Role of androgens, progestins and tibolone in the treatment of menopausal symptoms: a review of the clinical evidence

Garefalakis, Maria; Hickey, Martha

doi:10.2147/cia.s1043

Cited by 16 publications

(2 citation statements)

References 98 publications

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“…• Tibolone (2.5 mg dose per day), which leads to a decrease in cholesterol, used above all in the case of hypertensive women, also combats vaginal atrophy and hot flushes [173,174]; and • Others are veralipride, bromocriptine, clonidine, effective against headaches and hot flushes, and methyl-dopa which works on alpha-adrenergic receptors [175]. Among these are phytotherapeutics (phyto-SERMs) which have both agonist and antagonist actions on estrogen; all SERMs tend to decrease cholesterol [176][177][178][179].…”

Section: Managementmentioning

confidence: 99%

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

Comparetto,

Borruto

2023

OBM Geriatr

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In the United States (US), menopause occurs at an average age of 52. Menopausal symptoms tend to be maximal during the few years before and the year after menopause (during perimenopause), except for symptomatic vulvovaginal atrophy, which may worsen over time. Up to 20% of bone density loss occurs during the first 5 years after menopause, followed by an age-related bone loss rate similar to that in men. Menopause should be considered confirmed if an age-appropriate woman who is not pregnant has not had a menstrual period for 12 months. Regarding treatment, for vaginal dryness or dyspareunia due to menopause, vaginal stimulation and vaginal lubricants and moisturizers are recommended, and if these are ineffective, low-dose vaginal estrogen, in the form of creams, tablets, suppositories, or rings should be considered; other options include oral ospemifene or intravaginal dehydroepiandrosterone (DEHA) suppositories. Before prescribing hormone replacement therapy (HRT) and periodically while therapy continues, women should be informed of risks (e.g., deep vein thrombosis [DVT], pulmonary embolism [PE], stroke, breast cancer, gallbladder disease, and urinary incontinence); potential harms are greatest for women who start HRT after 60 years of age or who are 10-20 years past menopause onset. If women choose HRT to relieve hot flushes, estrogen plus, a progestin or conjugated estrogen/bazedoxifene could be prescribed for women who still have the uterus. Treatment with HRT should be tailored to maximize benefits and minimize harms, and periodically benefits and harms should be reassessed; low-dose transdermal HRT may lead to a lower risk of DVT and stroke. Selective serotonin reuptakereuptake inhibitors (SSRIs), selective serotonin-nor-epinephrine reuptake inhibitors (SNRIs), and gabapentin could be considered as less effective alternatives to HRT for relieving hot flushes; paroxetine 7.5 milligrams (mg) is the only non-hormonal drug approved in the US for the relief of hot flushes. Effective non-drug options include cognitive behavioral therapy and hypnosis.

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Section: Managementmentioning

confidence: 99%

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

Comparetto,

Borruto

2023

OBM Geriatr

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“…Despite these recommendations, tibolone is not currently available in the United States. However, it is now available in over 70 countries [ 89 , 90 ].…”

Section: Reviewmentioning

confidence: 99%

Oral Therapeutics Post Menopausal Osteoporosis

Schroeder,

Staszkiewicz,

O'Quin

et al. 2023

Cureus

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Osteoporosis affects a significant number of postmenopausal women in the United States. Screening is performed using clinical assessments and bone mineral density scans via dual x-ray absorptiometry. Oral therapy is indicated to prevent pathologic fractures in those deemed at increased risk following screening. Bisphosphonates including alendronate, ibandronate, and risedronate are currently first-line oral therapeutics in fracture prevention following the diagnosis of osteoporosis. Hormonal therapies include estrogen-containing therapies, selective estrogen receptor modulators, and other compounds that mimic the effects of estrogen such as tibolone. Lifestyle modifications such as supplementation and physical activity may also contribute to the prevention of osteoporosis and are used as adjuncts to therapy following diagnosis. These therapeutics are limited primarily by their adverse effects. Treatment regimens should be tailored based on significant risk factors demonstrated by patients, adverse effects, and clinical response to treatment. The most severe risk factors relevant to pharmacological selection involve hormone replacement therapies, where concern for venous thrombosis, coronary artery disease, breast, and uterine cancer exist. Bisphosphonates are most commonly associated with gastrointestinal discomfort which may be mitigated with proper administration. Although adverse effects exist, these medications have proven to be efficacious in the prevention of vertebral and non-vertebral fractures in post-menopausal women. Fracture risk should be weighed against the risk of adverse events associated with each of the regimens, with clinical judgment dictating the treatment approach centered around patient goals and experiences.

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RETRACTED ARTICLE: Prevention of hip fractures by exposure to sunlight and pharmacotherapy in patients with Alzheimer’s disease

et al. 2009

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Role of androgens, progestins and tibolone in the treatment of menopausal symptoms: a review of the clinical evidence

Cited by 16 publications

References 98 publications

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

Oral Therapeutics Post Menopausal Osteoporosis

RETRACTED ARTICLE: Prevention of hip fractures by exposure to sunlight and pharmacotherapy in patients with Alzheimer’s disease

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