Tablets and patches usually contain a combination of estrogen and progesterone but may contain estrogen alone if the woman has had a hysterectomy. Sometimes the hormones are given on a cyclical basis, which can produce a monthly bleed similar to a period. While this is acceptable for premenopausal women with symptoms, it may not be the best method for women who have not had a period for some time. For postmenopausal women a continuous level of hormones is usually given which may produce some bleeding or spotting initially—this should stop completely after a few months. The hormones given may be estradiol combined with levonorgestrel (Seasonique, Camrese), norethindrone (Junel 21 1/20Loestrin 21 1/20) norgestrel (Cryselle, Ogestrel) or medroxyprogesterone (Prempro). The patches are usually replaced every three to four days and the tablets are taken once daily.

First-line treatments for the prevention of osteoporosis include a group of drugs known as bisphosphonates, for example, alendronate (Binosto, Fosamax), etidronate, ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast). Certain bisphosphonates can also be used to treat established osteoporosis such as risedronate (Atelvia). A combination product containing alendronate and vitamin D3 (Fosamax Plus D) is also available. Calcium supplements to prevent bone loss may also be recommended if dietary intake of calcium is insufficient. A hormone called calcitonin-salmon (Miacalcin injection, Fortical nasal spray) may used in the short term to treat postmenopausal osteoporosis.

Further information
American Menopause Society: www.menopause.org

Last Reviewed: May 2013