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Prescribable non-HRT

Prescribable non-HRT

Menopause Matters
(Link to article)

Please note: Patients should consult a health professional to decide on the appropriate treatment option to be prescribed.

CLONIDINE/DIXARIT This is a prescription drug which can be used for migraine or high blood pressure and can also help a small proportion of women who suffer from hot flushes, although the NICE guideline on diagnosis and management of the menopause recommended that Clonidine should not be offered routinely for control of menopausal symptoms. The dose ranges from 2 to 3 25mcg tabs two times per day according to response. It is usually well tolerated but possible side effects include difficulty sleeping, dry mouth, dizziness, constipation and sedation.

SSRI DRUGS (Selective Serotonin Reuptake Inhibitors). This is a class of anti-depressant drugs which seem to work on the "thermostat" receptor as well as neurotransmitters. Examples are Venlafaxine, Fluoxetine, and Paroxetine. They have been studied and widely used effectively for reducing flushes in women who have had breast cancer [Ref 11 and Ref 28] . They should not be taken however, if Tamoxifen is being taken as part of the treatment for breast cancer since studies have shown that some SSRIs, particularly Paroxetine and Fluoxetine, may interfere with the action of Tamoxifen. Venlafaxine seems to be less likely to have this effect and so is the preferred option in this situation. The dose of SSRIs can be started low and increased gradually to minimize side effects. A greater reduction in hot flushes is seen at higher doses but the side effects such as nausea, dizziness, problems with sleeping, agitation and confusion may be worse. The NICE guideline recommended that SSRIs should not be offered routinely for control of menopausal symptoms, even for low mood if related to the menopause.

GABAPENTIN Gabapentin, a drug which is used to treat epilepsy, migraine and nerve-related pain, has been shown to reduce flushes [Ref 12], [Ref 54] and [Ref 65] but was not recommended in the NICE guideline. It may be particularly beneficial for the symptoms of aches, pains and paraesthesia which many menopausal women suffer. Possible side effects include dizziness, fatigue, tremor and weight gain but side effects can be reduced by starting at a low dose and increasing the dose gradually.

HIGH DOSE PROGESTOGENS (MPA) Medroxyprogesterone Acetate and Megestrol Acetate (Megace) are synthetic forms of progesterone which sometimes reduce hot flushes and sweats. They also offer a degree of bone protection. They have been prescribed to women who cannot take estrogen after breast cancer treatment but concern currently exists about the possible effect of progestogen on the breast and so are now used less often. The side effects of these drugs can sometimes outweigh the benefits. In particular there is known to be an increased risk of clotting with higher doses of progestogens.

NATURAL PROGESTERONE CREAM This is only available on a private prescription and is used in varying strengths. Some individuals believe that the replacement of progesterone rather than estrogen is needed at the menopause but many experts still believe that the symptoms of menopause are due to estrogen lack and therefore the main hormone to replace should be estrogen, with forms of progesterone only being added to protect the womb lining from stimulation by estrogen. However, progesterone cream has been shown to be of some help in the relief of flushes and sweats at the menopause but natural progesterone cream is not suitable for providing protection to the womb lining.

There are claims that it can offer bone protection but the National Osteoporosis Society funded a study into these claims and they have not been confirmed. Therefore any individual at risk of osteoporosis should NOT consider this as effective for offering bone protection.