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What treatments are available for menopausal hormone therapy?

A variety of treatment options are available to alleviate bothersome menopausal symptoms. Relief can come in the form of patches, pills, rings, creams and sprays. The various treatments can begin to work within a few weeks or in cases of more serious vaginal atrophy, a few months. In any case, the lowest effective dose of estrogen should be used. It’s important to consider the risks and benefits of each option before deciding which is right for you. Some options are described below. For more information or to schedule an appointment please contact us at 513-404-4166.

  • Low Dose Birth Control Low Dose Birth Control pills treat hot flashes and irregular vaginal bleeding and also provide reliable birth control for women going through menopause. Post menopausal women should not use this treatment because it is too much estrogen to treat hot flashes alone. Birth Control Pill Options
  • Estrogen Patches Containing estradiol, estrogen patches may come with a lower risk of blood clots than estrogen pills, making them a good option for women experiencing menopausal symptoms and / or loss of bone density. 
  • Estrogen and Progestin Combination Patches Combination patches of estrogen and progestin are available to treat menopausal symptoms. The addition of progestin decreases the risk of uterine cancer, and is therefore recommended for any women who still have a uterus and want to try menopausal hormone therapy. There are a number of types and sizes to choose from when it comes to patches. Some need to be replaced more frequently than others, ranging from every couple of days to every 7 days.  
  • Estrogen Pills Estrogen pills come in different varieties as well. There are conjugated estrogen pills, for example Premarin.  There are estradiol pills, which contain the same estrogen that ovaries make prior to menopause. There are also combination pills that deliver both estrogen and progestin, reducing the risk of uterine cancer for menopausal women with a uterus. 
  • Vaginal Estrogen Vaginal Estrogen is typically used to treat dryness as a result of menopause. It is not usually an effective treatment for hot flashes because the dose of estrogen is too low to be absorbed into the blood stream. For this reason, unlike estrogen pills and patches, the addition of progestin is unnecessary when treating women with a uterus. Without estrogen absorption into the bloodstream, there is no added risk of uterine cancer. Vaginal estrogen works by increasing blood flow to tissue, providing stretchiness and immediate relief. More importantly though, vaginal estrogen actually reverses the thinning and dryness of vaginal tissue caused by the onset of menopause. It can be a welcome relief for those who aren't satisfied with moisturizers and lubricants alone, or for those suffering with severe vaginal atrophy. Vaginal estrogen comes in the form of cream, tablets or in a ring. All forms of vaginal estrogen require a prescription and the lowest effective dose should be used.
    • Creams: Vaginal creams should be applied to the vagina 2-3 times per week and not just before intercourse. These creams contain estrogen that can be absorbed into a partner’s skin and therefore should not be used as a lubricant. Common brands are Estrace, Premarin, and Neo-Estrone.
    • Tablets: The vaginal tablet, called Vagifem , effectively treats dryness and may be less messy than estrogen creams. Vagifem should be inserted onto the vagina 2 times per week. 
    • Rings: A low dose vaginal ring, called Estring , treats vaginal dryness but should not be confused with FemRing, a higher dose estrogen that also treats hot flashes and other menopausal symptoms. Estring works by delivering estrogen in a slow release over a 3 month period. A new Estring should be inserted every 3 month, but it does not need to removed prior to intercourse. This is a convenient option for those menopausal women suffering from vaginal dryness. 
    • Pellets: Pellets can provide many benefits to both men and women. Visit our Compounded Testoterone Pellets page for information
  • Available Forms of Progestin Post-menopausal women with a uterus are at an increased risk of uterine cancer if their symptoms are treated with estrogen alone. To help prevent uterine cancer and its precursor, hyperplasia, progestin is prescribed in combination with estrogen. Oral, intrauterine and transdermal (patch) forms of progestin are available to accompany estrogen and alleviate menopausal symptoms.
    • Oral Progestins Oral Progestins include medfroxyprogesterone acetate, and norethindrone and norgesterel (synthetics). Natural progesterone is preferred over synthetics by most doctors because it doesn't affect lipids or cholesterol. Somi Javaid MD & Associates will help you determine which treatment is best for you.
    • Intrauterine Progestin Intrauterine Progestin is delivered thru an IUD, or intrauterine device, in order to prevent pregnancy. Women with an IUD, like Mirena, may want to keep it until menopause is complete if they are taking estrogen as well.
    • Transdermal Progestin -Estrogen and Progestin combination patches work similarly to estrogen skin patches.