From the Guidelines
Management of menopause symptoms involves several effective regimens, with hormone therapy being the most effective option for vasomotor symptoms like hot flashes and night sweats. The different regimens available for managing menopause symptoms include:
- Hormone therapy, such as estrogen therapy (ET) for women without a uterus, using medications like oral estradiol (0.5-1mg daily), transdermal estradiol patches (0.025-0.1mg/day), or vaginal estrogen for local symptoms 1
- Combined estrogen-progestin therapy (EPT) for women with an intact uterus, such as oral estradiol with medroxyprogesterone acetate (1-2.5mg daily) or using combination patches 1
- Non-hormonal options, such as SSRIs/SNRIs like paroxetine (7.5-25mg daily) or venlafaxine (37.5-150mg daily), gabapentin (300-900mg daily), or clonidine (0.1-0.2mg daily) 1
- Lifestyle modifications, including maintaining a cool environment, dressing in layers, regular exercise, and avoiding triggers like alcohol, caffeine, and spicy foods 1
- Vaginal moisturizers and lubricants to address vaginal dryness, while cognitive behavioral therapy and mindfulness practices may help with mood changes and sleep disturbances 1 Treatment should be individualized based on symptom severity, medical history, and personal preferences, with the lowest effective dose used for the shortest duration necessary to minimize risks. It is essential to consider the potential benefits and harms of each regimen, as well as the individual woman's preferences and values, when making treatment decisions. Some regimens, such as hormone therapy, may have specific benefits, such as reducing the risk of osteoporosis and fractures, but also carry potential risks, such as an increased risk of breast cancer and venous thromboembolism 1. Ultimately, the goal of treatment is to alleviate symptoms and improve quality of life while minimizing risks.
From the FDA Drug Label
When estrogen is prescribed for a postmenopausal woman with a uterus, a progestin should also be initiated to reduce the risk of endometrial cancer. 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. Administration should be cyclic (e.g., 3 weeks on and 1 week off). The usual initial dosage range is 1 to 2 mg daily of estradiol adjusted as necessary to control presenting symptoms.
The different regimens available for managing menopause symptoms are:
- Cyclic administration: 3 weeks on and 1 week off, with a dosage range of 1 to 2 mg daily of estradiol 2
- Combination therapy: estrogen with a progestin for women with a uterus to reduce the risk of endometrial cancer 2
- Topical vaginal products: for treatment of symptoms of vulvar and vaginal atrophy 3 Key considerations:
- Use the lowest effective dose and for the shortest duration consistent with treatment goals and risks for the individual woman
- Reevaluate patients periodically (e.g., 3-month to 6-month intervals) to determine if treatment is still necessary 2
From the Research
Available Regimens for Managing Menopause Symptoms
The following regimens are available for managing menopause symptoms:
- Hormonal options:
- Systemic estrogen alone or combined with a progestogen, which reduces the frequency of vasomotor symptoms by approximately 75% 4
- Low-dose vaginal estrogen, which is associated with subjective improvement in genitourinary syndrome of menopause (GSM) symptom severity by approximately 60% to 80% 4
- Bioidentical estrogens, which are approved by the US Food and Drug Administration and have an identical chemical structure to naturally produced estrogens 4
- Nonhormonal options:
- Selective serotonin reuptake inhibitors (SSRIs) such as citalopram, desvenlafaxine, escitalopram, paroxetine, and venlafaxine, which are associated with a reduction in frequency of vasomotor symptoms by approximately 40% to 65% 4
- Gabapentin, which is also associated with a reduction in frequency of vasomotor symptoms 4
- Phytoestrogens, which may be used as an alternative therapy for managing menopause symptoms 5
Hormone Replacement Therapy (HRT) Regimens
HRT regimens are available for managing menopause symptoms and preventing chronic diseases such as osteoporosis and cardiovascular disease:
- Continuous combined estrogen-progestin regimens, which are effective in increasing and maintaining bone mineral density (BMD) and provide a good endometrial safety profile 6
- Low-dose estrogen-progestin regimens, which are effective in preventing postmenopausal bone loss and have a good safety profile 6
- Individualized HRT regimens, which aim to maximize efficacy and minimize clinically relevant risks 7, 8
Other Options
Other options are available for managing specific menopause symptoms: