One of the ways to manage the symptoms associated with menopause is to replace the hormones you are losing with one of several types of prescription drugs known as hormone therapy (HT), listed below:
For women who still have their uterus, a combination of the hormones estrogen and progestin (a synthetic form of the hormone progesterone) is recommended. Estrogen used alone increases the risk for endometrial cancer (cancer of the tissue lining of the uterus) for women with a uterus, so progestin is added to counter this risk. A new drug, Duavee, which contains a mixture of estrogens and bazedoxifene was recently approved by the FDA for hot flashes and to prevent postmenopausal osteoporosis in women with a uterus. Bazedoxifene is an estrogen agonist/antagonist and reduces the risk for endometrial hyperplasia and is a substitute for progestin.
For women who have had their uterus removed, the prescription of estrogen alone is the recommended hormone therapy typically prescribed.
Another type of hormone therapy for women who have their uterus and want to avoid estrogen is progesterone-only therapy. It is sometimes used during perimenopause to relieve hot flashes. The December 2013 ACOG guidelines do not recommend progesterone alone due to "inconsistent scientific data" and side effects that can include mood swings, spotting or bleeding, breast tenderness and headaches. However, results from a new study published in PLoS One in January 2014, reported that progesterone (oral micronized) has short-term cardiovascular safety.
You can choose from many types of delivery systems to administer hormone therapy, such as:
- Pills—taken orally
- Creams—applied to skin
- Gels—applied to skin
- Patches—applied or adhered to skin
- Rings—inserted vaginally/applied directly
- Suppositories—inserted vaginally, rectally or in the urethra
Side effects and dosages vary for each of these methods and should be discussed with your OB/GYN or healthcare provider. Certain risks associated with HT may be averted by changing the mode of drug delivery.