Menopause management: How you can do better
Let patients know that hot flashes, vaginal dryness, and other common menopausal symptoms can be treated successfully with hormonal and nonhormonal agents.
Cyproterone acetate, which has also been shown to be effective, is usually administered as an oral contraceptive regimen: The patient takes 100 mg/d on Days 5 to 15 and 50 mcg ethinyl estradiol on Days 5 through 25. Up to 88% of women either have no progression of hair loss or actually experience hair regrowth with the use of cyproterone.53 However, the risks associated with exposure to ethinyl estradiol may limit use of this therapy.
CASE After an extensive discussion about treatment options, Barbara decided to start taking venlafaxine for her hot flashes and mood swings. She also began using an estrogen-containing vaginal ring (the device contains 2 mg estradiol and must be replaced every 90 days) to alleviate atrophic vaginitis symptoms. When she returned to the office 6 months later, the patient reported that the frequency of her hot flashes was down to only one or 2 per week, and they rarely disrupted her sleep. She also noted that her mood had improved, she was arguing with her husband far less often, and her pain during intercourse had resolved.
CORRESPONDENCE Gretchen M. Dickson, MD, MBA, Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, 1010 North Kansas, Wichita, KS 67214; gdickson@kumc.edu
