Menopause medical therapy: Difference between revisions

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==='''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]] 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). 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]].
*The most effective [[treatment]] of sever menopausal symptoms is [[hormone therapy]], it used to treat [https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms vasomotor symptoms], [[osteoporosis]], prevent [[genitourinary]] [[atrophy]] and [[sleep disturbances]]. In [[Hormone|HT]], [[estrogens]] and [[progesterone]] are administered to compensate for the [[body]]'s own insufficiency to produce them. And "should only be used for the shortest duration 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). 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]].


====Selective Estrogen Receptor Modulators (SERMs)====
====Selective Estrogen Receptor Modulators (SERMs)====
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*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 23:09, 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)

Selective Estrogen Receptor Modulators (SERMs)

Other forms of hormone therapy:

Adverse effects:


Non Hormonal therapy:

Complementary and alternative therapies:

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

  1. Bansal R, Aggarwal N (2019). "Menopausal Hot Flashes: A Concise Review". J Midlife Health. 10 (1): 6–13. doi:10.4103/jmh.JMH_7_19. PMC 6459071. PMID 31001050.


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