As mentioned in our article, ‘Update In Menopause Therapies', there are 3 types of medicinal treatments available for menopause symptoms. The first being traditional, prescription conjugated estrogens or ‘synthetic' hormones. These hormone products are typically made from the urine of pregnant mares or from plant sources. Examples of these products include Premarin and Enjuvia. The second type of product is referred to as ‘bioidentical hormones'. These are hormones that are 'identical' to human estrogen on a molecular basis. These hormones are typically isolated from natural sources such as soy beans and yams, but are modified so that they are just like the human hormone. There are a couple of commercially available bioidentical products available by prescription including Ogen, Estrace and Estraderm. It is also possible to have custom doses of these hormones compounded by a specialty pharmacy. The third type of therapy is referred to as ‘natural' hormone products. The term ‘natural' is very misleading and is not a scientific term. Typically, natural is used to describe products that are derived from plants, also called ‘phytoestrogens'. Phytoestrogens are not the same as human hormones.

There are two new hormone therapies available for the treatment of symptoms associated with menopause. The first one, Elestrin is a bioidentical estradiol gel. The other one, Angeliq, is a synthetic tablet that is able to treat more symptoms than its counterparts.

Elestrin

Elestrin is an estradiol gel that is indicated for the treatment of moderate to severe symptoms such as hot flashes and night sweats. It is available by prescription and is dispensed in a unique pump device, much like the ones some facial moisturizers come in. The dose of Elestrin is the lowest commercially available dose of estradiol available. 

When first using the Elestrin pump, you will need to unlock the pump top by turning the spout one-quarter turn. Once you unlock it, you will need to prime it by depressing the spout 10 times. This priming is to ensure that each pump delivers the precise amount of estradiol it was created to dispense with each pump.  Following this first use, the pump will not need to be primed for subsequent doses.¹

 Elestrin should be applied the same time each day and should be applied to dry, clean unbroken skin on the entire upper arm and shoulders areas. It is best to apply it after a bath or shower. One should use two fingers to apply. At least 2 hours should elapse between application of Elestrin and a bath, shower or swimming. Be sure to wash your hands after applying Elestrin with soap and water.¹

Angeliq

Hormones called progestins are typically good for treating vaginal symptoms of menopause like vaginal dryness. Not only does Angeliq contain estradiol, it is the first hormone product to contain the synthetic progestin, drospirenone. Because of this, it is not only indicated for the treatment of symptoms like hot flashes and night sweats, but is also indicated for vulvar and vaginal symptoms. Although it is a wonderful product that can treat more symptoms than its counterparts, women who only suffer from vulvar or vaginal symptoms and not hot flashes or night sweats should opt for a locally applied cream instead. This is to minimize the side effects that can occur with taking oral hormone therapy.²

Drospirenone acts more like natural progesterone than its other synthetic counterparts. It also helps reduce the risk of salt, fluid retention and weight gain that is sometimes associated with estrogen therapy. This medication does tend to increase your triglycerides (this is not desirable). However, it also promotes the lowering of LDL (bad cholesterol) and increasing of your HDL (good cholesterol). Also, because of the way drospirenone works, Algeliq may cause a lowering of your blood pressure as well.^3-5

Angeliq can increase your potassium levels. Be sure to tell your doctor or pharmacist if you have liver, kidney or adrenal disease. Also make sure they screen the rest of your medications for other drugs that can increase potassium as well. This includes any over-the-counter medications such as aspirin or ibuprofen.²

Conclusions

If you and your doctor decide you need hormone therapy to manage your menopause symptoms, please keep the following in mind:

• Use oral or transdermal (cream, patch) if you have moderate to severe symptoms.
• Start your dose out low and increase slowly so that you can find the least amount of medication that will control your symptoms.
• If you suffer from only vaginal or vulvar discomfort, use a local, topical cream first before you try medication you take by mouth. This will help minimize the side effects that you may experience from the hormone therapy.

References

1. Product information for synthetic conjugated estrogens, B estradiol gel (Elestrin). Kenwood Therapeutics, Inc. Subsidiary of Bradley Pharmaceuticals, Inc. Fairfield, New Jersey 07004. December 2006

2. Product information for drospirenone and estradiol (Angeliq). Berlex. Montville, New Jersey 07045. September 2005.

3. Sitruk-Ware R. Pharmacology of different progestogens: the special case of drospirenone. Climacteric 2005;8(suppl 3):4-12.

4. Ylikorkala O. Drospirenone, a progestin with a unique cardiovascular profile, for a safe contraception and treatment of menopausal symptoms. Climacteric 2005;8(suppl 3):1-3.

5. Oelkers WH. Drospirenone in combination with estrogens: for contraception and hormone replacement therapy. Climacteric 2005;8(suppl 3):19-27.