Some Medications Used to Treat Symptoms and Effects of Menopause

Medication	Benefits	Disadvantages
Treatment: General Menopausal Symptoms (such as hot flashes, mood changes, sleep issues)
Menopausal hormone therapy (previously called hormone replacement therapy)
Estrogen therapy, usually with a progestogen (estrogen is used alone only if a woman has had a hysterectomy [surgical removal of the uterus]*)	Relieves hot flashes, night sweats Usually relieves vaginal dryness and pain during intercourse Helps prevent osteoporosis and reduce the risk of bone fractures	Combination therapy (estrogen plus a progestogen): Increases the risk of blood clots in the legs, blood clots in the lungs, stroke, gallbladder disorders (such as gallstones), and urinary incontinence† After 3–5 years of use, increases the risk of breast cancer slightly If women are over age 65 when they start it, increases the risk of coronary artery disease and dementia Estrogen therapy alone: Most risks are the same as combination therapy May slightly increase the risk of breast cancer but probably not for many years, and the increase in breast cancer risk appears to be less than with combination estrogen and progestogen therapy
Progestogen alone, includes synthetic progestins (such as medroxyprogesterone acetate) and natural progesterone (micronized progesterone)	Relieves hot flashes but is not as effective as estrogen therapy Reduces the risk of endometrial cancer (cancer of the lining of the uterus) An option for some women who are at high risk of forming blood clots and cannot use estrogen therapy	Does not relieve vaginal dryness May cause abdominal bloating, breast tenderness, increased breast density, mood disturbances, and/or headache May increase LDL (the unhealthy type of cholesterol) levels May increase the risk of blood clots in the legs and lungs, but probably has less risk than estrogen therapy Micronized progesterone: May have a less negative effect on mood and LDL cholesterol than synthetic progestins May cause drowsiness (and so is usually taken at night) Appears to have fewer side effects (such as moodiness, bloating, or breast tenderness) than synthetic progestins
Conjugated estrogen plus bazedoxifene
Conjugated estrogen plus bazedoxifene (a SERM)	Relieves hot flashes, night sweats Improves sleep Usually relieves vaginal dryness and pain during intercourse Protects the uterus without the need for a progestogen Helps prevent osteoporosis and reduce the risk of bone fractures	May increase the risk of blood clots in the legs and lungs Does not appear to increase breast density or incidence of breast cancer Less breast tenderness and breakthrough vaginal bleeding than with other types of hormone therapy
Nonhormonal medications
Antidepressants: SSRIs, such as desvenlafaxine, fluoxetine, sertraline, low-dose paroxetine salt, and sustained-release paroxetine salt SNRIs, such as venlafaxine	Relieve depression, anxiety, irritability, and insomnia May be effective for relieving hot flashes	Side effects vary depending on the medication and may include sexual dysfunction, nausea, diarrhea, weight loss, weight gain, drowsiness, dry mouth, confusion, and increased or decreased blood pressure
Fezolinetant	Reduces hot flash frequency and severity	Side effects include abdominal pain, diarrhea, difficulty sleeping, back pain, hot flushes, and rare reports of liver injury. Liver function tests are needed before starting and every 3 months for first 9 months of treatment
Gabapentin	May be effective for relieving hot flashes and night sweats	Side effects include drowsiness, dizziness, headache, rash, weight gain, or leg swelling
Treatment of vaginal and urinary tract symptoms
Low-dose vaginal estrogen therapy	Relieves vaginal dryness and pain during intercourse Decreases incidence of recurrent urinary tract infections Improves stress and urge urinary incontinence	Low-dose vaginal estrogen therapy is unlikely to increase the risk of estrogen sensitive cancers such as breast or uterine cancer.
Vaginal DHEA	Relieves vaginal dryness and pain during intercourse Decreases incidence of recurrent urinary tract infections Improves urge urinary incontinence	May cause increased vaginal discharge or changes in Pap test results
Ospemifene (a SERM)	Relieves pain during intercourse Usually used by women who are not able to self-administer vaginal medications, estrogen, or DHEA (eg, if they have severe arthritis)	May worsen hot flashes temporarily May increase the risk of blood clots in the legs and lungs
* At a dose level used for general menopausal symptoms, estrogen therapy used alone (without a progestogen) can cause cancer of the uterine lining (endometrial cancer) in women with a uterus (have not had a hysterectomy). † Lower doses of estrogen and estrogen given as a skin patch (transdermal) or vaginal ring have a lower risk of blood clots, stroke, and gallbladder disorders (such as gallstones) than when estrogen is taken as a pill.
DHEA = dehydroepiandrosterone; HDL = high-density lipoprotein; LDL = low-density lipoprotein; SERM = selective estrogen receptor modulator; SNRI = serotonin-norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor.

