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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