Hormone Replacement Therapy
Hormone replacement therapy, or HRT, is one of the best known, yet controversial, types of menopause medications. It is often referred to as menopausal hormone therapy (MHT), or simply hormone therapy.
As the name suggests, HRT works by replacing reproductive hormones in a woman's body when her ovaries no longer make sufficient amounts. It contains synthetic hormones: estrogen, progesterone, or, less commonly, testosterone.
HRT is considered highly effective for relieving numerous menopause symptoms, from hot flashes, memory lapses, and tingling extremities to loss of libido, vaginal dryness, and sleep disorders. It may also help reduce the risk of osteoporosis.
However, studies have linked long-term HRT use to serious health risks, including an increased likelihood of heart disease, stroke, and certain cancers.1 Some of those risks may still exist after a decade after its discontinuation.2 As a consequence, HRT use is now generally limited to short-term treatment of severe symptoms or significant health risks.
Bioidentical Hormone Replacement Therapy
Bioidentical hormone replacement therapy (BHRT) is another type of menopause medication that may be offered to menopausal women. It is also called natural hormone replacement therapy.
BHRT contains hormones from plant (e.g., yams or soy) or animal sources (pregnant mare urine) that are processed to be chemically identical to human hormones. Their exact hormone composition can be customized to fit a woman's needs.
By supplying the body with external hormones, these medications help alleviate a variety of menopause symptoms, including vaginal dryness, mood swings, night sweats, fatigue, and difficulty concentrating.
While the fact that these medications are made from natural sources may make one think that they are a better alternative to synthetic HRT, studies have not proven their superiority in terms of safety or efficacy.3 As such, their use should also be closely evaluated by the prescribing physician to ensure their risks do not outweigh their benefits.
Non-Hormonal Menopause Medications
For women who do not want to or cannot be on hormone therapy, other non-hormonal menopause medications may bring relief. They are generally tailored to each woman's discomforts.
Some of the most common symptom-specific menopause medications include the following:
Antidepressants, such as citalopram, can be prescribed at low doses to relieve various psychological difficulties, including depression, anxiety, and panic attacks. They can also be used for intense hot flashes and night sweats.
Osteoporosis medications, such as raloxifene or risedronate, can be offered to slow down bone loss, which is a major risk factor in postmenopausal women.
Antihistamines, such as cetirizine, can be beneficial for alleviating midlife allergies and - possibly – other menopause symptoms, although more studies are needed to validate their non-allergy uses.
Prescription sleeping aids, such as benzodiazepines, can help treat symptoms of sleep disorders as well as anxiety.
Other medications that are normally used to treat seizures or high blood pressure may offer relief from hot flashes, including gabapentin and clonidine.
While middle-aged women are encouraged to relieve menopausal discomforts naturally, medications are sometimes necessary for intense symptoms. Hormone replacement therapy is a well-known type of treatment that contains synthetic hormones. Though effective, HRT use is limited to severe symptoms due to serious health risks. Its closest alternative, bioidentical hormone therapy, contains hormones made from plant or animal sources. While it may seem safer than HRT, studies have shown it can cause similar complications. In terms of non-hormonal medications for menopause, women may be offered various options depending on the discomforts they experience. Since all medications come with potential side effects, their use should be carefully evaluated by women's physicians on an individual basis.
- American Family Physician. (2016). Hormone Therapy and Other Treatments for Symptoms of Menopause. Retrieved April 26, 2021 from https://www.aafp.org/afp/2016/1201/p884.html
- Australian Menopause Society. (2017). Non-hormonal treatment options for menopausal symptoms. Retrieved April 26, 2021 from https://www.menopause.org.au/health-info/fact-sheets/non-hormonal-treatment-options-for-menopausal-symptoms
- Better Health Channel. (2018). Hormone replacement therapy (HRT) and menopause. Retrieved April 26, 2021 from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hormone-replacement-therapy-hrt-and-menopause
- Cleveland Clinic. (2014). Bioidentical Hormones. Retrieved April 26, 2021 from https://my.clevelandclinic.org/health/articles/15660-bioidentical-hormones
- Harvard Health Publishing. (2019). Sex hormones and your heart. Retrieved April 26, 2021 from https://www.health.harvard.edu/heart-health/sex-hormones-and-your-heart
- Medline Plus. (2021). Hormone Replacement Therapy. Retrieved April 26, 2021 from https://medlineplus.gov/hormonereplacementtherapy.html
- National Cancer Institute. (2018). Menopausal Hormone Therapy and Cancer. Retrieved April 26, 2021 from https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/mht-fact-sheet#are-there-alternatives-for-women-who-choose-not-to-take-menopausal-hormone-therapy
- NHS. (2019). Hormone replacement therapy (HRT). Retrieved April 26, 2021 from https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/
- Planned Parenthood. (n.d.). What treatments are there for menopause symptoms? Retrieved April 26, 2021 from https://www.plannedparenthood.org/learn/health-and-wellness/menopause/what-treatments-are-there-menopause-symptoms
- JAMA. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. Retrieved April 26, 2021 from https://pubmed.ncbi.nlm.nih.gov/12117397/
- The Lancet. (2019). Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Retrieved April 26, 2021 from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext
- Mayo Clinic. (2019). Bioidentical hormones: Are they safer? Retrieved April 26, 2021 from https://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/bioidentical-hormones/faq-20058460