What is the comparison between Veo AH and estrogen therapy (estradiol) for menopausal symptoms?

Comparison of Veo AH and Estrogen Therapy for Menopausal Symptoms

For menopausal symptoms, nonhormonal agents like Veo AH should be considered first-line therapy over estrogen due to estrogen's increased risk of serious adverse events including stroke, invasive breast cancer, dementia, gallbladder disease, deep vein thrombosis, and pulmonary embolism. 1

Efficacy Comparison

• Estrogen therapy (estradiol) is highly effective for treating menopausal symptoms including hot flashes, night sweats, and vaginal dryness 2, 3
• Both oral and transdermal estradiol formulations significantly reduce vasomotor symptoms and improve quality of life in menopausal women 3
• Estradiol vaginal rings can effectively deliver estrogen locally for urogenital symptoms while minimizing systemic absorption 4
• Nonhormonal alternatives like Veo AH may be less effective than estrogen but offer a safer profile, particularly for women with contraindications to estrogen therapy 1

Safety Considerations

• Estrogen therapy is associated with significant risks including:

  • Increased risk of stroke
  • Higher rates of invasive breast cancer (with combined estrogen-progestin)
  • Greater incidence of gallbladder disease
  • Elevated risk of venous thromboembolism including deep vein thrombosis and pulmonary embolism 1

• Estrogen-only therapy has been associated with:

  • Reduced risk of fractures (approximately 56 fractures of any type prevented per 10,000 person-years)
  • Small reduction in invasive breast cancer risk (about 8 fewer cases per 10,000 person-years)
  • Increased risk of stroke and gallbladder disease 1

• Nonhormonal alternatives like Veo AH have fewer systemic side effects and are safer for women with:

  • History of breast cancer
  • Increased risk of cardiovascular disease
  • History of thromboembolic events 1, 5

Special Populations

Women with Breast Cancer History

• Estrogen therapy is generally contraindicated in women with a history of breast cancer, particularly hormone receptor-positive cancers 1
• For women with breast cancer experiencing menopausal symptoms:
  • Nonhormonal agents should be first-line therapy 1
  • Vaginal estrogens may be considered for severe atrophic vaginitis when nonhormonal options fail, but their safety is not fully established 1
  • Estriol-containing preparations may be preferable to estradiol for vaginal use in women on aromatase inhibitors 1

Older Women

• Ultra-low dose transdermal estradiol (0.014 mg/day) did not significantly improve menopausal symptoms in women aged 60-80 years compared to placebo 6
• Benefits of estrogen therapy for symptom relief may be less pronounced in older postmenopausal women who are further from menopause onset 6

Treatment Algorithm

1. First-line therapy for most women with menopausal symptoms:

   • Nonhormonal approaches like Veo AH 1, 5
   • Lifestyle modifications (temperature control, avoiding triggers) 1

2. For women with persistent symptoms despite nonhormonal approaches:

   • Consider lowest effective dose of estrogen therapy for shortest duration if no contraindications exist 1
   • For women with intact uterus: estrogen plus progestin to prevent endometrial hyperplasia 1
   • For women without uterus: estrogen-only therapy may have better risk profile 1

3. For women with primarily vaginal symptoms:

   • Nonhormonal vaginal moisturizers and lubricants (e.g., Replens, Sylk) 1
   • If ineffective, consider local vaginal estrogen preparations which have lower systemic absorption 1

4. For women with contraindications to estrogen:

   • Nonhormonal alternatives like Veo AH should be used exclusively 1, 5
   • For vaginal symptoms, nonhormonal lubricants are preferred 1

Important Caveats

• FDA-approved indications for hormone therapy are limited to treatment of menopausal symptoms and prevention of osteoporosis 1
• Estrogen with or without progestin should be prescribed at the lowest effective dose and for the shortest duration consistent with treatment goals 1
• The decision to use estrogen therapy should be based on individual risk factors and preferences after thorough discussion of potential benefits and harms 1
• Ethnic differences may affect response to estrogen therapy, with some studies showing variations in symptom reporting and treatment response between different populations 7