These Medications May Help Ease Specific Menopause Symptoms

Scientists reviewed dozens of studies and found evidence that three specific prescription treatments and one over-the-counter option have the potential to improve vaginal and urinary tract symptoms of menopause.

The transition through menopause can be one of the most daunting journeys in a woman's life. In addition to hot flashes, mood changes, and sleep disturbances, menopause can contribute to other challenging conditions, including genitourinary syndrome of menopause (GSM).

GSM-related symptoms include vaginal dryness, reduced libido, and bladder issues such as frequent urination and urinary tract infections (UTIs). They can occur due to a decrease in estrogen and other hormones during and after menopause. For some, these symptoms are minor, but for others, GSM can significantly impact sexual health and overall quality of life.

While doctors can treat GSM and other menopause symptoms by prescribing hormone replacement therapy, other options, such as vaginal estrogen or vaginal moisturizers, can also help. However, it's unclear which of these non-systemic treatments are most effective.

To investigate this further, a team of scientists from the Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, and the Agency for Healthcare Research and Patient-Centered Outcomes Research Institute scoured dozens of studies to determine the effectiveness and potential side effects of vaginal estrogen, non-estrogen hormone therapies, and vaginal moisturizers.

Their analysis, published on September 9 in Annals of Internal Medicine, found that three specific medications, and one over-the-counter remedy, are likely more effective than others, at least for short-term GSM symptom relief.

Which menopause treatments work best?

To conduct the study, the team analyzed data from 46 randomized controlled trials. The trials involved postmenopausal participants with at least one GSM symptom.

The analysis showed that compared with placebo or no treatment, vaginal estrogen may improve vaginal dryness and painful intercourse, which were the most bothersome symptoms noted in the trials. Participants using vaginal estrogen also reported the most satisfaction with treatment.

In addition, the researchers found that vaginal dehydroepiandrosterone (DHEA), a prohormone produced by the adrenal glands, has the potential to ease dryness, pain during sex, and other genitourinary symptoms.

Ospemifene, a non-hormonal oral pill sold under the brand name Osphena, is another medication the research team identified as a potentially effective treatment for vaginal dryness and pain during intercourse. Moreover, participants in the trials who took ospemifene reported a high level of treatment satisfaction.

Vaginal moisturizers, which are available without a prescription, also appeared to help ease vaginal dryness.

The researchers note that none of the studies reviewed reported serious harms with these medications. Still, data on long-term outcomes were limited. Moreover, the improvements observed were modest compared to placebo.

In contrast, the analysis found that vaginal testosterone, DHEA supplements, vaginal oxytocin, and oral raloxifene or bazedoxifene — medications used to treat postmenopausal osteoporosis— appeared to provide no benefits for women with GSM.

Can alternative treatments relieve GSM symptoms?

In a second review of research, the team analyzed 57 studies involving complementary and alternative (CAM) treatments for GSM. Most studies investigated over-the-counter products and supplements such as soy, fenugreek, and probiotics, while a few focused on acupuncture and mind-body therapies.

However, after analyzing the data, the team found that most trials were too limited in size and duration to draw conclusions on the effectiveness of these alternative treatments for reducing GSM symptoms.

"Well-designed, adequately powered, placebo-controlled and comparative effectiveness trials of specifically defined CAMs are needed to assist women and clinicians in making informed decisions about how to best manage patient symptoms," the study's authors wrote.

Overall, the two research reviews revealed how little scientists know about GSM and the safety and effectiveness of the available treatment options. The research team says future studies should include diverse participant populations and head-to-head comparisons of different therapies to improve the care of all women with GSM.