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Dear Changes…
Your Menopause Questions Answered
Need advice on resources available to you for controlling
menopausal symptoms? Here are some frequently asked
questions about what options are available to you.
What is the best way to relieve my
typical symptoms of hot flashes and
vaginal dryness, and if it’s estrogen,
what dosage form is the best?
Prescription estrogen therapy (ET)—as an oral tablet,
skin patch, gel, mousse, spray, or lotion—remains the
most effective treatment for hot flashes. When this type of
“systemic” (circulated through the body) ET is chosen, women
with a uterus must also use another prescription hormone,
progestogen, to protect the uterus. This combined estrogenprogestogen
therapy is called EPT. If hot flash relief from
hormone therapy is the goal, systemic ET or EPT is best.
ET in all dosage forms (oral tablets, skin products, and vaginal
products) is also the most effective treatment for moderate
to severe vaginal dryness. Vaginal forms of ET provide estrogen
“locally” (not circulated through the body); in this case,
progestogen may not be required. If vaginal symptoms are the
only reason to consider hormone therapy, local vaginal ET is
the most appropriate choice. Choices include vaginal creams
(Estrace Vaginal Cream, Premarin Vaginal Cream), a vaginal
ring (Estring), and a vaginal tablet (Vagifem). The newer vaginal
ring (Femring) has both local and systemic effects.
Is hormone therapy for life?
In the past, most women who started hormone therapy for relief
of symptoms such as hot flashes and vaginal dryness stayed on
hormone therapy for life. Although the time of symptoms may
have passed, women liked the fact that using estrogen reduced
their risk of fractures from osteoporosis. Newer research has
resulted in a different practice for most women. Hormone
therapy, even at the lowest dose, should always be used for the
shortest duration possible consistent with treatment goals.
A woman should eventually attempt to reduce or stop hormone
therapy when appropriate for her, and always in consultation
with her healthcare provider. If bothersome symptoms
persist, hormone therapy can be resumed or other strategies
can be tried. For the majority of women, a point will be reached
when symptoms are gone for good, and hormone therapy can
be stopped.
Importantly, however, hormone therapy is an effective
option for some women to use long-term to keep bones
strong. Some women may decide to continue long-term
hormone therapy for other potential or perceived benefits.
The decision should be revisited regularly to reassess the
risk/benefit ratio for each individual in light of her health and
research advances.
I have a very similar body type to
my sister, so why do we receive very
different dosages of hormone therapy?
Each woman experiences their menopausal transition in
a unique way, and therapy needs can vary. Several factors
to consider include the kind of therapy as well as the dose.
These decisions will be based on finding a treatment that
works while minimizing any associated risks.
One way to lower potential risk with any type of drug
treatment, including hormone therapy, is to use the lowest
effective dose. Some clinicians start with a standard dose
and adjust up or down as needed for symptom relief. Other
clinicians start very low and go up when required. Today’s
hormone therapies are available in very low doses to help
with this approach. Research has shown that “lower than
standard” doses of estrogen are almost as effective for
symptom relief as standard doses.
It is important to remember that one milligram of one type
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