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Managing menopause with: Hormonal therapies

Dr. Cynthia Ferrier

For many menopausal women, combined estrogen-progestin therapy remains a reasonable treatment choice, Dr. Ferrier says. Although the WHI study indicated that Prempro, the estrogen-progestin medication used, increased the risk of certain serious conditions, the increased risk was slight. Compared to women taking a placebo, the women who took Prempro had:

0.8 percent more breast cancer
0.7 percent more heart attacks
0.8 percent more strokes
1.8 percent more blood clots
0.6 percent fewer colon cancer
0.5 percent fewer hip fractures

For some women, the benefits of HRT outweigh those risks. HRT effectively manages the symptoms of early menopause, prevents and treats osteoporosis, and may reduce the risk of serious diseases like colon cancer. And for many women, “Being on HRT helps them feel like their ‘old selves’ – and that’s important,” says Dr. Ferrier.

“You don’t have to make a decision about HRT now and stick with it for the rest of your life,” she says. “You may want to take HRT for a short time to manage the worst menopause symptoms, or to prevent osteoporosis if you’re at increased risk. If you’re on HRT, reconsider your choice yearly. Keep discussing alternative treatment options with your doctor.”

There are several hormonal medications other than HRT that may help your manage menopause. Ask your doctor if these may help you:

Estrogen-only (Premarin) therapy. The WHI study included a group of women who took estrogen alone. These women did not have the same risks as the combined estrogen-progestin group. That part of the WHI study continues.
Natural compounded estrogen formulas (Tri-est, Bi-est). These medications offer various combinations and doses of the estrogens made naturally by your body. They effectively manage menopause symptoms in some women.
Birth control pills. If you’re a perimenopausal woman, the birth control pill may effectively relieve your symptoms. “And birth control is proven safe for most women right up to menopause,” Dr. Ferrier says.
Evista (raloxifene). This drug is a selective estrogen receptor modulator (SERM), a category of drugs that mimic the effects of estrogen in the body. It effectively reduces the risk of osteoporosis in many women and can help lower cholesterol, but it can cause uncomfortable side effects. “Menopausal patients can develop severe hot flashes when taking Evista,” Dr. Ferrier says. “Women well past menopause may tolerate it better.”

Managing menopause with:

For more information:

Hormone Replacement Therapy (National Library of Medicine)