title: An update on drugs for the treatment of menopausal symptoms.
abstract: BACKGROUND
  Vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) are recognized as the most frequent and bothersome symptoms associated with menopause. There are different treatments for both groups of symptoms, being necessary to individualize them.
  
  
  METHODS
  There are different therapies for VMS including hormonal treatments with estrogen, with and without progestins; the new alternative, tissue-selective estrogen complex (TSEC), tibolone, phytoestrogens and only progestins. Evidence also shows efficacy with selective serotonin reuptake inhibitors. Other nonhormonal alternatives exist as second-line treatments, all with not conclusive results. The GSM can be treated with nonhormonal treatments such as vaginal lubricants and moisturizers, other alternatives as vaginal laser needs to have more evidence. On the other hand, there is the possibility to use the hormonal treatments with systemic or local estrogen, which are the most effective treatment, the TSEC and the newest selective estrogen receptor modulator (SERM), ospemifene. Therapies with testosterone and dehydroepiandrosterone (DHEA) are still under study. The GSM can be treated with nonhormonal treatments such as vaginal lubricants and moisturizers, and other alternatives as vaginal laser need to have more evidence. On the other hand, there is the possibility to use the hormonal treatments with systemic or local estrogen, which are the most effective treatment, the TSEC and the newest SERM, ospemifene. Therapies with testosterone and DHEA are still under study.
  
  
  CONCLUSIONS
  The increasing numbers of therapies for menopausal symptoms open up new options, but we must individualize treatments. New possibilities arise in patients who did not have them and which can improve compliance and is also important to design strategies using combined or sequential treatments.
authors.affiliation: a Institute Palacios of Women's Health , Madrid, Spain +34 9 15 78 05 17 ; +34 9 14 31 99 51 ; ipalacios@institutopalacios.com.
authors.forename: Santiago
authors.initials: S
authors.lastname: Palacios
authors.affiliation: a Institute Palacios of Women's Health , Madrid, Spain +34 9 15 78 05 17 ; +34 9 14 31 99 51 ; ipalacios@institutopalacios.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mejias
mesh_terms: D000728:Androgens / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008593:Menopause; D011372:Progestins / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014623:Vaginal Diseases / Q000517:prevention & control; D014666:Vasomotor System / Q000187:drug effects / Q000503:physiopathology
chemical_list: D000728:Androgens; D004967:Estrogens; D011372:Progestins; D020845:Selective Estrogen Receptor Modulators; D017367:Selective Serotonin Reuptake Inhibitors
keywords: genitourinary syndrome of menopause; hormonal therapy; selective estrogen receptor modulator; selective serotonin reuptake inhibitors; tissue-selective estrogen complex; vaginal laser; vasomotor symptoms