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Are there any prescription treatments for the symptoms of menopause?

Menopause is the time in life when a woman stops having menstrual periods. As a woman approaches menopause, her body gradually makes less estrogen and progesterone hormone. This can lead to symptoms such as hot flashes, vaginal dryness, and urinary incontinence. After menopause, women are also at higher risk for developing osteoporosis (brittle bones) and heart disease.

Hormone replacement therapy (HRT) with oral estrogen or an estrogen patch can prevent hot flashes, relieve vaginal dryness, and improve bladder control. These forms of estrogen also reduce the risk of developing osteoporosis. Oral forms of estrogen include conjugated estrogens (brand names >Premarin and >Cenestin), estradiol (>Estrace), estropipate (Ogen), and esterified estrogens (>Menest). Estrogen patches contain estradiol (>Estraderm, >Climara, >Vivelle).

You can also apply estrogen to the vagina to reduce vaginal dryness and help with urinary incontinence. Vaginal estrogen is available as a cream (>Premarin) or as a ring (>Estring) that is inserted into the vagina.

Sometimes doctors prescribe the male hormone methyltestosterone along with estrogen for women when their symptoms aren't adequately relieved by estrogen alone. >Estratest and >Estratest H.S. are combination estrogen and methyltestosterone medicines.

Taking estrogen can increase a woman's risk of developing uterine cancer. But taking progesterone reduces this risk. That's why most doctors recommend that women who have not had a hysterectomy take progesterone along with oral estrogen or the estrogen patch. You can take medroxyprogesterone orally (>Provera, Cycrin), or use a patch that contains both estrogen and progesterone (>CombiPatch). HRT may increase your risk of breast cancer. You should discuss this and other risks with your doctor. Due to the results from a large study in 2002, doctors are now prescribing estrogen alone rather than in combination with progesterone. The study showed an increased risk of stroke, heart disease, and breast cancer when combining estrogen and progesterone. With a low dose of estrogen alone, the risk of heart complications appears to be less than when using the combination.

Like all medications, HRT has positive and negative effects. The benefits and risks often depend on your genetic background and health history. It's important for you and your doctor to decide together if HRT is right for you.

There are several medications that may reduce hot flashes, but they carry their own set of side effects. These medications include venlafaxine (Effexor), gabapentin (Neurontin), and clonidine (Catapress). Doctors may also prescribe medicines to prevent osteoporosis and vaginal dryness as well.

Sources:
Applied Therapeutics: The Clinical Use of Drugs. Applied Therapeutics, 1995.
Danforth's Obstetrics and Gynecology. Lippincott Williams & Wilkins, 1999.
Eastell, R. "Drug Therapy: Treatment Of Postmenopausal Osteoporosis." The New England Journal of Medicine, 338 (1998).
Medline Plus. Medline, 2007.
Diseases and Conditions, "Menopause." http://www.mayoclinic.com. Mayo Clinic Health. Last accessed 1/3/2007.
Drug Facts and Comparisons. Facts & Comparisons, 2007.

This answer prepared 9/16/2000.
This information updated 1/3/2007.