Mechanism of Action
The primary mechanism of action of spironolactone in treating female pattern hair loss.
What is blocks androgen receptors to reduce DHT activity?
This route of estradiol administration is the MOST effective for treating GSM.
What is local (vaginal) route?
In November 2025, the FDA made these changes to the labeling of estrogen products used for the treatment of menopause.
The FDA removed the warnings for cardiovascular disease, breast cancer, and possible dementia for all forms of estrogen (pill, patch, vaginal, etc.). The warning from risk of endometrial cancer remains.
Pathophysiology of GSM in menopausal women includes these two features.
What is loss of estrogen leading to vaginal thinning/reduced elasticity AND higher vaginal pH leading to inflammation and irritation?
This type of aging is caused by UV light, smoking, pollution, and poor diet.
What is extrinsic aging?
Phytoestrogens may help reduce vasomotor symptoms via this mechanism of action.
What is Selective Estrogen Receptor Modulation?
This estradiol formulation has the lowest risk for VTE in postmenopausal women.
What is the estradiol PATCH?
FSH > 35 on two separate occasions one month apart.
What is one way to diagnose menopause?
Three types of nonhormonal over the counter options for GSM symptom control.
What are vaginal lubricants, vaginal moisturizers, 4% lidocaine?
This type of hair loss is due to a triggering event and is usually temporary.
What is telogen effluvium?
These multi-ingredient products increase genital blood flow and improve arousal through nitric oxide signaling or adrenergic activity.
What are scream cream/libido cream, etc.
In addition to HSDD, some functional medicine practitioners prescribe this to improve cognitive symptoms (“foggy brain”), prevent muscle loss, and prevent loss of bone density.
What is testosterone?
This area of topical hormone application can result in a greater risk of transference to others and should be avoided if possible.
What are the arms?
FDA approved SERM to treat moderate to severe dyspareunia.
What is ospemifene (Osphena)?
This class of drugs used to treat acne and wrinkles is teratogenic.
What are retinoids?
This drug is metabolized to estrogen and testosterone in the vaginal tissue making it a useful GSM treatment.
What is prasterone (Intrarosa)?
This treatment appears in ACOG and Menopause Society guidelines for hypoactive sexual desire disorder despite lacking FDA approval.
What is testosterone?
Two ways to assess the quality of herbal supplements used to treat menopause.
What are the USP verified mark or Consumer Labs?
This brand of estradiol vaginal ring does not require progesterone for women with a uterus.
What is Estring?
This dermatologic procedure causes tissue injury resulting in increased collagen production. It is sometimes used along with minoxidil hair loss treatment.
What is microneedling?
Its metabolite, allopregnanolone, binds to the GABA receptor resulting in sedative and anxiolytic actions.
What is progesterone?
These are the reasons a prescriber might recommend a compounded hormone rather than a commercially manufactured product.
What is an allergy, preference for a different dosage form, or more accurate dosing?
These types of prescribers tend to frequently check urine, saliva, or hormone levels to adjust hormone doses.
Who are functional medicine practitioners?
These two drugs are FDA approved to treat HSDD in premenopausal women.
What are Flibanserin (Addyi) and Bremelanotide (Vyleesi)?
The main side effect of botulinum toxin injections when used for facial wrinkles.
What is ptosis?