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Medications for Menopause
by Amy Scholten, MPH
En Español (Spanish Version)
The information provided here is meant to give you a general idea about each of the medications listed below.
Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use
each of these medications as recommended by your doctor, or according to the instructions provided. If you have
further questions about usage or side effects, contact your doctor.
There are a number of prescription therapies available for treating menopause-related symptoms. The most
common drug used for menopause is the hormone estrogen, which helps make up for the lower levels secreted by
your ovaries at menopause.
Since each person is unique, a number of factors need to be considered before you make the decision to use
hormone therapies, including your family and medical history. The results of recent studies on estrogen
replacement therapy (ERT) and estrogen plus progestin (hormone replacement therapy or HRT) suggest that the
risks of long-term hormone replacement therapy (> 3 years) outweigh the benefits for many women. Therefore,
you need to discuss the pros and cons of treatment with your doctor.
Prescription Medications
+ Estrogen Replacement Therapy
Conjugated Equine Estrogens (Premarin, Premarin Vaginal Cream)
Synthetic Conjugated Estrogens (Cenestin)
Esterified Estrogens (Estratab, Menest)
Estropipate (Ortho-Est, Ogen, Ogen Vaginal Cream)
Micronized 17-beta estradiol (Estrace, Matrix Patch: Alora, Climara, Esclim, Vivelle, Vivelle-Dot; Reservoir
Patch: Estraderm; Estrace Vaginal Cream, Estring Vaginal Ring)
Estradiol Hemihydrate (Vagifem Vaginal Tablet)
Estradiol Transdermal Spray (Evamist)
+ Progestogen
Progestin Oral Tablet
Progestin Injectable
Progestin Intrauterine Device (IUD)
Progesterone Oral Capsule
Progesterone: Vaginal Gel
Progesterone IUD
+ Estrogen Plus Progestogen (Hormone Replacement Therapy–HRT)
Oral, Continuous Cycle
Oral, Continuous-Combined
Oral, Intermittent-Combined
Skin Patch, Continuous Cycle
Skin Patch, Continuous Combined
+ Androgen
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Androgen Oral Tablet
+ Bisphosphonates
Alendronate (Fosamax)
Risedronate (Actonel)
Pamidronate (Aredia)
Etidronate (Didronel)
+ Selective Estrogen Receptor Modulators (SERMs)
Raloxifene (Evista)
Nonhormonal Medications
Prescription Medications
Estrogen Replacement Therapy (ERT)
Common names include:
Conjugated Equine Estrogens (Premarin, Premarin Vaginal Cream)
Synthetic Conjugated Estrogens (Cenestin)
Esterified Estrogens (Estratab, Menest)
Estropipate (Ortho-Est, Ogen, Ogen Vaginal Cream)
Micronized 17-beta estradiol (Estrace, Matrix Patch: Alora, Climara, Esclim, Vivelle, Vivelle-Dot; Reservoir
Patch: Estraderm; Estrace Vaginal Cream, Estring Vaginal Ring)
Estradiol Hemihydrate (Vagifem Vaginal Tablet)
Estradiol Transdermal Spray ( Evamist)
Estrogen replacement therapy (ERT) provides you with a fraction of the amount of estrogen that was produced by
your ovaries before menopause. It helps reduce hot flashes and vaginal dryness and may reduce your risk of
osteoporosis. Even low doses of estradiol (given as a skin patch) may help with vaginal dryness and pain during
sexual activity. Evamist, which is a spray, is another type of low-dose estradiol that may reduce the number of hot
flashes.
Estrogen may be administered as an oral tablet, patch, injection, pellet placed under the skin, vaginal cream, ring,
tablet, or spray
Recent scientifically strong studies now show that estrogen replacement therapy increases a woman's risk of heart
disease, endometrial cancer, ovarian and breast cancers, blood clots, and stroke.
In general, you should NOT be using ERT if you have cardiac risk factors or known cardiac disease, are or may be
pregnant, have a history of breast cancer or other hormone-sensitive cancer, have unexplained bleeding from your
uterus, or a history of blot clotting disorders. You should also avoid ERT over the long term (more than one or two
years). You should discuss the risks and benefits of ERT with your doctor.
Possible side effects include:
Uterine bleeding
Enlargement of benign uterine tumors
Sore breasts
Abdominal bloating
Nausea
Fluid retention
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Headache, including migraine
Dizziness
Corneal changes in the eye
Increased risk of breast, ovarian, and endometrial cancers
Increased risk of heart attacks and strokes
Increased risk of blood clots
Progestogen
If you choose ERT, the progesterone that your ovaries once produced must be replaced to reduce the increased risk
of uterine cancer from taking ERT alone. Progesterone or progestin (synthetic progesterone) is available as
replacement therapy. If you have had your uterus removed ( hysterectomy), you are not at risk for uterine cancer
and do not need to take progesterone with ERT.
