Merck Manual

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Some Drugs Used to Treat Symptoms and Effects of Menopause

Some Drugs Used to Treat Symptoms and Effects of Menopause

Drug

Advantages

Disadvantages

Female hormones

*Estrogen therapy, with or without a progestogen

Relieves hot flashes, night sweats, vaginal dryness, and pain during intercourse

Helps prevent osteoporosis and reduce the risk of bone fractures

Combination therapy (estrogen plus a progestogen):

*Estrogen alone:

  • Increases the risk of blood clots in the legs and lungs, stroke, gallbladder disorders, and urinary incontinence

  • Increases the risk of endometrial cancer (cancer of the lining of the uterus)

  • May slightly increase the risk of breast cancer but probably not for many years

A progestogen, such as medroxyprogesterone acetate or micronized progesterone (a natural rather than synthetic progesterone)

Reduces the risk of endometrial cancer, which is associated with taking estrogen alone

Is not as effective as estrogen for relieving hot flashes

Does not relieve vaginal dryness

May cause abdominal bloating, breast tenderness, increased breast density, mood disturbances, and/or headache

Increases LDL (the bad) cholesterol levels

May increase the risk of blood clots in the legs and lungs

Has less clear effects on the risk of other disorders

Micronized progesterone: May have a less negative effect on mood and LDL cholesterol than synthetic progestins

May cause drowsiness (and so is usually taken at night)

Appears to have fewer side effects than other progestogens

Selective estrogen receptor modulators (SERMs)

Ospemifene

Relieves pain during intercourse

May worsen hot flashes temporarily

Conjugated estrogen plus bazedoxifene

Conjugated estrogen plus bazedoxifene (a SERM)

Relieves hot flushes, improves sleep, prevents bone loss, and lessens vaginal atrophy (thinning and drying of the vagina with loss of elasticity)

Decreases incidence of breast tenderness and bleeding

Does not appear to increase breast density or incidence of breast cancer

Protects the uterus without the need for a progestogen

May increase the risk of blood clots in the legs and lungs

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs), such as desvenlafaxine, fluoxetine, sertraline, paroxetine in low doses (particularly), and sustained-release paroxetine

Serotonin- norepinephrine reuptake inhibitors, such as venlafaxine

Relieve depression, anxiety, irritability, and insomnia

Are somewhat effective for relieving hot flashes

Depending on the drug, can have side effects, such as sexual dysfunction, nausea, diarrhea, weight loss (in the short term), weight gain (in the long term), drowsiness (sedation), dry mouth, confusion, and increased or decreased blood pressure

Antiseizure drug (only one)

Gabapentin

Is somewhat effective for relieving hot flashes and may help relieve night sweats

Can have side effects, such as drowsiness, dizziness, headache, rash, weight gain, and leg swelling

* Determining whether the risk of certain disorders is increased by estrogen alone or by estrogen plus a progestogen (combination therapy) is difficult.

HDL = high-density lipoprotein; LDL = low-density lipoprotein.