Mayo Clinic the Menopause Solution by Stephanie S. Faubion

Author:Stephanie S. Faubion [Stephanie S. Faubion]
Language: eng
Format: epub
Tags: HEA000000
Publisher: Oxmoor House
Published: 2016-04-26T00:00:00+00:00

Alternative options

In addition to standard hormone therapy preparations for menopausal symptoms, other options exist.

TSEC In 2013, the Food and Drug Association (FDA) approved a new type of drug called a tissue-selective estrogen complex (TSEC). This drug pairs a selective estrogen receptor modulator (SERM) with conjugated estrogens. SERMs are estrogen-like compounds but are not hormones per se. As their name implies, they have a selective effect — either blocking or allowing the activity of estrogen in the tissues it acts upon. A number of SERMs are used in the treatment of women’s health conditions. For example, the drug raloxifene (Evista) is a SERM used to prevent and treat osteoporosis. Tamoxifen (Soltamox) is used to prevent and treat breast cancer, and ospemifene (Osphena) is used to treat pain during intercourse.

In the case of the TSEC drug Duavee, conjugated estrogens provide relief from hot flashes, and the SERM bazedoxifene is used in place of a progestogen. Bazedoxifene has a protective effect on the uterus, similar to progestogens, but it seems to have a neutral effect on the breasts — not causing the increase in density seen with some progestogens. However, its long-term effect on breast cancer risk is unknown. The drug also reduces the risk of fractures and is approved to prevent osteoporosis.

The TSEC treatment is relatively new, and more research is needed to fully understand its benefits and risks and the role it might play in the treatment of menopausal symptoms. In theory, it offers an alternative to progestogens for women who are concerned about the increased health risks that seem to come from adding a progestogen to estrogen therapy. However, keep in mind that not all progestogens are the same, and evidence indicates that progesterone doesn’t seem to have the same adverse effects that have been found with synthetic progestins. In addition, the TSEC pairing still contains oral conjugated estrogens, which are associated with an increased risk of stroke and blood clots.

Contraceptives during the menopausal transition

Combination oral contraceptives containing both estrogen and a progestin are a good option for controlling hot flashes in perimenopausal women who still require birth control. They lead to lighter and more-regular periods — which can be a relief if irregular and heavy bleeding is bothersome. They also help preserve bone density, reduce the risk of ovarian and endometrial cancers, reduce painful cramps, and help manage acne. These combination treatments are generally safe for healthy nonsmokers who aren’t overweight, and long-term use hasn’t been shown to increase the risk of breast cancer. Progestin-only options can be used in women who smoke or have other health complications that prevent use of a pill containing estrogen; however, the progestin-only treatments likely won’t help with hot flashes.

If birth control is your primary goal and you prefer to avoid the hassle of a daily pill, longer term options such as subdermal implants that are inserted just under your skin, a copper IUD or a levonorgestrel- releasing intrauterine system (LNG-IUS) are available. Keep in mind these delivery methods won’t improve your hot flashes.

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