Menopausal symptoms

 

Lifestyle measures: Healthy diet/regular exercise/avoiding smoking/reducing alcohol, caffeine, and stress, can all help to reduce symptoms to some extent.

 

Therapy for hot flushes:

 

  • HRT – 77% reduction relative to placebo, plus significant reduction in symptom severity.

  • SSRIs – 60% reduction with fluoxetine 20 mg od, 50% with paroxetine 12 – 25 mg od

  • Venlafaxine – 37% reduction at 37.5 mg daily and 61% reduction at 75 mg daily, but no extra benefit in going up to 150 mg daily. (Note no longer needs to be prescribed by psychiatrists only.)

  • Progestagens – megestrol 20 – 80 mg daily reduces by 85%, but note glucocorticoid activity hence risk adrenal suppression. Also, can cause transient increase hot flushes for first fortnight. Medroxyprogesterone 20 – 100 mg daily and norethisterone 5 – 10 mg daily can also be effective. However, note possible risk VTE at high doses. Breast safety unknown.

  • Gabapentin 300 – 1600 mg daily – 45% reduction (and can also help with general aches & pains).

 

 

Possible causes of poor symptom control on HRT:

 

  • Insufficient time – needs 3 – 6 months to get full benefit of therapy

  • Inadequate oestrogen dosage (changing to non-oral route can help as well as increasing dose)

  • Poor compliance

  • Drug interactions

  • For patches – poor adhesion (change route)

  • Incorrect diagnosis (consider thyroid dysfunction as alternative)

  • If bowel disorder, poor absorption

  • Unrealistic expectations.

 

 

HRT risks:

 

  • Cardiovascular – note possibly cardioprotective when used in early stages, though evidence conflicting.

  • Breast cancer (use >5 yrs)

  • VTE – about an extra 1 in 500 for combined, 0.69/1000 for oestrogen only.

  • Endometrial cancer – note small risk remains with sequential HRT though apparently not with combined.

 

Try reducing then stopping every 2 – 3 years, but emphasis is moving away from feeling there to be a set time limit on the duration of use.

 

 

JAMA 1980; 244: 1443 – 5 and BJOG 1992; 89: 464 – 72.

 

 

(Prescriber 24(1/2) Jan 2013)

 

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Credits 2013, Gynaecology, HRT, Medication. Bookmark the permalink.

One Response to Menopausal symptoms

  1. Pingback: HRT | A Spoonful Of Sugar

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