Medications and Menopause: What Can Help?

Menopause is a natural stage in every woman’s life, but it is often accompanied by symptoms that can significantly impact quality of life. In this article, we will review the pharmacological treatment options available to women going through menopause, and examine how to alleviate the various symptoms. At Pharma Care, we believe that reliable and comprehensive information can help you make informed decisions about your health.

What is menopause and common symptoms?

Menopause is defined as the period in a woman's life when ovarian activity ceases and the menstrual cycle ends. Menopause usually occurs between the ages of 45 and 55, with the average age in Israel being 51. The process begins with the perimenopause period, continues into menopause itself (officially defined as 12 months without a period), and finally into postmenopause.

Common symptoms of menopause include:

• Hot flashes and night sweats
• Vaginal dryness and pain during intercourse
• Sleep disorders
• Mood swings and anxiety
• Decreased bone density
• Increased risk of cardiovascular disease
• Decreased libido
• Bladder control problems

It is important to emphasize that not all women experience all symptoms, and their intensity varies from woman to woman. However, when symptoms impair quality of life, menopausal medication may be an effective solution.

Drug treatment options during menopause

Hormone replacement therapy (HRT)

Hormone Replacement Therapy (HRT) is one of the main options for treating menopausal symptoms. This treatment is based on replacing the hormones whose levels are decreasing in the body – estrogen and progesterone.

There are several types of hormonal treatments:

• Estrogen-only therapy – Especially suitable for women who have had a hysterectomy
• Combined treatment – Estrogen and progesterone, suitable for women with a uterus
• Cyclic treatment – Taking estrogen regularly and progesterone for 12-14 days per month
• Continuous treatment – Taking both hormones regularly

Hormone therapy can be given in a variety of forms:

Benefits and risks of hormone therapy Hormone therapy is particularly effective in relieving:

• Hot flashes and night sweats (75%-80% reduction in frequency and intensity)
• Vaginal dryness and pain during intercourse
• Sleep disorders
• Preventing bone loss and osteoporotic fractures

However, it is important to be aware of the possible risks:

• Slight increase in the risk of breast cancer (especially with long-term combination therapy)
• Increased risk of blood clots and stroke (especially when taking tablets)
• A slight increase in the risk of heart disease (especially if treatment begins many years after menopause)
• Increased risk of endometrial cancer (with estrogen-only therapy without progesterone, in women with a uterus)

Important to know: The decision about hormone therapy should be made in consultation with a doctor, weighing the individual benefits and risks, your medical history, and your personal preferences.

Alternatives to hormone therapy during menopause For women who cannot or do not want hormone therapy, there are several other medication options: Medications to treat hot flashes

• SSRI/SNRI antidepressants – Medications such as fluoxetine (Prozac), paroxetine, venlafaxine (Effexor), and sertraline (Loseral) have been shown to be effective in reducing hot flashes. They may reduce the frequency and intensity of hot flashes by 50%-60%.
• Clonidine – A drug used primarily to treat high blood pressure, but can reduce hot flashes.
• Gabapentin and pregabalin – Anticonvulsant medications that have also been found to be effective in reducing hot flashes.

Treatment for Vaginal DrynessVaginal dryness is a common symptom of menopause that affects quality of life and sexual activity. Treatment options include:

• Topical estrogen preparations – Creams, vaginal tablets, or rings containing low-dose estrogen
• Non-hormonal moisturizing creams – Provide temporary relief
• Vaginal DHEA (Prestrone) – A hormone that is converted to estrogen in vaginal tissues
• Ospemifene – Selective estrogen receptor modulator (SERM) approved for the treatment of vaginal dryness

Medications to prevent osteoporosis: Decreased bone density is common after menopause, which increases the risk of fractures. Treatment options include: Complementary therapies and lifestyle changes In addition to medication, there are lifestyle changes and complementary therapies that may help relieve menopausal symptoms: Diet and exercise

• A diet rich in calcium and vitamin D – Essential for bone health
• Reducing caffeine and alcohol intake – May reduce hot flashes
• Regular physical activity – Improves bone health, mood and sleep
• Maintaining a healthy weight – Overweight women tend to suffer more from hot flashes

Phytoestrogens and Dietary Supplements Phytoestrogens are plant substances with estrogen-like activity, found in foods and dietary supplements:

• Isoflavones from soy – Found in soy products and dietary supplements
• Black cohosh – A plant used to treat hot flashes
• Evening primrose oil – May help relieve vaginal dryness
• Magnolia tree bark – Used in Chinese medicine to relieve menopausal symptoms

Important to note: The effectiveness of most dietary supplements has not been conclusively proven in controlled studies, and a doctor should be consulted before using them, especially if there is a history of breast cancer or blood clots.

A personalized approach to menopause treatment The best treatment for menopause symptoms is personal and tailored to each woman according to:

• Severity of symptoms and their impact on quality of life
• The woman's age and the time since the onset of menopause
• Personal and family medical history
• Personal risk factors for various diseases
• Personal preferences regarding types of treatment

It is important to have regular medical follow-up during menopause, perform periodic tests, and consult with your doctor regarding the appropriateness of treatment over time. Frequently Asked Questions Does every woman need medication during menopause? No, not every woman needs medication. Approximately 20%-25% of women experience only mild symptoms that do not require medication. The decision to take medication during menopause depends on the severity of the symptoms and their impact on quality of life. How long is it recommended to take hormone therapy? There is no uniform answer to this question. In the past, short-term treatment (up to 5 years) was recommended, but today the approach is to consider continuing treatment every year, while assessing the benefits against the risks. For some women, long-term treatment may be appropriate, especially if symptoms return when treatment is stopped. Does hormone therapy increase the risk of breast cancer? Combined hormone therapy (estrogen and progesterone) may increase the risk of breast cancer to some extent, especially with long-term treatment (over 5 years). Estrogen alone (for women without a uterus) is associated with a smaller increase in risk. It is important to note that the absolute risk remains low and must be weighed against the benefits of treatment. Can hormone therapy be taken if there is a family history of breast cancer? A family history of breast cancer is not an absolute contraindication to hormone therapy, but it requires careful consideration. The decision depends on other risk factors, the severity of symptoms, and the degree of genetic predisposition to cancer in the family. Women who carry mutations in the BRCA1/2 genes are generally not candidates for hormonal therapy. What are the options for treating vaginal dryness without hormones? There are several non-hormonal options: water-based vaginal moisturizers, gels containing hyaluronic acid, lubricants for use before sex, and more recently, vaginal laser treatments that encourage vaginal tissue regeneration. Ospemifene is a non-hormonal drug approved for the treatment of vaginal dryness. Are herbal supplements effective in treating menopausal symptoms? Research on the effectiveness of herbal supplements is inconclusive. Some women report symptom relief with the use of supplements such as black cohosh, soy isoflavones, or other plant extracts. However, it should be remembered that these supplements are not as regulated as medications and may contain active ingredients in varying concentrations. It is recommended to consult a doctor before using them.

Medical Disclaimer: The information presented in this article is for informational purposes only and is not a substitute for professional medical advice. The information presented should not be considered a recommendation for self-treatment or a guideline for the use of medications without consulting a doctor. Any decision regarding drug treatment during menopause should be made in collaboration with a specialist physician, taking into account your personal medical condition. The Pharma Care team recommends consulting with your family doctor or gynecologist before starting any new treatment.