by Scholten A

Medications for Menopause

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. 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 to treat menopause-related symptoms. The most common drug used for menopause is estrogen. This hormone 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 outweigh the benefits for many women. Therefore, you need to discuss the pros and cons of treatment with your doctor.

Prescription Medications

  • Conjugated equine estrogens
  • Synthetic conjugated estrogens
  • Esterified estrogens
  • Estropipate
  • Micronized 17-beta estradiol
  • Estradiol hemihydrate
  • Estradiol transdermal spray
  • 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 oral tablet
  • Androgen patches or transdermal gel
  • Alendronate
  • Risedronate
  • Pamidronate
  • Etidronate
  • Denosumab
  • Raloxifene

Prescription Medications

Estrogen Replacement Therapy (ERT)
Common names include:
  • Conjugated equine estrogens
  • Synthetic conjugated estrogens
  • Esterified estrogens
  • Estropipate
  • Micronized 17-beta estradiol
  • Estradiol hemihydrate
  • Estradiol transdermal spray
ERT provides you with a fraction of the amount of estrogen that was produced by your ovaries before menopause. It helps reduce hot flashes, vaginal dryness, and may reduce the risk of urinary tract infections. Even low doses of estradiol (given as a skin patch) may help with vaginal dryness and pain during sexual activity. It may also reduce your risk of osteoporosis. Evamist, which is a spray, is another type of low-dose estradiol that may help reduce 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 ERT increases a woman's risk of heart disease, and uterine, ovarian, and breast cancers, blood clots, and stroke.
In general, you should NOT be using ERT if you have heart-related risk factors or known heart 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 blood clotting disorders. You should also avoid long-term use of ERT. 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
  • Headache, including migraine
  • Lightheadedness
  • Corneal changes in the eye
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, a synthetic progesterone, is available as replacement therapy. If you had a hysterectomy, you are not at risk for uterine cancer and usually do not need to take progesterone with ERT.
Progestin oral tablet:
  • Medroxyprogesterone acetate
  • Norethindrone
  • Norethindrone acetate
  • Norgestrel
  • Levonorgestrel
  • Megestrol acetate
Progestin injectable:
  • Medroxyprogesterone acetate
Progestin IUD:
  • Levonorgestrel
Progesterone oral capsule:
  • Progesterone USP
Progesterone—vaginal gel:
  • Progesterone
Progesterone IUD:
  • Progesterone
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
  • Oral, continuous-combined:
    • Conjugated equine estrogens and medroxyprogesterone acetate
    • Ethinyl estradiol and norethindrone acetate
    • 17-beta estradiol and norethindrone acetate
  • Oral, intermittent-combined:
    • 17-beta estradiol and norgestimate
  • Skin patch, continuous cycle:
    • 17-beta estradiol and norethindrone acetate
  • Skin Patch, continuous combined:
    • 17-beta estradiol and norethindrone acetate
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, uterine, and invasive breast cancers. Therefore, you and your doctor should carefully discuss the risks and benefits.
Possible side effects include:
Androgen oral tablet:
  • Methyltestosterone and esterified estrogens
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 and 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.
Low dose androgen may be given through a patch or transdermal gel.
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.
Common names include:
  • Alendronate
  • Risedronate
  • Pamidronate
  • Etidronate
  • Zoledronate
These non-hormonal 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.
RANKL Inhibitor
Common names include denosumab.
Denosumab is used to prevent bone fractures in postmenopausal women with osteoporosis. Side effects may include allergic reaction, low blood calcium, infection, skin problems, and unusual fractures.
Selective Estrogen Receptor Modulators (SERMs)
Common names include:
  • Raloxifene
SERMs are used to treat or prevent osteoporosis in postmenopausal women. They have some of the beneficial effects of estrogen, especially improved bone strength. They do not increase your risk of breast cancer or uterine bleeding. However, these medications tend to cause, rather than relieve, hot flashes. They also 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:
  • Clonidine—medication that lowers blood pressure
  • Gabapentin—an antiseizure medication
  • Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
    • Common names: fluoxetine, paroxetine, venlafaxine, desvenlafaxine
    • 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
If you are taking medications, follow these general guidelines:
  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Plan ahead for refills if you need them.
  • Do not share your prescription medication with anyone.
  • Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.


Menopause. EBSCO DynaMed website. Available at: Updated February 2, 2016. Accessed February 17, 2016.
Menopause. National Institute on Aging website. Available at: Updated July 20, 2015. Accessed February 17, 2016.
The menopause years. The American Congress of Obstetricians and Gynecologists website. Available at: Updated May 2015. Accessed February 17, 2016.
North American Menopause Society. The 2012 hormone therapy position statement of: The North American Menopause Society. Menopause. 2012;19(3):257-271.
Osteoporosis. EBSCO DynaMed website. Updated October 13, 2015. Accessed February 17, 2016.
9/16/2008 DynaMed's Systematic Literature Surveillance 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(3):265.
9/30/2008 DynaMed's Systematic Literature Surveillance Jacobson BC, Moy B, Colditz GA, Fuchs CS. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168(16):1798-1804.
11/19/2008 DynaMed's Systematic Literature Surveillance 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(6):1343-1351.
4/14/2009 DynaMed's Systematic Literature Surveillance Archer DF, Dupont CM, Constantine GD, et al. 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(3):238.
7/15/2013 DynaMed's Systematic Literature Surveillance FDA approves the first non-hormonal treatment for hot flashes associated with menopause. US Food and Drug Administration website. Available at: Updated July 2, 2013. Accessed February 17, 2016.

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