Vaginal lubricants and moisturizers such as Replens can help with the atrophy and dryness associated with menopause. In addition, regular sexual intercourse may help maintain elasticity in the vagina. Intravaginal estrogen (cream that is placed directly into the vagina) also helps with pain and dryness and may decrease the number of recurrent urinary tract infections. The intravaginal estrogen dose is low and does not affect overall estrogen blood levels. Therefore, this cream does not seem to pose a high risk of negative side effects. Addressing Hot Flashes:
Estrogen is the most beneficial medication for treating hot flashes, and has been used for almost sixty years. It decreases hot flashes by about 80%, or two to three hot flashes a day. Estrogen is given most commonly as part of hormone replacement therapy (HRT). Hormone replacement therapy involves the prescription of both estrogen and progesterone if a woman still has a uterus. This combination protects a woman from developing endometrial cancer, by limiting the amount of unopposed estrogen that enters the body. In addition, the presence of progesterone stops the uncontrolled growth of the uterine lining. If a woman does not have a uterus, she can be placed solely on estrogen to treat menopausal symptoms.
Potential side effects of estrogen treatment include bloating, headache, breast tenderness and irritability. Women often have unpredictable uterine bleeding during the first six to twelve months of treatment, but eventually there is shrinking of the endometrial lining and bleeding ceases. As mentioned above, a potential risk of hormone replacement therapy is endometrial cancer (if an estrogen-only regimen is used for a woman who still has a uterus). There is also an increased risk of deep vein thrombosis (most commonly a blood clot forms in a blood vessel deep in the leg) in the first year of treatment, as well as a possible increase in the likelihood of developing gallbladder disease and/or increased triglyceride levels. Concerns about increased heart disease, stroke and breast cancer still remain. Ongoing research is being conducted to help clarify the relationship between HRT and these illnesses. Estrogen therapy and hormone replacement therapy during the menopausal years remains controversial. See our section on Menopausal controversies for more discussion about this topic.
Other medications such as SSRIs (a class of antidepressant medications) are used to treat women with severe hot flashes who cannot use HRT. While the decrease in hot flash symptoms with SSRIs is less than with estrogen therapy, there is still benefit. On average, SSRI's such as venlafaxine, fluoxetine and paroxetine decrease hot flashes by about 40 to 60% depending on the dose and type of medicine used.
Alternative medications used if HRT and SSRI's are not an option include gabapentin and clonidine (which are medications traditionally used for seizures, chronic pain and blood pressure control).