Commonly Used Types of Postmenopausal Estrogen for Treatment of Hot Flashes

Abstract

1940s to treat menopausal symptoms. During the ensuing years, observational studies indicated additional health benefits for estrogen users such as prevention of chronic diseases like cardiovascular disease and osteoporosis. 1 A national survey conducted in 1995 indicated that 37% of women aged 50 years or older were using estrogen for multiple purposes. 2 Estrogen use has decreased since 2002 3,4 when the results of the Women's Health Initiative (WHI), the first large randomized controlled trial of estrogen for prevention of disease, released its findings contradicting previous beliefs about cardiovascular benefits. 5 In this study, women using conjugated equine estrogen (CEE) and medroxyprogesterone acetate had significantly increased risks of coronary heart disease events, strokes, and breast cancer than women taking placebo. 5 The US Food and Drug Administration recently ordered estrogen safety warnings on product labels referring to WHI findings and altered approved indications for its use. 6,7 Package inserts indicate that treatment of menopausal symptoms remains an indication for estrogen use, although now physicians are advised to use the smallest effective dose for the shortest duration possible. 7 The National Institutes of Health added steroidal estrogens to its list of known hu

SSRIs for Hot Flashes: A Systematic Review and Meta-Analysis of Randomized Trials

“…The mean reduction observed with estrogen was (−2.7; 95 % CI -4.7 to -0.7) for conjugated equine estrogen, (−2.4; 95 % CI -3.3 to −1.45) for oral 17 β-estradiol and (−3.2; 95 % CI -5.1 to −1.48) for trans-dermal 17 β-estradiol. 5 Therefore, the effect of SSRIs on the frequency of hot flashes compared to estrogen, the most effective treatment, is smaller. In terms of hot flash severity, we noticed an improvement of 0.70 in standard deviation units across multiple scales.…”

“…4 Hormone replacement therapy (HRT) is the most effective and standard treatment for vasomotor symptoms of menopause. 5 However, a randomized controlled trial of 16,608 post-menopausal women receiving estrogen and progesterone HRT versus placebo showed an increased hazard ratio of coronary heart disease and breast cancer, which were present across racial/ethnic and age strata and were not influenced by the antecedent risk status or prior disease. HRT also showed increased risk of stroke and pulmonary embolism.…”

Metabolic syndrome after risk-reducing salpingo-oophorectomy in women at high risk for hereditary breast ovarian cancer: A controlled observational study

“…The use of estrogen has well-documented effects as to the relief of hot flashes and vaginal dryness in the perimenopause (206). Concerning HRT after RRSO, Madalinska et al (207) published questionnaire-based data on endocrine symptoms and sexual functioning from 450 premenopausal, high-risk women who had participated in their nationwide, crosssectional, observational study.…”

Esterified estrogens and conjugated equine estrogens and the risk of venous thrombosis

“…4,5 Clinical comparison studies of these compounds have focused mainly on mode of delivery, and outcomes have generally been restricted to the relief of menopausal symptoms and the occurrence of vaginal bleeding. [6][7][8] Nearly all comparisons have evaluated the most commonly used estrogens, CEE and micronized estradiol. Esterified estrogens (EEs) have received less attention.…”