Treatments and drugs
By Mayo Clinic staffDrug therapy is often used to treat perimenopausal symptoms.
- Hormone therapy. Systemic estrogen therapy — which comes in pill, skin patch, gel or cream form — remains the most effective treatment option for relieving perimenopausal and menopausal hot flashes and night sweats. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. If you still have your uterus, you'll need progestin in addition to estrogen. Systemic estrogen can help prevent bone loss.
- Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
- Antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may reduce menopausal hot flashes. An antidepressant for management of hot flashes may be useful for women who can't take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
- Gabapentin (Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can't use estrogen therapy for health reasons and in those who also have migraines.
Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.
- Lentz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-0-323-06986-1&eid=4-u1.0-B978-0-323-06986-1..C2009-0-48752-X--TOP. Accessed March 10, 2013.
- Casper RF. Clinical manifestations and diagnosis of menopause. http://www.uptodate.com/home. Accessed March 10, 2013.
- Melmed S, et al. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/191205553-3/0/1555/0.html#. Accessed March 10, 2013.
- AskMayoExpert. What are the US Food and Drug Administration (FDA)-approved clinical indications for menopausal hormone therapy (HT) prescribing? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
- Menopause and menopause treatments. Office on Women's Health. http://www.womenshealth.gov. Accessed March 8, 2013.
- Harlow SD, et al. Executive Summary of the Stages of Reproductive Aging Workshop + 10: Addressing the Unfinished Agenda of Staging Reproductive Aging. Journal of Clinical Endocrinology and Metabolism. 2012;97:1159.
- Casper RF, et al. Menopausal hot flashes. http://www.uptodate.com/home. Accessed March 10, 2013.
- Sood R, et al. Paced breathing compared with usual breathing for hot flashes. Menopause. 2013;20:179.
- Welt CK. Ovarian development and failure (menopause) in normal women. http://www.uptodate.com/home. Accessed March 11, 2013.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 128. Diagnosis of Abnormal Uterine Bleeding: in Reproductive-Aged Women. Clinical Management Guidelines. Obstetrics and Gynecology. 2012;120;197.
- Goodman AK. Initial approach to the premenopausal woman with abnormal uterine bleeding. http://www.uptodate.com/home. Accessed March 4, 2013.
- Bedell S, et al. The pros and cons of plant estrogens for menopause. Journal of Steroid Biochemistry and Molecular Biology. In press. Accessed April 7, 2013.
- MenoNote: Vaginal dryness. The North American Menopause Society. http://www.menopause.org/docs/for-women/mndryness.pdf. Accessed April 4, 2013.
- Zacur HA. Managing an episode of severe or prolonged uterine bleeding. http://www.uptodate.com/home. Accessed March 4, 2013.
- 15. Lo JC, et al. Bone and the perimenopause. Obstetrics & Gynecology Clinics of North America. 2011;38:503.
- 16. Leach MJ, et al. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007244.pub2/abstract. Accessed March 11, 2013.
- Lentz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-0-323-06986-1&eid=4-u1.0-B978-0-323-06986-1..C2009-0-48752-X--TOP. Accessed March 10, 2013.
- Fisher TE, et al. Lifestyle alterations for the amelioration of hot flashes. Maturitas. 2012;71:217.
- Kang HS, et al. The use of acupuncture for managing gynaecologic conditions: An overview of systematic reviews. Maturitas. 2011;68:346.
- Rosen HN, et al. Overview of the management of osteoporosis in postmenopausal women. http://www.uptodate.com/home. Accessed March 11, 2013.
- 21. Metzger ML, et al. Female reproductive health after childhood, adolescent and young adult cancers: Guidelines for the assessment and management of female reproductive complications. Journal of Clinical Oncology. 2013;31:1239.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Dec. 6, 2012.
- American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and the American Society for Reproductive Medicine Practice Committee. Committee Opinion No. 532: Compounded bioidentical menopausal hormone therapy. Obstetrics & Gynecology. 2012;120:411.


Find Mayo Clinic on