Burning Women’s Health Questions: What Can Help My Hot Flashes and Vaginal Dryness?
Posted on August 01, 2013
Hormone Therapy (HT)
Menopausal hormone therapy is the BEST treatment for moderate to severe hot flashes. So called “Bio-identical” estrogen is actually FDA approved and is the same estrogen (estradiol) that your own ovaries would produce if you still made eggs.
Prescription FDA-approved Biodentical Hormone Therapy (BHT) is NOT to be confused with the so-called ‘custom’ compounded “Bioidentical” medication that is mixed up in a pharmacy and is unregulated. These types of treatments are NOT approved by the FDA and we do not know the concentration of the medication being made “just for you” - and neither do you! We do not recommend this form of treatment. In fact, compounding should not be the first line of treatment for menopausal symptoms.
Approved BHT comes in many forms to suit a patient’s needs and their lifestyle. The following are available for women:
- Estrogen patches
- Oral tablets
- Vaginal rings
Since one-size does not fit all, there are multiple dosages which can be tailored to the patient’s symptoms. Progesterone is available in oral micronized capsule or vaginal gel and progestins are available with bioidentical estradiol in tablet and patch form.
There are oral therapies that are not BHT, but are FDA-approved medications and well-studied:
- Conjugated estrogens
- Plant based esterified estrogens
Remember: If you have a uterus you must balance the estrogen with progesterone in order to help prevent the stimulation of the lining of your uterus.
Paroxetine Mesylate (Brisdelle)
The FIRST non-hormonal agent Paroxetine mesylate (Brisdelle) 7.5mg/day orally was recently approved for women who suffer from hot flashes that are unable to take estrogen or who choose not to take HT.
The following are OFF Label non-FDA approved options:
- SNRIs - inhibits the uptake of both 5-HT, NE, and dopamine activities
- Venlafaxine (Effexor) (37.5-75mg/day)
- Desvenlafaxine (Pristiq) (50mg/day)
- Duloxetine (Cymbalta) (60-120mg/day)
- SSRIs – inhibits the uptake of 5-HT, and minimal uptake of NE and dopamine
- Fluoxetine (Prozac, Sarafem) (20mg/day)
- Citalopram (Celexa) (20mg/day)
- Sertraline (Zoloft) (50-100mg/day)
The mechanism of action of how Neurontin (gabapentin) (300mg/bedtime) helps with Vasomotor Symptoms (VMS) is unclear, but has been shown to be effective in treating VMS in studies. Therapy is typically started at night as a side effect of the medication is drowsiness. The medication may be increased to three times a day.
Clonidine (catapres) (0.05 mg/twice daily) is a medication best saved for women with the following symptoms:
- Hot flashes
A word of caution, when discontinuing this medication you need to taper off otherwise you might get rebound hypertension, headaches, and/or agitation.
The question many patients are embarrassed to bring up to their doctors: Why does it hurt when I have sex and what can be done about it?
When a woman no longer produces estrogen, her vaginal tissues as well as her urinary tract are at risk for vaginal atrophy. Atrophied tissue is much thinner and more friable (delicate) than normal, healthy estrogenized tissue. This can cause the following symptoms:
- Infections (urine infections)
- Urinary urgency
- Leakage of urine
Systemic estrogen can also help vaginal and urogenital atrophy, but sometimes a woman may need a little more local therapy.
Local vaginal estrogen also comes in various forms:
- Low dose tablet (Vagifem)
- Creams (Premarin vaginal cream or Estrace/estradiol cream)
- Estradiol ring (Estring)
The medication stays locally in the vagina and helps to keep the tissues healthy in the vagina and may reduce urinary tract infections and minor irritative bladder symptoms.
Vaginal atrophy FDA-approved Medication
The first FDA-approved ORAL NON-ESTROGEN medication was recently approved for the treatment of moderate to severe dyspareunia (painful sexual experience due to vulvar-vaginal atrophy). The Osphena (ospemifene) (60 mg/daily) medication is taken orally with food and is a SERM, selective estrogen receptor modifier agonist/antagonist.
Non-FDA approved treatment for VA
If someone does not want to use estrogen or the new oral SERM, there are vaginal DHEA troches where the hormone is converted into estrogen locally, in the vagina and does not stimulate the uterine lining. This treatment is not FDA approved; however, there are trials currently taking place for FDA approval.
Over the counter medication can be used to help reduce the friction during sex, but does not change the actual issue at hand, which is lack of estrogen. If someone is unable to take hormones or does not want to use them, vaginal moisturizers can be used, but these do not change the integrity of the tissue. Lubricants that can be used during sex:
- Olive oil as a moisturizer
- Hyaluronic acid gel (this has been studied and treats dryness effectively and safely)
You simply need to know there are hormonal and non-hormonal options for hot flashes and vaginal dryness/painful intercourse. No woman needs to suffer!
Be Strong. Be Healthy. Be in Charge!
- Lauren Weber, DO
Women's Health Specialist and Family Practice
Center for Women's Health, A NorthBay Affiliate
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