Vaginal Therapies That Contain Hormones
Hormonal options for the relief of vaginal symptoms include:
- An estrogen-containing soft ring
- Vaginal estrogen suppositories
- Vaginal estrogen cream
Vaginal estrogen rings and suppositories may slightly increase blood estrogen levels, but for only a short time .
Creams may slightly increase blood estrogen levels for a longer time . If your breast cancer was hormone receptor-positive, using a vaginal estrogen ring or vaginal estrogen suppositories is preferred over a vaginal estrogen cream .
Talk with your health care provider about whether these products may be safe options for you. All require a prescription.
Common Types Of Lubricants: Oil Water
Ideal for people with sensitive skin or vaginal irritation and are safe to use with condoms and sex toys. However make sure your lube has proper osmolality and pH level . Water-based lubes tend to get “sticky” and you may need to re-apply if you are engaging in sex for a long time.
Very slippery and long lasting and is safe to use with condoms. However, silicone-based lubes cannot be used with silicone sex toys, as they can damage the toy. Silicone-based lubes may be more difficult to wash off skin than water-based and may stain sheets, so keep that in mind.
We like to recommend organic coconut oil. Oil based lubes are slippery and last longer than water-based lubes. However, oil based lubes are not compatible with latex condoms, as they make the condoms easier to break. Like silicone-based lube, oil-based can stain sheets and be harder to wash off than water-based lube.
Consult with your doctor to see if a genital-safe lidocaine gel or ointment could help with your pain with sex. Lidocaine temporarily numbs whatever it comes in contact, so it may help reduce pain at the opening of the vagina. However, be aware that lidocaine may affect the sensation of your partner as well.
Ongoing Treatment And Follow
Any treatment for hot flushes needs to be evaluated periodically. Before switching from one treatment to another there may need to be a gradual tapering of medication.
Content updated August 2016
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Prescribing Nk3 Antagonists After Hrt
Originally developed for schizophrenia, its action against NK3 led to Imperial researchers, in collaboration with the pharma developers, to identify NK3 antagonist MLE4901 as a potential candidate against menopause-related VMS.
In a study carried out between 2016 and 2017 led by Imperial professor Waljit Dhillo, MLE4901 reduced the frequency of hot flushes by 50% in just three days and by 75% over four weeks in post-menopausal women aged between 40 and 62 who reported having seven or more bothersome hot flushes per day.
Dhillo commented: We already knew this compound could be a game-changer for menopausal women, and get rid of three-quarters of their hot flushes in four weeks. But this new analysis confirms the beneficial effect is obtained very quickly within just three days.
Lead author of the study, which was published in the journal Menopause, Dr Julia Prague added: To see the lives of our participants change so dramatically and so quickly was so exciting, and suggests great promise for the future of this new type of treatment.
In addition to reducing the frequency of hot flushes, MLE4901 was able to mitigate the severity of this VMS, as well as improve sleep quality women involved in the study reported an 82% decrease in the amount hot flushes interrupted their sleep.
Treatments For Vaginal Dryness
Vaginal dryness and discomfort can be bothersome menopausal symptoms for some women.
Several non-hormone treatments, including vaginal moisturizers, lubricants, and gels, are available to help treat vaginal dryness. If these aren’t helpful, low-dose hormonal rings, tablets, capsules, or creams that are put directly into the vagina might be helpful.
Devices that use lasers or other forms of energy to ‘rejuvenate’ vaginal tissue are now being studied as well, although it’s not yet clear how helpful they might be. It’s important to discuss the possible risks and benefits of these treatments with your doctor before deciding if one is right for you.
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Diet Supplements And Plant
Theres little evidence that diet supplements or plant-based remedies reduce hot flashes or vaginal symptoms.
Randomized controlled trials of the following dietary supplements have found no benefit over a placebo for hot flashes or vaginal symptoms :
- Black cohosh
|For a summary of research studies on other supplements for menopausal symptoms, visit the Breast Cancer Research section.|
Menopausal Hormone Therapy After Breast Cancer
Taking post-menopausal hormone therapy , also called hormone replacement therapy , to help with menopause symptoms may not be safe for women who have had breast cancer. If you are bothered by menopause symptoms, talk to your doctor about ways to get relief.
Many women have menopause symptoms such as hot flashes after treatment for breast cancer. This can happen naturally as women get older, but it can also be caused by some breast cancer treatments. Some pre-menopausal women have menopause symptoms as a result of chemotherapy or from hormone therapy drugs used to treat breast cancer . Women who are past menopause might also get symptoms if they had to stop taking PHT when they were diagnosed with breast cancer.
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How Long Do You Take Mht
Current guidelines recommend women who take MHT for menopausal symptoms take the lowest effective dose to alleviate symptoms for as long as is needed. For the treatment of symptoms, women can stay on MHT for as long as is required to relieve their symptoms. Current thinking is that the benefits of MHT far outweigh the risks in healthy women within 10 years of the menopause or between 50 and 60 years of age. MHT does not need to be discontinued after five years because:
- the mean duration of menopausal symptoms is approximately eight years
- 20â25% of women will have bothersome symptoms in their 60s and 70s
- 10% of women will have bothersome symptoms for 10 years or more.
