Individualized Plans for Managing Menopause

Individualized Plans for Managing Menopause

By Janice Harvey, RPh, CDE

In Canada, there are ongoing challenges in the supply of certain estrogen products, specifically vaginal rings and topical patches, that are used to treat menopausal symptoms. With no end in sight, what other options are available?

Alternatives to the vaginal ring

There is only one vaginal estrogen ring marketed in Canada, namely Estring. It is used for genitourinary symptoms of menopause, such as vaginal atrophy and urinary urgency. It may also be used to supplement oral hormone therapy. As there is no other similar product, alternative options include vaginal creams (Premarin, Estragyn), tablets (Vagifem), and inserts (Imvexxy).

Vaginal moisturizers (Replens, Gynatrof) that are available without a prescription may also be helpful for some symptoms, or a lubricant (e.g., K-Y Jelly, Astroglide) can be used when needed.

Accommodating for estrogen patch shortages

There are several brands of estrogen patches, and while all contain 17-beta estradiol in varying strengths, not all of the patches are considered interchangeable. Even if the strengths are the same, it is not possible to confirm that the dose will be delivered through the skin at the same rate. As well, they aren’t used in the same way. Estradot, Estradiol Derm, and Oesclim are applied twice a week, whereas the Climara patch is applied once a week. The two products that are most commonly used are Estradot and Estradiol Derm. Both of these products are made by Sandoz Canada and they can be substituted for each other.

Not all strengths of the patches are available. For example, Estradot patches come in 25 mcg, 37.5 mcg, 50 mcg, 75 mcg, and 100 mcg strengths, but there is a shortage of only the two lower strengths. The 25 mcg patch is expected to be available by the end of July, yet there is no expected date of availability for the 37.5 mcg patch. What can you do if you need one of the lower dose patches?

All estrogen patches are what are referred to as “matrix” patches and they can be cut. If you need a 37.5 mcg patch, you might simply want to use one-half of a 75 mcg patch. It is important to acknowledge that the dose may not be precise when cutting patches. It has been suggested that cutting diagonally (from one corner to the opposite corner) will create more equal doses. Be sure to place the unused half back in its original packaging after cutting and use this for the subsequent application.

Estrogen patches provide systemic hormone therapy, which is used to treat vasomotor and other symptoms of menopause. Topical gels (Estrogel, Divigel) and oral tablets (Premarin, Lupin-Estradiol) are alternative choices for systemic hormone replacement. In addition, there are many non-hormonal options, as well as behavioural and lifestyle changes, that can improve vasomotor and other symptoms. The British Menopause Society has produced an excellent patient handout about cognitive behavioural therapy for symptoms from hot flashes to sleep difficulties. More general information about menopause is available here.

How can your pharmacist help?

Menopause is a normal body process that results from a gradual decrease in the production of estrogen and progesterone. Up to 15% of women have very few symptoms of menopause; however, many women experience significant symptoms that affect their quality of life. Genitourinary symptoms affect 45-77% of women and are often undertreated. About 80% of women experience vasomotor symptoms, and these can be severe in about 20% of women.

There is no one-size-fits-all plan for managing menopause. If you would like to discuss the available treatments for menopause, please schedule a medication review with our pharmacists. We will be happy to sit down with you to discuss prescription and non-prescription options and make recommendations for a treatment plan that is tailored to your needs.

It’s easy to schedule an appointment with us online or you can phone (250) 338-4790 to book a time that is convenient for you. We’re here to help you achieve your best health.


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