MENOPAUSE

Progesterone

Estrogen stimulates the growth of the inner lining of the uterus (endometrium); it is the endometrium that sheds during menstruation. ERT used after menopause can also stimulate endometrium growth, but this growth may occur uncontrollably and even result in cancer.

Progesterone counteracts this dangerous effect on the uterus and reduces the risk of developing uterine cancer by causing monthly shedding of the endometrium. Therefore, when a menopausal woman has not had a hysterectomy (has an intact uterus), progesterone is used in combination with estrogen.

In rare instances, progesterone may be used without estrogen to treat hot flashes and other symptoms of menopause. Generally, however, most physicians recommend that women who have a uterus use a combination of estrogen and progesterone to combat symptoms of menopause and reduce the risk of uterine cancer.

Progesterone is available in synthetic forms (progestins) and natural forms. Natural progesterones appear to cause fewer side effects than synthetic progesterones.

Progesterones frequently prescribed include:

1. Medroxyprogesterone acetate-tablet or injection
2. Norethindrone acetate-tablet
3. Micronized progesterone-tablet, cream, or suppository

Combination Therapy

Combinations of estrogen and progesterone in a single pill may be prescribed to make the daily treatment regimen easier.Common combination prescriptions include:

• Conjugated estrogens and medroxyprogesterone-tablet
• Estradiol and norethindrone-tablet or patch
• Estradiol and micronized progesterone-tablet

Testosterone

Although generally considered a male hormone, testosterone may be prescribed to a woman in small amounts in combination with estrogen. Testosterone appears to improve bone mass, sexual drive, and mental alertness. Side effects of this therapy include increased body hair, acne, fluid retention, anxiety, and depression.

The long-term risks of testosterone are not well known at this time.Common prescriptions with testosterone include:

A woman who either cannot or who chooses not to take estrogen may be advised to try a class of drugs called selective estrogen-receptor modulators (SERMs). Raloxifene, the main drug in this category used for menopause, helps to prevent osteoporosis without increasing a woman's risk of developing breast or uterine cancer. These medications do not improve symptoms of menopause, however, and may even make those symptoms worse.

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