Progestin Oral Tablet
Medroxyprogesterone acetate (Amen, Cycrin, Provera)
Norethindrone (Micronor, Nor-QD)
Norethindrone acetate (Aygestin)
Norgestrel (Ovrette)
Levonorgestrel (Norplant)
Megestrol Acetate (Megace)
Progestin Injectable
Medroxyprogesterone acetate (Depro-Provera)
Progestin IUD
Levonorgestrel (Mirena)
Progesterone Oral Capsule
Progesterone USP (Prometrium)
Progesterone: Vaginal Gel
Progesterone (Crinone)
Progesterone IUD
Progesterone (Progestasert)
Possible side effects include:
Fluid retention
Weight gain
Headache
Mood changes
Estrogen Plus Progestogen (Hormone Replacement Therapy–HRT) Oral, Continuous Cycle:
Conjugated Equine Estrogens and Medroxyprogesterone Acetate (Premphase)
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Oral, Continuous-Combined:
Conjugated Equine Estrogens and Medroxyprogesterone Acetate (Prempro)
Ethinyl Estradiol and Norethindrone Acetate (Femhrt)
17-Beta Estradiol and Norethindrone Acetate (Activella)
Oral, Intermittent-Combined:
17-Beta Estradiol and Norgestimate (Ortho-Prefest)
Skin Patch, Continuous Cycle:
17-Beta-Estradiol and Norethindrone Acetate (CombiPatch)
Skin Patch, Continuous Combined:
17-Beta-Estradiol and Norethindrone Acetate (CombiPatch)
When progesterone is taken with estrogen, it is called Hormone Replacement Therapy (HRT). Options for HRT
include cyclic, continuous-cyclic, continuous-combined, and intermittent-combined. Long-term HRT increases the
risk of strokes, blood clots, heart attacks, ovarian, endometrial, and invasive breast cancers. Therefore, you and
your doctor should carefully discuss the risks and benefits.
Possible side effects include:
Uterine bleeding or “spotting”
Fluid retention
Sore breasts
Headache
Mood changes
Increased risk of endometrial, breast, and ovarian cancers
Increased risk of heart attacks and strokes
Increased risk of blood clots
Increased risk of gastroesophageal reflux disease (GERD)
Androgen
Androgen Oral Tablet
Methyltestosterone and esterified estrogens (Estratest, Menogen)
Androgen is a hormone produced by both males and females. In women, the ovaries secrete androgen as
testosterone and androstenedione which are then converted into estrogen and progesterone. As you get older, your
ovaries produce less androgen as well as less estrogen. As a result of less androgen, some women notice a decline
in their sex drive. Androgen, which must be taken with estrogen, may help improve sex drive in some women.
Possible side effects* include:
Restlessness
Depression
Growth of facial and body hair
Acne
An enlarged clitoris
Increased muscle mass
A lowered voice
Increased cardiovascular risks
*These side effects often occur as the result of improper dosages of androgen.
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Bisphosphonates
Common names include:
Alendronate (Fosamax)
Risedronate (Actonel)
Pamidronate (Aredia)
Etidronate (Didronel)
These nonhormonal medications are used to prevent or treat osteoporosis. These agents effectively reduce both
bone loss and your risk of fractures. Alendronate may cause gastrointestinal problems and irritation of your
esophagus.
Selective Estrogen Receptor Modulators (SERMs)
Common names include:
Raloxifene (Evista)
SERMs have some of the beneficial effects of estrogen, especially improved bone strength, but no increased risk
of breast cancer or uterine bleeding. However, these medications tend to cause, rather than relieve, hot flashes and
increase your risk of blood clots and gallstones.
Nonhormonal Medications for Hot Flashes
Your doctor may prescribe other types of medication to relieve hot flashes. . Examples include:
Certain blood pressure medications (taken in lower doses)
Common names: clonidine (Catapres), methyldopa (Aldomet)
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors
(SNRIs)
Common names: fluoxetine (Prozac), paroxetine (Paxil), venlafaxine (Effexor), desvenlafaxine (Pristiq)
Note: SSRIs and SNRIs should not be used if you are taking tamoxifen, a medication to reduce the risk
of breast cancer recurrence.
Special Considerations
Whenever you are taking a prescription medication, take the following precautions:
Take your medicine as directed. Do not change the amount or the schedule.
Do not stop taking them without talking to your doctor.
Do not share them.
Know what the results and side effects may be. Report bothersome side effects to your doctor.
Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one
drug. This includes over-the-counter medicine and herb or dietary supplements.
Plan ahead for refills so you don’t run out.
REFERENCES:
The American College of Obstetricians and Gynecologists website. Available at: http://www.nia.nih.gov/ .
Accessed November 2009.
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Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed
February 15, 2006.
National Women's Health Resource Center website. Available at:
http://www.healthywomen.org/content.cfm?L1=3&L2=52&L3=2.0&SS=0 . Access date unknown.
North American Menopause Society website. Available at: http://www.menopause.org/default.htm . Accessed
February 15, 2006.
Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated
September 2008. Accessed September 23, 2008.
USP DI . 21st ed. Micromedex; 2001.
9/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Huang
A, Yaffe K, Vittinghoff E, et al. The effect of ultralow-dose transdermal estradiol on sexual function in
postmenopausal women. Am J Obstet Gynecol. 2008;198:265.e1-7.
9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php :
Jacobson BC, Moy B, Colditz GA, Fuchs CS. Postmenopausal hormone use and symptoms of gastroesophageal
reflux. Arch Intern Med. 2008;168:1798-1804.
11/19/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Buster
JE, Koltun WD, Pascual ML, Day WW, Peterson C. Low-dose estradiol spray to treat vasomotor symptoms: a
randomized controlled trial. Obstet Gynecol. 2008;111:1343-1351.
4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Archer
DF, Dupont CM, Constantine GD, Pickar JH, Olivier S; Study 319 Investigators. Desvenlafaxine for the treatment
of vasomotor symptoms associated with menopause: a double-blind, randomized, placebo-controlled trial of
efficacy and safety. Am J Obstet Gynecol. 2009;200:238.e1-238.e10. Epub 2009 Jan 24.
Last reviewed September 2011 by Ganson Purcell Jr., MD, FACOG, FACPE
Last Updated: 9/20/2011
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