From the Guidelines
Hormone therapy, specifically systemic estrogen, is the most effective treatment for severe vasomotor symptoms of menopause, but topical estrogen is not recommended as a first-line treatment for vasomotor symptoms. The recommended approach is to use the lowest effective dose of estrogen, often combined with progestogen in women with an intact uterus [ 1 ]. Common regimens include oral estradiol (0.5-1 mg daily), transdermal estradiol patches (0.025-0.05 mg/day), or conjugated equine estrogens (0.3-0.625 mg daily). For women with a uterus, add either cyclic progesterone (200 mg for 12-14 days per month) or continuous micronized progesterone (100 mg daily) or medroxyprogesterone acetate (2.5 mg daily) to prevent endometrial hyperplasia.
Key Considerations
- Treatment duration should be limited to the shortest time needed for symptom relief, typically reassessing after 3-5 years.
- Before starting therapy, patients should undergo screening for contraindications including history of breast cancer, coronary heart disease, previous venous thromboembolism, or stroke.
- Non-hormonal alternatives for those with contraindications include certain antidepressants (such as venlafaxine 37.5-75 mg daily or paroxetine 7.5-25 mg daily), gabapentin (300-900 mg daily), or oxybutynin (2.5-5 mg twice daily) [ 1 ].
Alternatives to Systemic Hormone Therapy
- For women who cannot use systemic hormone therapy, alternatives such as paroxetine, venlafaxine, gabapentin, or clonidine may be considered [ 1 ].
- Psychosocial counseling (cognitive behavioral therapy) and/or clinical hypnosis may also provide a benefit and reduce vasomotor symptoms [ 1 ].
From the FDA Drug Label
For treatment of moderate to severe vasomotor symptoms, vulval and vaginal atrophy associated with the menopause, the lowest dose and regimen that will control symptoms should be chosen and medication should be discontinued as promptly as possible. Treatment of moderate to severe vasomotor symptoms associated with the menopause.
The recommended treatment for severe vasomotor symptoms of menopause is estrogen therapy, which can be administered orally or transdermally. However, the provided drug labels do not specifically mention topical estrogen as a treatment for vasomotor symptoms. Topical estrogen is mentioned as an option for the treatment of vulvar and vaginal atrophy associated with menopause 2.
Therefore, based on the provided information, topical estrogen is not directly recommended for the treatment of vasomotor symptoms of menopause.
From the Research
Treatment Options for Vasomotor Symptoms of Menopause
- Hormonal therapy with estrogen is considered the first-line therapy for bothersome vasomotor symptoms and genitourinary syndrome of menopause (GSM) symptoms 3.
- Systemic estrogen alone or combined with a progestogen reduces the frequency of vasomotor symptoms by approximately 75% 3.
- Topical estrogen, such as transdermal estrogen sprays and estradiol topical emulsion, may also be effective in managing menopause-associated vasomotor symptoms 4.
- Nonhormonal options, such as selective serotonin reuptake inhibitors (SSRIs) and selective noradrenergic reuptake inhibitors (SNRIs), are available for women who are not candidates for hormonal treatments or prefer not to use them 5, 6, 7.
Efficacy of Topical Estrogen
- Transdermal estrogen sprays and estradiol topical emulsion have been shown to be effective in reducing the frequency and severity of vasomotor symptoms 4.
- However, more research is needed to fully understand the efficacy and safety of topical estrogen for the treatment of vasomotor symptoms of menopause.