NOVEMBER 28 • 2024 | 47
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One form of topical medication
is bio-identical hormone treatment
which adjusts the dose based on the
severity of the patient’s symptoms. It is
usually made by a compounding phar-
macy based on the physician’s pre-
scription, according to Dr. Benjamin.
“It makes sense to prescribe this way,
since not all patients respond to the
same dose. Many of the prescription
meds routinely used only have a few
options for dosing.”
These medications are metabolized
differently than oral hormones, so they
pose less risk of adverse side effects.

NON-HORMONAL TREATMENTS
Recently the Food and Drug
Administration approved a new medi-
cation —VEOZAH — for night sweats
and hot flashes. This medication has
no hormones and works through
the hypothalamus — the area of the
brain that controls body temperature.
Dr. Eisenberg says that it has been
well-received, but some patients can’t
take it because of underlying medical

conditions including liver and kidney
disease. She adds that it’s important
to re-
assess menopausal symptoms and
treatments at least annually.
“We use VEOZAH selectively,”
says Dr. Dean. “You have to treat the
patient holistically, considering blood
pressure, diabetes and nutritional
issues. There are behavioral options
too — meditation, yoga, acupuncture,
as well as calcium and herbal supple-
ments,” he adds.
Their practice stresses evaluation of
the patient’s entire lifestyle — includ-
ing recommending an alternative to
the typical American diet of processed
foods that they believe can lead to
inflammation.
Anti-depressive medications such
as Paxil and Effexor are another
alternative to hormone therapy, pro-
viding relief from some mood-related
symptoms but not for hot flashes and
other issues. Gynecologists report that
anti-depression medications help some
patients but can have side effects.

NON-MEDICINAL TREATMENTS
FOR VAGINAL SYMPTOMS
Other therapies are available for vag-
inal symptoms. Pelvic floor physical
therapy can alleviate vaginal dryness
and discomfort as well as bladder
issues, says Dr. Benjamin. “Once
learned, patients need to
continue the exercises
on their own. However,
vaginal estrogen used in
combination with PT is
even better.”
“I usually recommend
pelvic floor physical
therapy to my post-meno-
pausal patients for issues like incon-
tinence, prolapse and painful inter-
course to help them strengthen their
pelvic floor and have better support. I
think it can be quite helpful to many
patients,” says Dr. Eisenberg.
Another option is vaginal “rejuve-
nation,” which stimulates growth of
connective tissue in the pelvic floor by
using a low-dose CO2 (carbon diox-
ide) laser. According to Dr. Benjamin,

it can reduce vaginal dryness, make
intercourse less painful and improve
bladder problems. Dr. Eisenberg cau-
tions that some “rejuvenation” clinic
providers may not have adequate
gynecological training and data to
support their claims.
Dr. Joshua Dean also cautions about
its effectiveness. “Vaginal rejuvenation
is a broad term that can encompass
many different therapies; however, the
treatments for vaginal dryness, such
as CO2 laser or radio frequency treat-
ment to the vagina, have been shown
to have no evidence to support its effi-
cacy to make a difference. Other surgi-
cal vaginal rejuvenation procedures are
more for cosmetic management and
not for menopause,” he says.
Women today have many more
treatment options than in the past.
Dr. Benjamin points out “that women
are living longer —healthier lifestyle
and diet. If you live to 90 years old or
longer, almost one-half of your life can
be during the menopause years ... and
why not feel as good as possible!”

Danny
Benjamin,
M.D.

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