Menopause drugs: summary of recommendations
Over the last decade there has been conflicting research and advice about the safety of hormones. This report incorporates the latest evidence to help you make sense of an often confusing topic.
First, you should know that medicines containing various forms of the female hormones estrogen and progestin are highly effective at reducing the symptoms of menopause. Studies show that 70 to 90 percent of women experience an average 75 percent reduction in the frequency of hot flashes and night sweats. The drugs also reduce vaginal dryness.
But these benefits must be weighed against serious adverse effects that hormones can cause. They have been linked to a higher risk of heart disease, heart attack, blood clots, and strokes. Recent research, however, has helped clarify which women are most at risk for such problems and which can consider using hormone products. From that research we make the following general recommendations:
- Don't take hormones if your symptoms are mild and can be managed by changing your lifestyle and habits, such as quitting smoking, sleeping in a cooler room, reducing stress, exercising regularly, and limiting caffeine and alcohol.
- Don't take hormones if you have heart disease or have had a stroke or cancer of the breast, ovaries or uterus.
- Don't take hormones if you have diabetes, high cholesterol or high blood pressure, all of which are risk factors for heart disease; hormones may add to that risk. Also consider avoiding hormones if your father or mother died early from heart disease.
- If the factors above don't apply to you, if your symptoms are severe, and if you are in the first 5 to 10 years of menopause, talk to your doctor about hormones. They could significantly improve your quality of life and pose a low risk of adverse effects for you. The evidence is strong, for example, that women ages 50 to 59 who have a low risk of heart disease and who have entered menopause within the past five years incur no added risk of heart disease when they take hormones. However, they still face an increased risk of breast cancer, blood clots, and stroke.
- Always take hormones for the shortest time possible and at the lowest dose.
- Tell your doctor about your complete medical history. Ultimately, every decision about hormone use must be made on a case-by-case basis.
- Hormones should never be used to treat mood swings, irritability, depression, anxiety, mental lapses, forgetfulness, cognitive difficulties, reduced libido, urinary incontinence, back pain, chronic pain, joint pain, stiffness, or fatigue. They don't help these conditions and could make them worse.
- Be cautious if a doctor or pharmacist recommends using so-called bio-identical hormone products made in pharmacies. They are not regulated by the FDA and have not been shown to be better or safer than commercial products.
Studies continue to examine whether any one form of estrogen or estrogen plus progestin (there are many) is more effective or safer than others. Some forms of estrogen and some types of products may have advantages. But none of this research is definitive at this time.
More important, women differ in their responses to hormone products. For example, pills work better for some women while patches work better for others. Research has shown that hormone products containing estrogen alone pose less risk of heart disease and breast cancer than those containing both estrogen and progestin. However, women who have not had a hysterectomy (surgical removal of the uterus) should take both because estrogen-only products have been conclusively linked to a much higher incidence of cancer of the uterine lining (endometrial cancer).
Many hormone products are available as less-expensive generics, and some brand-name products are reasonably priced, too. Taking into account the wide array of products available to meet women's individual needs and preferences, we chose the following as Best Buys if you need a hormone product:
- Generic estradiol pills
- Gynodiols (estradiol pills)
- Menest (esterified estrogen pills)
- Generic estropipate (pills)
- Generic medroxyprogesterone (pills)
- Generic estradiol (skin patch)
- Estraderm (estradiol skin patch)
- Prempro (estrogen-progestin combination pill)
- Prefest (estrogen-progestin combination pill)
- Climara Pro (estrogen-progestin skin patch)
- Combipatch (estrogen-progestin skin patch)
- Premarin vaginal cream (conjugated equine estrogen)
- FemRing (estradiol vaginal ring)
- Estring (estradiol vaginal ring)
All these medicines are as effective as other hormone drugs, and several are considerably cheaper. Most generic estradiol pills, for example, cost less than $15 a month, and could save you up to $400 a year compared with brand-name Premarin, one of the best-selling products in this class. Likewise, we'd urge you to choose a generic estrogen-only hormone patch if that is clinically appropriate for you; it could save you around $300 a year.
This information was updated in October 2008.