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Menopause - Medications

From DrKoop's partner site on breast cancer, MyBreastCancerNetwork.com

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Bisphosphonates. Bisphosphonates help increase bone mass, and are among the primary drugs against osteoporosis in postmenopausal women and in people taking corticosteroids or hormonal drugs that suppress estrogen. They are proving to reduce the risk of both spinal and hip fractures in women who have had prior bone breaks. The standard bisphosphonates include alendronate (Fosamax) and risedronate (Actonel).

Calcitonin. Produced by the thyroid gland, natural calcitonin regulates calcium levels by inhibiting the osteoclastic activity, the breakdown of bone. The drug version is derived from salmon and is available as a nasal spray (Miacalcin) and in injected form (Calcimar). Calcitonin is not used to prevent osteoporosis; it is used to treat osteoporosis. Calcitonin may be an alternative for patients who cannot take a bisphosphonate or SERM. It also appears to help relieve bone pain associated with established osteoporosis and fracture.

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Low-Dose Parathyroid Injections. Although high persistent levels of parathyroid hormone can cause osteoporosis, daily injections of this hormone stimulate bone production. Unlike most treatments for osteoporosis, including bisphosphonates, the benefits may persist even after the injections have been stopped. Teriparatide (Forteo), a drug made from selected amino acids found in parathyroid hormone, is approved for treatment of osteoporosis in postmenopausal women. Studies suggest it may lower the risk of fracture and increase bone mineral density. In one small study, parathyroid significantly reduced spinal fractures compared to hormone replacement therapy.

Drugs to Prevent and Treat Heart Disease

Statins are the most effective drugs for treatment of unhealthy cholesterol levels and are now strongly recommended as the first choice for lipid-lowering treatment for older women with heart disease. Brands include lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), atorvastatin (Lipitor), and rosuvastatin (Crestor). A major analysis of over 200 studies found that statins reduced the risk for heart problems by 60% and stroke by 17%. A 2005 review found that the more that statins lower LDL, the more they reduce CAD and other heart disease risks.

Specific Hormone Replacements Drugs and Brands

HRT Form

Brand Name

Active Ingredient

Side Effects

Oral Estrogens

Premarin

Natural conjugated estrogen, which is a mixture of estrogens derived from the urine of pregnant mares.

Bleeding after withdrawal. It is a primary reason why many women stop treatment, although usually lighter or shorter compared to before menopause. If it is distressing, patient should consider continuous estrogen and progestin therapy.

Irregular bleeding. This should be checked with the doctor for possible problems.

Nausea and vomiting. If it occurs, usually does so only during the first three months and is minimal. Rarely with low doses.

Headaches.

Cramps.

Risk for blood clots.

Cenestin

Synthetic conjugated estrogen, which is a mixture of estrogens derived from compounds found in yams and soy.

Estratab, Menest

Plant-derived estrogens, called esterified estrogens. Usually made from modified soy

Estrace (oral)

Estradiol, the most potent natural estrogen.

Ogen, Ortho-Est

Estropipate, a version of estrone, which is a weaker form of estrogen.

Estrovis

Quinetrol, a synthetic estrogen

Estinyl

Synthetic form estradiol, the most potent estrogen.

Oral Progestins

Provera, Amen, Curretab, Cycrin

Medroxyprogesterone, a synthetic progestin.

Breast tenderness. Usually subsides in three to four months and can be relieved with over-the-counter pain killers and possibly by decreasing caffeine intake and adding vitamin E.

Headache.

Fluid build-up.

Bloating.

Fatigue, unusual tiredness, weakness.

Depression, irritability, or other mood changes.

Norlutin, Aygestin, Norlutate

Norethindrone and norethindrone acetate, synthetic progestins.

Norgestrel.

Oral Combinations of Estrogen and Progestin

Prempro, Premphase

Conjugated estrogens plus medroxyprogesterone.

May have some of the side effects of both estrogen and progestin. Continuous regimens eliminate menstrual bleeding in more than half of women. Investigators are studying the use of higher progestin doses or a lower estrogen doses and comparing combinations for further reduction of bleeding risk.

Activelle, Femhrt

Estradiol and norethindrone or norethindrone acetate.

Ortho-Prefest

Estradiol and norgestimate.
Angeliq

Estradiol and drospirenone.

Skin Patch Administration of HRT

Estraderm, Alora, Climara, Vivelle, FemPatch, Evorel

Estradiol.

Skin irritation where the patch is applied most common. Hormonal side effects associated with formulation of patch.

CombiPath

Estradiol plus norethindrone (a progestin).

Vaginal Creams for dryness and irritation

Estrace (cream)

Estradiol (potent estrogen).

Hormonal side effects associated with estrogen or progestins, depending on formulation.

Ogen (cream)

Estropipate (weaker estrogen.).

Premarin (cream)

Conjugated natural estrogens.

Ortho-dienestrol (cream)

Dienestrol (synthetic estrogen).

Crinone (cream)

A natural progesterone.

Other forms of vaginal administration

Vagifem (vaginal tablet)

Estring (vagina Ring)

Estradiol.

Other forms: injections, nasal sprays, and as pellets inserted under the skin twice a year.

Topical Gel

EstroGel

Estradiol.

Hormonal side effects associated with estrogen.

Review Date: 06/11/2006
Reviewed By: Harvey Simon, M.D., Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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