Medications for Menopause

Menopause is a natural part of aging. It often brings changes like hot flashes, mood swings, and vaginal dryness. These symptoms happen because the body makes less of the hormones, estrogen and progesterone. For many people, these changes can be hard to manage.¹

Thankfully, several types of medicine can help you manage the symptoms of menopause and help you to feel better.

Hormone therapy

Hormone therapy, also called hormone replacement therapy (HRT), is a common treatment for menopause symptoms. It replaces the hormones your body no longer makes. HRT helps reduce hot flashes and night sweats. It may also help prevent bone loss.^1,2

HRT can be systemic or local. Systemic HRT is delivered through pills, patches, or gels. This type of treatment affects the whole body. Systemic HRT can increase your risk of breast cancer, but this effect is only seen after 5 or more years.²

Local HRT is delivered only to the vagina, usually as a suppository or cream. Because the majority of the hormone stays in the vagina, local HRT has fewer side effects. However, it only treats vaginal symptoms.²

There are 2 main types of HRT. Some people take estrogen alone (those without a uterus). Others take a mix of estrogen and progestin. You can take HRT as a pill, a patch, or a gel.^1-3

Common side effects of HRT include breast tenderness, nausea, and vaginal spotting. It is normal to need some trial and error to find the best treatment and dose for you.²

The timing of this treatment is very important. HRT works best and is safest when you start it early. This means starting it within 10 years of the start of menopause. It is also best to start before you are age 60. Talk to your doctor about how to make HRT safest for you.^1-3

Is it safe to take hormone therapy?

While recent guidelines indicate that HRT is generally considered safe, it does carry some risks. These include a higher risk of blood clots, stroke, heart disease, or cancer for some people.^1-3

For example, those with breast or uterine cancer cannot take it because it can cause a relapse. Those with unexplained uterine bleeding cannot take it because the unexplained bleeding could be cancer.^1-3

Those with liver disease, a history of blood clots, or heart disease should not take HRT because of the increased risk of blood clots or heart disease.^1-3

Though there are risks to HRT, there are also many benefits. Treating menopause symptoms can significantly improve your quality of life. When used properly, HRT can also protect your bones, lower your risk of heart disease, and lower your risk of type 2 diabetes. Talk with your doctor about your health history and whether HRT is right for you.^1-3

Non-hormonal prescription drugs for hot flashes

Some people cannot take hormones or prefer not to use them. There are non-hormonal drugs that can help with hot flashes. Examples include:^1,3,4

• Elinzanetant (Lynkuet®) – This is a new drug used to treat moderate to severe hot flashes. It works by blocking 2 signals in the brain that cause hot flashes. Common side effects may include stomach pain or feeling tired.
• Fezolinetant (Veozah®) – This drug works by targeting the part of the brain that controls body temperature. It does not use estrogen to stop hot flashes. Common side effects may include stomach pain or diarrhea.
• Gabapentin (Neurontin®) – A common nerve pain and seizure medicine, it may also be used for hot flashes and night sweats. A side effect of this drug is drowsiness.

Anti-depressants for mood changes

Menopause can cause feelings of sadness or anxiety. It can also cause mood swings. Some low-dose antidepressants can help manage these mood changes.¹

These medicines are called SSRIs or SNRIs. They work by changing levels of the chemicals in the brain that affect mood. Some of these drugs also help reduce hot flashes. Side effects can include nausea or feeling tired. Always tell your doctor about all the medicines you take. If you are struggling with anxiety or depression, you may also find talk therapy, specifically cognitive behavior therapy (CBT) or mindfulness therapy, helpful.¹

Medicines for vaginal dryness

Some menopause symptoms only affect certain parts of the body. Low estrogen levels can cause dryness, pain during sex, or urinary tract infections (UTIs). Local estrogen treatments can help with these symptoms.^1,2

Local estrogen

Local estrogen is applied directly to the area. It comes in several forms:^1,2

• Creams (examples include: Estrace®, Premarin®)
• Vaginal rings/inserts (examples include: Estring®, Femring®, Intrarosa®)
• Tablets (examples include: Vagifem®, Yuvafem®)

These treatments use a very low dose of estrogen (or DHEA in the case of Intrarosa). Most of the hormone stays in the local area. It does not travel through the whole body like systemic HRT drugs do.^1,2

This may make it a safer choice for some people who cannot take other forms of hormone therapy. If vaginal estrogen alone is not improving your symptoms, talk to your OBGYN to see if there are more specialized treatments that may work for you.^1,2

Non-hormonal options

There is a non-hormonal drug that can be used for vaginal dryness and thinning. This drug is:⁵

• Ospemifene (Osphena®) – This is a daily pill that works by making vaginal tissue thicker and less fragile. It can help reduce pain during sex. Osphena has a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). It has this warning because it can increase the risk of endometrial cancer in people with a uterus.

Medicines for improving libido

Hormone changes can lead to a low desire for sex, also called low libido. Some medicines are used to help with these symptoms, including:⁶

• Flibanserin (Addyi®) – This drug can help women under age 65 who have a low sex drive. It works by balancing brain chemicals like serotonin and dopamine to increase sexual desire. Addyi has a boxed warning, the strictest warning from the FDA. It has this warning because, if taken with alcohol, it can lead to severely low blood pressure and loss of consciousness.

Medicines for improving bone health

A drop in estrogen can cause bones to get thin. This is called osteoporosis. Your doctor may suggest medicine to stop bone loss. This reduces the risk of broken bones. You might also take vitamin D or calcium to keep bones strong.¹

Other things to know

Every person experiences menopause differently. A treatment that works for one person might not work for you. It is important to have a fair and balanced view of your options.

Side effects can vary depending on the specific treatment/drug you are taking. Before beginning treatment for menopause, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

You have treatment options

Menopause symptoms like hot flashes and mood changes can be difficult. However, many medicines are now available to help. You can choose from hormone therapy, non-hormonal drugs, or local treatments. There are also lifestyle changes you can make that can help with symptoms.

Each treatment has its own benefits and risks. Work closely with your doctor to find a safe and effective way to feel your best.