Prescription remedies
Several prescription drugs are available to help relieve menopause related symptoms and decrease long-term risks. However, none have been adequately tested in women experiencing early menopause, whether natural or induced.
For these women, healthcare professionals have traditionally selected therapies tested in older women reaching menopause.
The following prescription drugs are the most effective options for relieving severe hot flashes. They all have side effects and contraindications (circumstances where they should not be used), so not all are appropriate options for all women.
Systemic Estrogen Therapy.
Multiple studies have documented that prescription hormone therapy with estrogen that is “systemic” (circulated throughout the body in the blood) is the most effective treatment for hot flashes available, and often with lower doses than those used in the past. Systemic estrogen therapy is the only therapy approved by the U.S. Food and Drug Administration (FDA)—and Health Canada—for treating hot flashes.
The approved indication is for moderate to severe hot flashes. Indeed, severe hot flashes can often be managed with systemic estrogen alone. Some women notice relief within a few days, but in the majority of cases the maximum effect is reached only after 6 to 12 weeks of use, especially with lower doses.
Several types of systemic estrogen products are available. When using systemic estrogen for hot flashes, women should use the lowest effective dose for the shortest time necessary to provide relief and avoid the increased risks associated with higher doses and long-term use. (See more about hormone therapy, including adverse effects and contraindications in next topic.)
The decision to use, or not use, hormone therapy is a personal and complex one, especially for younger women. Unfortunately, there is inadequate scientific evidence regarding hormone therapy in younger women. Women who experience early menopause may have more reasons to consider estrogen than those who reach menopause at the typical time, although low-dose estrogen does not maintain bone density as effectively in younger women. Furthermore, in order to control symptoms, these women may require full-dose estrogen rather than the lower doses used by women reaching menopause at midlife.
For some women with induced menopause, estrogen may not be an option. This includes women who have been treated for estrogen-sensitive cancers (such as breast or uterine). Systemic hormone therapy will not be recommended by a healthcare provider. However, women who have severe symptoms of vaginal atrophy may consider using low-dose, localized, vaginal preparations to prevent dryness and discomfort with intercourse.
Other treatments, along with healthy lifestyle choices, will be needed to manage symptoms and long-term health risks. If a woman’s treatment was performed for a benign (noncancerous) condition, the risks and benefits of estrogen can be explored based on her symptoms, other health issues, risk profile, and personal philosophy.
Other Hormone Drugs.
Other prescription hormonal therapies are sometimes used to treat hot flashes. Although they are not government approved for this use, research documents relief from these drugs for some women, and prescribing drugs “off-label” is a common practice. For instance, a perimenopausal woman who is healthy and doesn’t smoke can choose a combination estrogen-progestin birth control pill for hot flash relief, whether or not she needs contraception.
Hormonal options for hot flash relief for women who can’t use estrogen include progestin-only contraceptives, other progestins such as medroxyprogesterone acetate (Provera or Depo-Provera) or megestrol acetate (Megace), and oral progesterone (Prometrium).
Topical progesterone cream custom made from a prescription has not been studied for its effect on hot flashes. Remember, each therapy has its own contraindications and risks.
Non-hormonal Drugs.
When hormones are not an option, women may choose from several nonhormonal prescription medications. Again, they are not government approved for hot flash treatment, but some research supports their use, including research in women with breast cancer.
These include a drug used to treat epilepsy and migraine, gabapentin (Neurontin). A number of drugs approved to treat depression, such as paroxetine (Paxil), fluoxetine (Prozac), and venlafaxine (Effexor); and drugs used to treat high blood pressure, such as methyldopa (Aldomet) and clonidine (Catapres in the United States, Dixarit in Canada). Again, each therapy has its own contraindications and risks.
Prescription Remedies: Risk & Side Effects
Stopping prescription therapy after a while lets a woman know if she will still have hot flashes. She should always check first with her healthcare provider, as adverse side effects may occur.
The best way to stop estrogen therapy is unknown, but some prefer to slowly taper its use, as this may help avoid rebound hot flashes, which can be severe. Some drugs, such as the antidepressants, must be tapered to avoid side effects that could be life-threatening. If hot flashes recur after therapy ends, therapy can be restarted and stopped at a later time.
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