Every year, it is important to have a discussion with your doctor about management of your menopausal symptoms. Some women can take MHT safely for many years, but this must be assessed on an individual basis and be supported with annual reviews by your doctor.
In women with premature menopause, MHT is prescribed in high doses and recommended to continue until the age of expected menopause, about 50-52 years.
A progestogen may be prescribed as an IUD, usually initiated in the perimenopause
As a general rule when using MHT in midlife:
- start low
- review often
Selective Serotonin Reuptake Inhibitors And Selective Serotonin
Selective serotonin reuptake inhibitors and selective serotonin-norepinephrine reuptake inhibitors are effective non-hormonal alternatives for vasomotor symptoms , reducing HFs intensity and frequency in percentages ranging from 20% to 65% .
Since HFs are thought to occur due to the changes in thermoregulation induced by oestrogen deprivation, with a consequent decrease in serotonin levels , the block of serotonin and norepinephrine receptors induced by SSRIs and SNRIs may oppose this imbalance.
Even if many studies have assessed the efficacy of SSRIs and SNRIs in reducing HFs , paroxetine salt 7.5 mg/day is the only officially Food and Drug Administration -approved product for the treatment of moderate-to-severe vasomotor symptoms in menopausal women .
Among SSRIs, paroxetine, sertraline, fluoxetine and escitalopram have been studied for HFs in menopausal women, with most of the studies reporting positive results . As regards SNRIs, duloxetine, venlafaxine and its active metabolite O-desmethylvenlafaxine have also shown a benefit in HF reduction .
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Adverse Effects And Dosage
Most of the studies reported transient, dose-related adverse effects. The most common adverse effects reported were insomnia or excitement, nausea, constipation, and anorexia.2,5,7 In the trials using venlafaxine for hot flashes there were no reported increases in blood pressure, which is a dose-related adverse effect commonly associated with this agent.6,8
The dosage and duration of these medications most appropriate in alleviating hot flashes is unknown however, regimens using low to moderate dosages seem to be as effective as those using high dosages and have significantly fewer reported adverse effects. Therefore, when using an SSRI or venlafaxine to treat hot flashes, it is prudent to initiate the medication at a low dosage and titrate to effect.
Non Hormone Menopause Treatments
Herbal supplements are definitely worth a try.
- black cohosh
- high intensity interval training
These can all increase the level of your endorphins and enkephalins. Whether you’re in menopause or not, all these forms of exercise will lead to a greater sense of well-being, more muscle and bone strength, and less depression and anxiety. Weight loss may be a side effect of exercise, expecially when it’s combined with strategic calorie reduction and adjusting your “macros,” which are your carbohydrate, protein, and fat intake.
In menopause, many of these same benefits are going to come your way with exercise. In addition, you may have fewer hot flashes when you exercise regularly.
Side note: Vigorous exercise after you go into menopause, even 5 or more times a week, may not give you the weight loss results you once achieved. It’s a lot harder to lose weight in menopause because your reduced hormone levels are causing your body to conserve fat instead of letting it go. That’s why women over 50 get something called “visceral fat.” Visceral fat is fat inside your abdomen, around your organs. It’s closely associated with a bunch of serious health risks as you get older.
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Interactions With Other Drugs
It is not recommended to take non-hormonal drugs at the same time with menopause with barbiturates and Rifampicin .
You should not combine hormonal and non-hormonal drugs without the permission of the doctor – especially for medications based on estriol and corticosteroid hormones.
The combination of different herbal preparations, if their kinetic properties are not investigated, is also not recommended, since this can lead to unpredictable effects.
Why Would I Choose An Alternative To Hrt
Not every woman chooses HRT or can have HRT to help their symptoms of the menopause. For you, this may be because:
- You want an alternative treatment that works especially well for one particular symptom
- You have concerns about the safety and side effects of HRT
- You would prefer alternative treatments to help alleviate symptoms of the menopause
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Tips For Managing Menopause
Get Help Ask QuestionsAvoid Scams
for the latest menopause alerts and other tips for women.
Hot flashes? Irregular periods? Mood changes?
Menopause can have a big impact on your daily life. Dont go it alone! Use these tips and resources from FDA to help you talk to your healthcare provider about managing your symptoms before, during, and after menopause.
How Do I Treat A Hot Flash
Hot flashes may seem like an inevitable symptom of menopause that you just need to deal with. But there are treatment options to improve your hot flashes. If you have hot flashes, particularly hot flashes that disrupt your daily life, reach out to your healthcare provider to learn more about your treatment options.
In general, there are two categories of treatment options for hot flashes: prescription medications and over-the-counter therapies. Some prescription medications are used as off-label treatments to help reduce hot flashes. Using a product off label means that its not FDA-approved for the treatment of hot flashes, but is often used because it can be safe and effective as a treatment option.
Its important to talk to your healthcare provider about any treatment option and discuss the pros and cons. Your provider is aware of your medical history and other medications. Some treatment options may not be safe to take with your other medications or other medical conditions.