Medication

Benefits

Disadvantages

Treatment: General Menopausal Symptoms (such as hot flashes, mood changes, sleep issues)

Menopausal hormone therapy (previously called hormone replacement therapy)

Estrogen therapy, usually with a progestogen (estrogen is used alone only if a woman has had a hysterectomy [surgical removal of the uterus]*)

Relieves hot flashes, night sweats

Usually relieves vaginal dryness and pain during intercourse

Helps prevent osteoporosis and reduce the risk of bone fractures

Combination therapy (estrogen plus a progestogen):

Increases the risk of blood clots in the legs, blood clots in the lungs, stroke, gallbladder disorders (such as gallstones), and urinary incontinence†
After 3–5 years of use, increases the risk of breast cancer slightly
If women are over age 65 when they start it, increases the risk of coronary artery disease and dementia

Estrogen therapy alone:

Most risks are the same as combination therapy
May slightly increase the risk of breast cancer but probably not for many years, and the increase in breast cancer risk appears to be less than with combination estrogen and progestogen therapy

Progestogen alone, includes synthetic progestins (such as medroxyprogesterone acetate) and natural progesterone (micronized progesterone)

Relieves hot flashes but is not as effective as estrogen therapy

Reduces the risk of endometrial cancer (cancer of the lining of the uterus)

An option for some women who are at high risk of forming blood clots and cannot use estrogen therapy

Does not relieve vaginal dryness

May cause abdominal bloating, breast tenderness, increased breast density, mood disturbances, and/or headache

May increase LDL (the unhealthy type of cholesterol) levels

May increase the risk of blood clots in the legs and lungs, but probably has less risk than estrogen therapy

Micronized progesterone: May have a less negative effect on mood and LDL cholesterol than synthetic progestins

May cause drowsiness (and so is usually taken at night)

Appears to have fewer side effects (such as moodiness, bloating, or breast tenderness) than synthetic progestins

Conjugated estrogen plus bazedoxifene

Conjugated estrogen plus bazedoxifene (a SERM)

Relieves hot flashes, night sweats

Improves sleep

Usually relieves vaginal dryness and pain during intercourse

Protects the uterus without the need for a progestogen

Helps prevent osteoporosis and reduce the risk of bone fractures

May increase the risk of blood clots in the legs and lungs

Does not appear to increase breast density or incidence of breast cancer

Less breast tenderness and breakthrough vaginal bleeding than with other types of hormone therapy

Nonhormonal medications

Antidepressants:

SSRIs, such as desvenlafaxine, fluoxetine, sertraline, low-dose paroxetine salt, and sustained-release paroxetine salt

SNRIs, such as venlafaxine

Relieve depression, anxiety, irritability, and insomnia

May be effective for relieving hot flashes

Side effects vary depending on the medication and may include sexual dysfunction, nausea, diarrhea, weight loss, weight gain, drowsiness, dry mouth, confusion, and increased or decreased blood pressure

Fezolinetant

Reduces hot flash frequency and severity

Side effects include abdominal pain, diarrhea, difficulty sleeping, back pain, hot flushes, and rare reports of liver injury.

Liver function tests are needed before starting and every 3 months for first 9 months of treatment

Gabapentin

May be effective for relieving hot flashes and night sweats

Side effects include drowsiness, dizziness, headache, rash, weight gain, or leg swelling

Treatment of vaginal and urinary tract symptoms

Low-dose vaginal estrogen therapy

Relieves vaginal dryness and pain during intercourse

Decreases incidence of recurrent urinary tract infections

Improves stress and urge urinary incontinence

Low-dose vaginal estrogen therapy is unlikely to increase the risk of estrogen sensitive cancers such as breast or uterine cancer.

Vaginal DHEA

Relieves vaginal dryness and pain during intercourse

Decreases incidence of recurrent urinary tract infections

Improves urge urinary incontinence

May cause increased vaginal discharge or changes in Pap test results

Ospemifene (a SERM)

Relieves pain during intercourse

Usually used by women who are not able to self-administer vaginal medications, estrogen, or DHEA (eg, if they have severe arthritis)

May worsen hot flashes temporarily

May increase the risk of blood clots in the legs and lungs

* At a dose level used for general menopausal symptoms, estrogen therapy used alone (without a progestogen) can cause cancer of the uterine lining (endometrial cancer) in women with a uterus (have not had a hysterectomy).

† Lower doses of estrogen and estrogen given as a skin patch (transdermal) or vaginal ring have a lower risk of blood clots, stroke, and gallbladder disorders (such as gallstones) than when estrogen is taken as a pill.

DHEA = dehydroepiandrosterone; HDL = high-density lipoprotein; LDL = low-density lipoprotein; SERM = selective estrogen receptor modulator; SNRI = serotonin-norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor.

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