Estrogen Replacement Therapy (ERT)

Common names are:

• Conjugated equine estrogens
• Synthetic conjugated estrogens
• Esterified estrogens
• Estropipate
• Micronized 17-beta estradiol
• Estradiol hemihydrate
• Estradiol transdermal spray

ERT provides a small amount of estrogen to replace what your body made during menopause. It helps ease hot flashes and vaginal dryness. Even low doses of estradiol (given as a skin patch) may help with vaginal dryness and pain during sex. It may also lower the risk of osteoporosis. Evamist, which is a spray, is another type of low-dose estradiol that may help ease hot flashes.

Estrogen may be given as a tablet, patch, injection, pellet placed under the skin, vaginal cream, ring, tablet, or spray.

ERT may raise a woman's risk of heart disease, and uterine, ovarian, and breast cancers, blood clots, and stroke. The benefits and risks will need to be weighed. ERT should not be taken long term.

Some problems may be:

• Bleeding
• Sore breasts
• Bloating in the belly
• Nausea
• Fluid buildup
• Headaches
• Light-headedness
• Vision changes

Progestogen

Women who choose ERT will also need to replace the progesterone that the ovaries once made. This is done to lower the risk of uterine cancer from taking ERT alone. Progesterone or progestin, a synthetic progesterone, can be taken as replacement therapy. Women who had a hysterectomy are not at risk for uterine cancer and usually do not need to take progesterone with ERT.

Progestin oral tablet:

• Medroxyprogesterone acetate
• Norethindrone
• Norethindrone acetate
• Norgestrel
• Levonorgestrel
• Megestrol acetate

Progestin injectable:

• Medroxyprogesterone acetate

Progestin IUD:

• Levonorgestrel

Progesterone oral capsule:

• Progesterone USP

Progesterone—vaginal gel:

• Progesterone

Progesterone IUD:

• Progesterone

Some problems are:

• Fluid buildup
• Weight gain
• Headache
• Mood changes

Estrogen Plus Progestogen (Hormone Replacement Therapy–HRT) Oral, Continuous Cycle

• Conjugated equine estrogens and medroxyprogesterone acetate
• Oral, continuous-combined:
  • Conjugated equine estrogens and medroxyprogesterone acetate
  • Ethinyl estradiol and norethindrone acetate
  • 17-beta estradiol and norethindrone acetate

• Oral, intermittent-combined:
  • 17-beta estradiol and norgestimate

• Skin patch, continuous cycle:
  • 17-beta estradiol and norethindrone acetate

• Skin patch, continuous combined:
  • 17-beta estradiol and norethindrone acetate

When progesterone is taken with estrogen, it is called hormone replacement therapy (HRT). Options for HRT are cyclic, continuous-cyclic, continuous-combined, and intermittent-combined. Long-term HRT raises the risk of strokes, blood clots, heart attacks, ovarian, uterine, and invasive breast cancers. The benefits and risks will need to be weighed.

Some problems may be:

• Bleeding or spotting
• Fluid buildup
• Sore breasts
• Headache
• Mood changes
• A risk of gastroesophageal reflux disease (GERD)

Androgen

Androgen oral tablet:

• Methyltestosterone and esterified estrogens

Androgen is a hormone that both men and women make. In women, the ovaries release androgen as testosterone and androstenedione. These are converted into estrogen and progesterone. As a woman ages, the ovaries make less androgen and estrogen. This causes a decline in sex drive in some women. Androgen, which must be taken with estrogen, may help improve it.

Low-dose androgen may be given through a patch or transdermal gel.

Problems are often related to taking the wrong dose. Some problems may be:

• Restlessness
• Depression
• Growth of facial and body hair
• Acne
• An enlarged clitoris
• Increased muscle mass
• A lowered voice
• Increased risk of heart problems

Nonhormonal Medications for Hot Flashes

Medicine may be given to ease hot flashes. Common ones are:

• Clonidine—a medicine that lowers blood pressure
• Gabapentin—an antiseizure medicine
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Common names are: fluoxetine, paroxetine, venlafaxine, desvenlafaxine