As a prominent European reproductive endocrinologist recently stated in an editorial: “The symptoms of menopause do not only consist of hot flashes. They also include insomnia, irritability, mood swings, anxiety, cognitive difficulties, joint aches, headaches, loss of libido, vaginal dryness, skin changes, bladder control difficulties, and so on … All women do not suffer from all of these conditions, but those who do beg for relief. ”(Cohen J, Reprod BioMedOnline 2005; 12:127)

It would, of course, appear naïve to assume that one wonder drug can take care of all symptoms of menopause. This is simply not a realistic assumption! The symptomatology of menopause, so well summarized in the above cited quotation, involves simply too many different body systems to allow for only one, such wonder drug to be effective. This is, indeed, one of the major reasons why menopausal care is so much more complicated than had been assumed for such a long period of time, and why the successful treatment of menopausal symptoms, in most cases, cannot only rely on one therapeutic modality. Consequently, there is NO ONE treatment that does it all!

It, therefore, is a mistake to assume that the pharmacological armentarium at MRI, for the relief of menopausal symptoms, exclusively involves hormone therapy. It, of course, goes far beyond that. And while hormones represent a very important component of menopausal treatment in battling hot flashes, sexual dysfunction, vaginal dryness and many other symptoms, hot flashes sometimes require quite different drugs, like Clondine® (an antihypertensive drug) or Bellergal® ( a combination drug, including a vasoactive component and a sedative). Mood and anxiety disorder may require very specific psychotrophic drugs, skin conditions may require topical agents. In other words, individualization of care is the motto! And the choice of medications has to be based on the organ systems involved in a patient’s specific symptomatology.

The successful relief of menopausal symptoms will, therefore, almost always, involve a combined approach of different therapeutic interventions, though principally driven by what organ systems are specifically involved in the symptomatology of a very specific patient. As we have repeatedly stressed in these pages, successful menopausal treatment of symptoms always has to be individualized! And such individualization of care can only be accomplished if, initially, the diagnostic work up was individualized in similar fashion. In other words, the woman who primarily suffers from hot flashes will need a different diagnostic work up, and then different treatment, than the female whose main complaint is sexual dysfunction, or depression.

Because menopausal symptoms can involve so many organ systems and because the pharmaceutical industry has given us such a large choice of medications, it is impossible to summarize here all the drugs we use at MRI treatment purposes. We can, however, make a very specific statement about our approach towards treating symptomatic women:

We will do our utmost to diagnose every component of your menopausal symptoms accurately, and then will treat each one of your physical and emotional complaints individually with the best possible pharmacological approach. Sometimes the right treatment can be found only by trial and error. In such cases, we will continue trying until you are symptom-free and have returned to a normal quality of life.

In principle, menopausal treatment involves the following groups of pharmaceutical agents:

• ESTROGENS: These female hormones are effective in treating vasomotor symptoms, vaginal and vulvar discomfort and are also effective in preventing osteoporosis.
• PROGESTERONES: These female hormones are usually prescribed in conjunction with estrogens in order to prevent estrogens from having a hyperplastic effect on the endometrium.
• ANDROGENS: These male hormones (also present in the female) are, at times, used to treat symptoms of sexual dysfunction in women.
• COMBINATION THERAPY: Some pharmaceutical companies offer products, which combine estrogens with with either progestational or androgenic hormones.
• SELECTIVE ESTROGEN – RECEPTOR MODULATORS (SERMs): These medications prevent osteoporosis without, like estrogens, slightly increasing the risks of breast and uterine cancers.
• BIPHOSPHONATES: These medications are effective in the prevention and treatment of osteoporosis. They slow bone loss by increasing bone formation and decreasing bone turnover.
• PARATHYROID HORMONE: This hormone stimulates bone formation.
• CALCITONIN: Increases calcium stores in bones in the presence of high calcium levels in bone.
• VARIOUS: In addition, menopausal treatment involves maintenance of normal CALCIUM and VITAMIN D levels, if needed through supplementation, the monitoring of MAGNESIUM, BORON, FATTY ACIDS, etc.