]<nowiki/>s are administered to compensate for the [[body]]'s own insufficiency to produce them. And "should only be used for the shortest duration of time and at its lowest [[effective dose]], It can be given in various forms (i.e., [[tablets]], creams, patches), in different modalities (i.e., continuous, versus, cyclic)."<ref>https://www.ncbi.nlm.nih.gov/books/NBK507826/#article-24984.s8</ref>There are several types of therapies such as combined [[oral contraceptives]], 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]]) contain [[estrogen]] molecules conjugated to [[hydrophilic]] side groups (e.g. [[sulfate]]) and are produced from [https://www.newworldencyclopedia.org/entry/Equidae Equidae-animals (horses)]. 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]] 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]]. 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]), it has been shown to enhance [[blood flow]] and reverse [[vaginal atrophy]] and carries a small risk of [[venous thromboembolism]].


====Adverse effects====
==== Adverse effects ====
[[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]].
* [[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]].


'''''Selective Estrogen Receptor Modulators (SERMs)'''''
==== '''''Selective Estrogen Receptor Modulators (SERMs)''''' ====


[https://www.breastcancer.org/treatment/hormonal/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]]. [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].<ref>https://www.ncbi.nlm.nih.gov/books/NBK507826/#article-24984.s8</ref>
* [https://www.breastcancer.org/treatment/hormonal/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]]. [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].<ref>https://www.ncbi.nlm.nih.gov/books/NBK507826/#article-24984.s8</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]<ref name="Bioidentical1">[http://www.womentowomen.com/bioidentical-hrt/bioidenticalhormones.asp "Bioidentical Hormones Come Of Age"], Marcelle Pick, OB/GYN Nurse Practitioner; published March 24, 2004; updated June 7, 2007; retrieved June 13, 2007.</ref>. 


However, 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].  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.
* 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="Bioidentical1">[http://www.womentowomen.com/bioidentical-hrt/bioidenticalhormones.asp "Bioidentical Hormones Come Of Age"], Marcelle Pick, OB/GYN Nurse Practitioner; published March 24, 2004; updated June 7, 2007; retrieved June 13, 2007.</ref>. 
 
* However, 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].  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.
*'''Non Hormonal therapy'''


=== '''Non Hormonal therapy:''' ===
[https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20044970#:~:text=Serotonin%20and%20norepinephrine%20reuptake%20inhibitors%20(SNRIs)%20are%20a%20class%20of,)%20pain%2C%20especially%20nerve%20pain. Serotonin-norepinephrine reuptake inhibitors]([[SNRIs]]), [[selective serotonin reuptake inhibitors]] ([[SSRIs]]), [[clonidine]], [[gabapentin]]. [[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 short durations (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]]. While neither is [[FDA]]-approved for the treatment of [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], both [[gabapentin]] and [[clonidine]] have been shown to reduce [[Hot flashes|hot flash]]<nowiki/>es 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 [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 merit special consideration by women suffering both from [[high blood pressure]] and [[Hot flash|hot flashes]] and most effective in mild [[Hot flash|hot flashes]], as it is less effective than [[SSRIs]]/[[SNRIs]] and [[gabapentin]].<ref>https://www.ncbi.nlm.nih.gov/books/NBK507826/#article-24984.s8</ref>
[https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20044970#:~:text=Serotonin%20and%20norepinephrine%20reuptake%20inhibitors%20(SNRIs)%20are%20a%20class%20of,)%20pain%2C%20especially%20nerve%20pain. Serotonin-norepinephrine reuptake inhibitors]([[SNRIs]]), [[selective serotonin reuptake inhibitors]] ([[SSRIs]]), [[clonidine]], [[gabapentin]]. [[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 short durations (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]]. While neither is [[FDA]]-approved for the treatment of [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], both [[gabapentin]] and [[clonidine]] have been shown to reduce [[Hot flashes|hot flash]]<nowiki/>es 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 [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 merit special consideration by women suffering both from [[high blood pressure]] and [[Hot flash|hot flashes]] and most effective in mild [[Hot flash|hot flashes]], as it is less effective than [[SSRIs]]/[[SNRIs]] and [[gabapentin]].<ref>https://www.ncbi.nlm.nih.gov/books/NBK507826/#article-24984.s8</ref>


*'''Complementary and alternative therapies'''
=== '''Complementary and alternative therapies:''' ===
 
It should be noted that medical non-[[Hormone treatment|hormone treatments]] provide less than complete relief, and each has [[side effects]].
It should be noted that medical non-[[Hormone treatment|hormone treatments]] provide less than complete relief, and each has [[side effects]].  


In the area of [[complementary]] and [http://www.alternative-therapies.com/ alternative therapies], [[acupuncture]] treatment is promising. There are some studies indicating positive effects, especially on [[hot flashes]]  but also others showing no positive effects of acupuncture regarding [[menopause]].
In the area of [[complementary]] and [http://www.alternative-therapies.com/ alternative therapies], [[acupuncture]] treatment is promising. There are some studies indicating positive effects, especially on [[hot flashes]]  but also others showing no positive effects of acupuncture regarding [[menopause]].
Line 41: Line 39:
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.


*'''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.  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] can help women with thinning [[vaginal]] tissue or [[Vaginal dryness|dryness]].  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 with lubrication difficulties 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]].   
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] can help women with thinning [[vaginal]] tissue or [[Vaginal dryness|dryness]].  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 with lubrication difficulties 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]].   



Revision as of 22:11, 17 February 2021

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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 (HT) provides the best relief, but hormone therapy should only be used for the shortest duration of time and at its 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)

Adverse effects

Selective Estrogen Receptor Modulators (SERMs)

Other forms of hormone therapy

Non Hormonal therapy:

Serotonin-norepinephrine reuptake inhibitors(SNRIs), selective serotonin reuptake inhibitors (SSRIs), clonidine, 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 short durations (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. While neither is FDA-approved for the treatment of vasomotor symptoms, 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 blood pressure medicine, this drug may merit special consideration by women suffering both from high blood pressure and hot flashes and most effective in mild hot flashes, as it is less effective than SSRIs/SNRIs and gabapentin.[4]

Complementary and alternative therapies:

It should be noted that medical non-hormone treatments provide less than complete relief, and each has side effects.

In the area of complementary and alternative therapies, acupuncture treatment is promising. There are 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 did 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.

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 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. 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. 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.

Obvious measures, such as drinking cold liquids and removing excess clothing layers when hot flashes strike, and avoiding hot flash triggers such as spicy foods, may supplement or supplant the use of medications for some women.



References


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