Prescription medications are typically considered to be more effective than over-the-counter treatments. These medications can include:
Hormone replacement therapy
Hormone replacement therapy boosts your hormone levels and can relieve some of the symptoms of menopause. Your provider will consider whether your uterus is in place or has been removed when prescribing hormone replacement therapy. Theyll prescribe:
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Frequently Asked Questions Expand All
When progestin is added, it can come in different forms, including pills you take by mouth, or tablets and gels you place in the vagina. The intrauterine device , which releases progestin, also may be an option. Progestin also can be combined with estrogen in the same pill or patch.
You and your obstetriciangynecologist can talk about what form may work best for you. You can decide based on your symptoms, medical history, and lifestyle.
Estrogen-only therapy is taken daily. There are two ways to combine estrogen and progestin for women who still have a uterus:
Continuous-combined therapy: Both estrogen and progestin are taken every day.
Cyclic therapy: Estrogen is taken daily. Progestin is added for 10 to 14 days each month . Another name for this is sequential hormone replacement therapy.
You and your ob-gyn can discuss the approach that works best for you.
Talk with your ob-gyn about what may work best for you based on your symptoms and your personal and family medical history. If you decide to take hormone therapy, you and your ob-gyn should talk every year about whether to continue hormone therapy. Each year, this decision will depend on your symptoms, risks, and benefits. Some women may need longer therapy if their symptoms go on for a long time.
Both systemic and local estrogen therapy relieve vaginal dryness.
Breast or endometrial cancer
Hot Flashes Insomnia And Mood Changes
Common non-hormone options here include SSRIs , SNRIs and anti-epileptics. Read on.
SSRI and SNRI antidepressants
Antidepressants in the SSRI and SNRI drug classes are some of the most effective alternatives to hormone therapy for hot flashes, insomnia and mood changes during menopause. And cool fact: SSRIs and SNRIs tend to work faster for menopause symptoms than for depression .
The following antidepressants seem to have similarly modest benefits for hot flashes. Since hot flashes eventually go away in postmenopausal women, these antidepressants can be gradually tapered after one to two years.
Anti-epileptic medications like gabapentin and pregabalin are another good non-hormone option for women with hot flashes from menopause.
Gabapentin: is recommended for women whose hot flashes happen mostly at night. In studies, gabapentin at 900 mg per day was more effective than placebo for hot flashes. Gabapentin works as well as venlafaxine at reducing hot flashes.
Pregabalin: relieves hot flashes at a recommended dose of 300 mg per day. However, gabapentin is probably a better choice than pregabalin, as gabapentin has been better studied for hot flashes and is less expensive.
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What Are The Other Treatment Options
If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your symptoms. Other treatment options include:
- Lifestyle changes: Improving diet, regular exercise and stopping smoking improve overall wellbeing and can make symptoms easier to tolerate. Some psychological treatments e.g. cognitive behavioural therapy and mindfulness may also help
- Menopausal Hormone Therapy : if other things do not work and you are able to have hormone treatment
- Complementary therapies:
If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.
NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individuals personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information must be agreed to and approved by the Australasian Menopause Society.
Common Treatments That May Not Relieve Menopause Symptoms
Although several nonhormonal treatments for menopause are often recommended, there is not enough evidence from clinical studies to recommend them. These include lifestyle changes like getting more exercise or practicing yoga, deep breathing, or relaxation techniques. Nor, despite scores of studies, is there convincing evidence that widely used herbal remedies like black cohosh, dong quai, ginseng, and wild yam are effective, either.
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Cardiovascular Disease & Mht
Cardiovascular disease is the leading cause of death in postmenopausal women. Women aged 50-59 years are generally either perimenopausal or postmenopausal. Cardiovascular disease is uncommon in this age group, but the incidence increases rapidly after 60 years of age.
MHT and cardiovascular health
- reduces cholesterol
- has positive effects on the blood vessel wall
The standard dose of MHT, usually started around the time of menopause, causes no significant increase in cardiovascular disease and may be cardio-protective.
MHT and cardiovascular risk
MHT can increase the risk of blood clots forming when blood-vessel plaques rupture.
MHT should be avoided in women who have established cardiovascular disease.
Increased risk if women commence MHT after 60 years of age.
The Risks & Benefits Of Mht
Many studies have investigated whether MHT increases the risk of cancers, further illness and disease. There have been many reports in the media about the risks of MHT.
In 2002, researchers from a large study in the United States reported that the risks of MHT outweighed the benefits of taking it. This caused an 80% drop in the use of MHT in the United States, and 50% of women in Australia stopped using their MHT. Professor Henry Burger, a founding director of Jean Hailes, says, “At least half of those women saw their symptoms return and that meant their quality of life significantly suffered”, and “I think that was one of the worst consequences â the decreased quality of life and feeling that you couldn’t do anything about it”.
However, a recent comprehensive review of evidence on MHT has found MHT is an effective and safe treatment for the relief of menopausal symptoms for healthy women. The data from this study has shown that in women between 50 and 60 years, the risks of MHT are low.
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