Anticholinergic drugs
Antihypertensives (blood pressure drugs)
Antidepressants/Anti-anxiety drugs
Osteoporosis drugs
Heart disease (cholesterol-lowering drugs)
Some women going through menopause use some sort of therapy to help with menopausal symptoms. When lifestyle changes and natural remedies aren't enough, they may feel as if they need something more "industrial strength." That's when they turn to their doctors for a prescription drug.
The prescription of choice, of course, has been estrogen therapy (ET) and hormone therapy (HT). The short-term use of hormone therapy is highly effective in relieving certain menopausal symptoms. However, ET and HT aren't a woman's only options. Some women prefer a medication that targets a particular symptom - an antidepressant, for example, for mood swings.
Hormone therapy has also been widely touted as prevention for a variety of diseases that postmenopausal women face, such as heart disease, Alzheimer's and osteoporosis. But hormone therapy is losing its luster as a preventive therapy because newer research is finding that the benefits of using HT, particularly long term, are questionable and the risks high. Here are other medications women can use for prevention of these diseases.
Anticholinergic/antispasmodics drugs (incontinence drugs)
Women sometimes experience various urinary conditions as menopause approaches and the years after. These include the need to urinate more often and stress incontinence, which causes urine leakage upon coughing, laughing, sneezing or lifting. Although up to 40 percent of women ages 45 to 64 have urinary incontinence, fewer than half seek help.
Anticholinergic drugs inhibit the involuntary contractions of the bladder and increase the capacity of the bladder, so they are most useful in treating incontinence. Some of these drugs include tolterodine tartrate (Detrol®) and propantheline (ProBanthine®).
Imipramine (Tofranil®), an antidepressant, can also be used. It causes the bladder muscle to relax and at the same time causes muscles at the bladder neck to contract. It is sometimes used along with anticholinergic drugs.
Antispasmodic drugs help relax the bladder muscle and are also used for treating incontinence. The three drugs most commonly prescribed include oxybutynin (Ditropan®), flavoxate (Urispas®) and hyoscyamine sulfate (Levsin®).
Elderly women and women with heart problems should use all anticholinergic drugs with care.
Side effects
Some possible side effects from taking these drugs include:
- Dry mouth
- Drowsiness
- Decreased sweating
- Blurred vision
- Heart beat irregularities
- Nausea/vomiting
- Impotence
Antihypertensive drugs (blood pressure drugs)
Certain antihypertensive drugs, or blood-pressure medications, have been moderately helpful in relieving menopausal symptoms, such as hot flashes. Obviously, these are particularly useful if you have high blood pressure. Some antidepressants, SSRIs (selective serotonin reuptake inhibitors), including Prozac®, Paxil® and Effexor® have not been approved by the FDA to treat hot flashes, but have been shown to work in some clinical trials.
Having high blood pressure puts you at greater risk for having a heart attack and stroke, and arteriosclerosis, commonly called "hardening of the arteries," which is also associated with heart disease. There are a wide variety of blood-pressure medications, such as diuretics, beta-blockers, angiotensin agonists, calcium channel blockers and alpha blockers.
The antihypertensive drugs that have been moderately helpful in relieving hot flashes include clonidine (Catapres®) and methyldopa (Aldomet®). Obviously, these drugs can be useful especially if high blood pressure is part of the picture. Clonidine is available in pill form or skin patch. Other antihypertensive drugs used for hot flashes are Propranolol (Inderal®) and verapamil (Calan®, Covera-HS® and Verelana®). Gabapentin (Neurontin®), an antizeizure medication, has also been found useful with hot flashes.
Who should not use this medicine
You may not be able to take an antihypertensive drug if you have kidney or liver disease, heart disease, or if you have had a heart attack or stroke.
Side effects
There are also numerous side effects from taking these drugs. They include:
- An allergic reaction
- An unusually fast or slow heartbeat
- Headache
- Dizziness
- Shortness of breath (heart failure)
- Fainting
- Jaundice (yellowing of skin or eyes)
- Swelling or legs or ankles
- Dry mouth
- Constipation, nausea or diarrhea
Furthermore, grapefruit and grapefruit juice have been found to interact with certain antihypertensive drugs, such as verapamil. This could lead to a potentially dangerous interaction. Discuss the use of grapefruit and grapefruit juice with your doctor. Another note about high blood pressure medications: They can create problems with sexual desire and orgasmic capacity - so they may not be appropriate to take for hot flashes if you also have a diminished libido.
Antidepressants/anti-anxiety medications
Some women find going through menopause stressful and mood swings can be a common complaint. Depression can leave a woman with negative feelings of hopelessness, helplessness, unworthiness and emotional exhaustion. Anxiety can make a woman feel irritable, uneasy, fretful and apprehensive. Antidepressants and anti-anxiety medications can be used to treat mood swings commonly associated with menopause.
The most commonly used antidepressant medications are selective serotonin reuptake inhibitors (SSRIs), tricyclics and monoamine oxidase inhibitors (MAOI), which affect neurotransmitters acting on the brain's chemical pathways. The most commonly used anti-anxiety drugs are SSRIs and benzodiazepines, which are central nervous system depressants. (Benzodiazepines can cause drowsiness and can be habit forming.)
Antidepressants have also been found to decrease hot flashes. Just as antihypertensives may be a good choice for a woman who has high blood pressure and hot flashes, antidepressants are a logical choice for a woman who has mood swings - or worse, depression - as well as hot flashes.
Examples of some antidepressants that are used to relieve hot flashes include sertraline (Zoloft®), venlafaxine hydrochloride (Effexor®) and fluoxetine (Prozac®). One study found that venlafaxine decreased hot flashes by 50 percent.
 Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns with a doctor.
Who should not use this medicine
Do not take an antidepressant if you are taking an MAOI. You may not a good candidate for an antidepressant if you have liver, kidney or heart disease, or if you have high blood pressure, epilepsy or seizures. You may also be precluded from taking an anti-anxiety medication if you have a history of kidney or liver disease, alcohol abuse or substance abuse, brain disease, a chronic lung disease (such as emphysema or asthma) or glaucoma.
Side effects
Some possible side effects include:
-
Antidepressants- Agitation; irregular or rapid heart rate; muscle pains; muscle weakness; rash; constipation; lowered sexual ability; diarrhea; dizziness; drowsiness; dry mouth; headache; excess perspiration; nausea; urination problems; tremor; shakiness; insomnia; fatigue; vomiting
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Anti-anxiety medications - Anxiety; confusion; irregular or rapid heart rate; depression; memory difficulties; clumsiness; dizziness; drowsiness; slurred speech
Like blood pressure medications, antidepressants can create problems with sexual desire and orgasmic capacity.
Osteoporosis Medications
There are a variety of highly effective prescription choices to treat postmenopausal osteoporosis - a disease in which bone mineral content decreases until the bone becomes brittle and prone to fracture. These drugs not only preserve bone density, but they have also been shown to reduce fracture risk. They include:
-
Bisphosphonates - These drugs can prevent bone loss and fractures. Biphosphonates include ibandronate (Boniva) alendronate (Fosamax), risedronate (Actonel), and etidronate (Didronel). These medications must be taken on an empty stomach, with water only, and at least 30 minutes before drinking other liquids, eating, or taking other medicines, since food reduces their absorption.
-
Calcitonin (Calcimar®,
Miacalcin®) - This drug is a nonsteroidal hormone available in injection or nasal spray form. Calcitonin is relatively safe and has no serious side effects. Calcitonin isn't as effective in increasing bone density as bisphosphonates. However, it is good for pain relief in spine fractures.
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Raloxifene (Evista®) - This drug is in a class of drugs called SERMS (selective estrogen receptor modulators), which act like estrogen in some parts of the body. Raloxifene has been shown to reduce spin fractures and interestingly the fracture reduction was independent of the improvement in bone density.
Although it acts like estrogen, raloxifene does not appear to harm the breast or uterus, as estrogen can. Unlike estrogen, however, raloxifene does not help with short-term menopause symptoms, such as hot flashes, and actually causes hot flashes in some women.
-
Parathyroid hormone - Teriparatide (Forteo) is given by daily injection to treat severe osteoporosis in men and women. It stimulates bone growth and slows the rate of bone loss. Forteo is very expensive and its long-term side effects are not known. It has been approved by U.S. Food and Drug Administration (FDA) to treat osteoporosis.
Who should not use this medicine
Some of the following conditions may preclude a woman from taking these medications:
-
Bisphosphonates - This drug may have a worsening effect on the following conditions: problems with digestion, esophageal, intestinal, stomach and kidney disorders.
-
Raloxifene - This drug may not be an appropriate choice for women with blot clots or a history of deep vein thrombosis, pulmonary embolism, or retinal embolism; cancers; tumors; congestive heart failure, and liver disease.
Side effects
Some possible side effects include:
-
Bisphosphonates - Abdominal pain, constipation, diarrhea, bloating, gas, fatigue, nausea. The FDA warns that people taking these drugs may have severe muscle and bone pain that can occur within days, months, or years after starting the medication. Tell your doctor about pain or other side effects.
-
Raloxifene - Cloudy urine or blood in urine; chest pain; urination that is difficult, burns, or is painful; fever; urgent need to urinate; infection with body aches and pain, throat congestion, cough, sore and dry throat, and loss of voice; runny nose; leg cramps; rash; swollen hands, ankles, or feet; vaginal itching with or without white discharge; hot flashes; joint or muscle pain; depression; stomach or intestinal difficulties including flatulence, stomach upset, or vomiting; insomnia; unexplained weight gain.
Heart disease (cholesterol-lowering drugs)
In addition to blood pressure medications, cholesterol-lowering drugs represent another of science's most powerful weapons against heart disease. Studies have shown that cholesterol-lowering drugs, called statins, can cut the risk of cardiovascular disease by at least 30 percent.
These powerful medications have provided doctors with an arsenal of therapies to lower elevated blood cholesterol levels, often dramatically, when diet and exercise have failed.
Studies have also demonstrated that patients with normal cholesterol levels could benefit from statins, even if they have no evidence of heart disease. As a result, statins, which were once reserved for people with dangerously high cholesterol, are now being recommended for healthy patients who have marginally high cholesterol numbers.
There are a variety of statins: Mevacor® (lovastatin), Lescol® (fluvastatin), Pravachol® (pravastatin), Zocor® (simvastatin), Zetia (ezetimibe) and Lipitor® (atorvastatin).
Who should not use this medicine
Do not take statins without first talking to your doctor if you have liver disease. You may not be a candidate if you have kidney disease, drink alcoholic beverages (alcohol and statins can both damage your liver), have a chronic muscular disease or have a blood disorder.
Side effects
Some possible side effects include:
- Allergic reaction
- Blurred vision
- Flu-like symptoms
- Yellowing of the skin or eyes
- Decreased urine or rust-colored urine
- Constipation, diarrhea, or nausea
- Heartburn
- Headache
- Insomnia
Grapefruit and grapefruit juice may interact with some statins, and could lead to potentially dangerous effects. Discuss the effects of consuming grapefruit and grapefruit juice with your doctor.
This article was reviewed and updated June 2007.
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