Medications

• Hot flashes: Hot flashes usually last 2-3 years, but many women can experience them for up to 5 years. An even smaller percentage may have them for more than 15 years. Prescription treatments for hot flashes include clonidine (Catapres), a medication that also lowers blood pressure, and belladonna (Bellergal), which contains a medication called phenobarbital. Bellergal has the potential to become addictive and should only be used for a short period of time. Bellergal also causes sleepiness. Studies are underway using certain antidepressants (known as SSRIs) to determine if they reduce hot flashes.
  
  
• Estrogen therapy: Estrogen is a well-established prescription therapy for hot flashes. Estrogen also helps build bone mass, reduces the risk of fractures, and improves cholesterol. Estrogen can be helpful in preventing urinary symptoms and in treating uncomfortable vaginal symptoms.
  
  
  • Some studies suggest women who take estrogen to replace the estrogen their bodies no longer produce may be at reduced risk for colon cancer, although more studies are needed in this area.
    
    
  • Recent clinical trial data indicate that combination therapy of estrogen and progesterone increases the risk of heart disease. The decision to take estrogen therapy (ET) can be made by a woman and her doctor after careful discussion about her symptoms, medical history, family medical history, and desires.
    
    
  • Estrogen is available in a variety of forms, including vaginal suppositories and creams (which are mainly useful for vaginal symptoms), skin patches (Vivelle, Climara, Estraderm, Esclim, Alora), and oral tablets.
    
    
  • Women who have not had a hysterectomy (they still have their uterus) must take estrogen in combination with the hormone progesterone. Estrogen alone increases the risk of abnormal growth in and cancers of the endometrium, or uterine lining. However, this risk is reduced when progesterone is taken along with estrogen on a regular basis. Taking estrogen in combination with progesterone is called hormone therapy (HT).
    
    
  • Hormone therapy appears to increase a woman's risk of breast cancer when used for more than 4 years. The Women's Health Initiative (2002), a large clinical trial, found that women who took estrogen and progesterone had an increased risk of breast cancer after 4 years of use. The Nurses' Health Study, which is following more than 120,000 nurses, has found that women who take hormone therapy for more than 5 years have an increased risk of breast cancer, but a reduced risk of heart disease. Researchers from one large study have shown that estrogen alone decreases the risk of hip fracture and increases the rate of stroke.
    
    
  • Women should undergo a breast exam and mammogram prior to starting estrogen. Once on estrogen, women must be monitored regularly with breast exams and mammograms.
    
    
  • Women who already have heart disease should not use estrogen.
    
    
  • Estrogen therapy does not prevent pregnancy.
    
    
  • Women who take estrogen also tend to have a higher risk of developing:
    
    
    • Gallstones
      
      
    • Increased triglyceride levels
      
      
    • Blood clots
      
      
    • Vaginal dryness and pain with intercourse
  
  
• Bone loss: Several medications may be used for preventing and treating osteoporosis.
  
  
  • The bisphosphonates, which include alendronate (Fosamax) and risedronate (Actonel), have been shown in clinical trials to reduce bone loss in postmenopausal women and to reduce fracture risk in women who have osteoporosis.
    
    
  • Raloxifene (Evista), a selective estrogen receptor modulator (SERM), is another therapy for osteoporosis. It reduces bone loss and appears to reduce the risk of back fractures in women with osteoporosis.
    
    
  • Calcitonin (Miacalcin or Calcimar) is a nasal spray that has been found to reduce the risk of back fractures in women who have osteoporosis.
    
    
  • A prevention drug currently under investigation is the drug PTH (parathyroid hormone).