What is the treatment for menopause?

From the Guidelines

Menopause treatment should focus on managing symptoms and preventing complications, with hormone replacement therapy (HRT) being the most effective treatment, using estrogen alone for women without a uterus or combined estrogen-progestin therapy for those with a uterus to prevent endometrial cancer, as recommended by the most recent and highest quality study 1.

Treatment Options

• Hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms, with typical regimens including oral estradiol (0.5-1mg daily), transdermal patches (0.025-0.1mg/day), or vaginal estrogen for localized symptoms 1.
• Non-hormonal options include SSRIs/SNRIs like paroxetine (7.5-20mg daily) or venlafaxine (37.5-150mg daily) for hot flashes, gabapentin (300-900mg daily) for night sweats, and clonidine (0.1-0.2mg daily) for vasomotor symptoms 1.
• Lifestyle modifications are important, including regular exercise, maintaining a healthy weight, avoiding triggers (caffeine, alcohol, spicy foods), dressing in layers, and using lubricants for vaginal dryness 1.

Considerations

• Treatment should be individualized based on symptom severity, medical history, and risk factors, with the lowest effective dose for the shortest duration necessary 1.
• Regular follow-up is essential to monitor effectiveness and adjust treatment as needed 1.
• HRT is contraindicated in survivors with a history of hormonally mediated cancers, and caution should be used in survivors with coronary heart disease or hypertension, current smokers, and those with an increased genetic cancer risk 1.

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. The usual initial dosage range is 1 to 2 mg daily of estradiol adjusted as necessary to control presenting symptoms.

The treatment for menopause symptoms, such as moderate to severe vasomotor symptoms, vulval and vaginal atrophy, is estrogen therapy, specifically estradiol (PO), with a progestin if the woman has a uterus. The recommended dosage is 1 to 2 mg daily, adjusted as necessary to control symptoms, and should be used at the lowest effective dose and for the shortest duration consistent with treatment goals and risks 2.

• Key points:
  • Use the lowest effective dose and for the shortest duration.
  • Progestin should be used with estrogen in women with a uterus.
  • Estradiol (PO) dosage range is 1 to 2 mg daily.

From the Research

Treatment Options for Menopause

The treatment for menopause typically involves hormone therapy, which can help alleviate symptoms such as vasomotor symptoms and genitourinary syndrome of menopause 3. Some key points to consider:

• Hormone therapy (HT) is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause 3.
• The Women's Health Initiative (WHI) hormone therapy trials clarified the benefits and risks of HT, including how the results differed by age 3.
• The risk:benefit ratio and safety profile of HT differ markedly by clinical characteristics of the participants, especially age, time since menopause, and comorbidity status 3.

Types of Hormone Therapy

There are different types of hormone therapy, including:

• Estrogen-only therapy, which is often used for women who have had a hysterectomy 4.
• Combination therapy, which includes both estrogen and progesterone, and is often used for women who still have their uterus 4.
• Different types of estrogen, such as estradiol and conjugated equine estrogens, which may have different effects on the body 4.
• Different routes of administration, such as oral, transdermal, and vaginal, which may have different effects on the body 5.

Non-Hormonal Treatment Options

For women who cannot or do not want to take hormone therapy, there are non-hormonal treatment options available, such as:

• Selective serotonin reuptake inhibitors (SSRIs) for vasomotor symptoms 6.
• Phytoestrogens, which are plant-based compounds that may help alleviate menopausal symptoms 6.
• Alternative therapies, such as acupuncture and herbal supplements, which may help alleviate menopausal symptoms 6.

Considerations for Treatment

When considering treatment for menopause, it's essential to take into account:

• The individual woman's symptoms and medical history 3.
• The potential risks and benefits of different treatment options 3, 7.
• The woman's age, time since menopause, and comorbidity status, as these factors can affect the risk:benefit ratio of hormone therapy 3.
• The different types, routes, and doses of hormone therapy, as these can affect the risk:benefit ratio and safety profile 4, 5.