Estrogen therapy has been the standard for post-menopausal hormone replacement for many years. Taking estrogens is the most effective treatment for reducing menopausal hot flashes, mood alterations and atrophy of the vagina and urethra. Some recent studies, notably the Women’s Health Initiative published in 2003, have raised concerns with women taking estrogens since this study showed a small increase in heart attack risk, venous clots and breast cancer when women took this medication. Unfortunately, this large study included many women who were older than those who typically start estrogen replacement therapy. Since these older women have a higher likelihood of developing these unfortunate outcomes, it is possible that these risks were falsely elevated in the group studied. Nevertheless, ARM currently recommends estrogen therapy only in those women who have severe hot flashes or mood swings related to their low estrogen status. The Food and Drug Administration also recommends that women receive estrogens for the shortest time period and at the lowest dose possible.
Post-menopausal women who take estrogens and still have a uterus will also need to take progesterone. Unopposed estrogen can lead to a condition known as “endometrial hyperplasia,” which is a precursor to cancer of the uterus. Formulations containing both estrogens and progesterones are available. The progesterone can also help to reduce hot flashes. In some cases where women are unable to take estrogens because of previous clots or a history of estrogen sensitive cancers, progesterone may be given alone in order to reduce low estrogen symptoms.
For women who cannot take estrogens due to previous health conditions, alternatives do exist. Serotonin reuptake inhibitors, a class of medications used in depression, can be used with moderate effectiveness. If symptoms are mild to moderate, these women can achieve a significant level of relief using these medications.
Other medications, including evening primrose oil, Catapres and belladonna alkaloids have been used but there is no evidence that they are effective in relieving menopausal symptoms.