What is Angelique HRT?
Angelique, also spelled Angeliq, is a brand-name, continuous combined hormone replacement therapy (HRT). It is an oral medication that contains two active ingredients: drospirenone (a progestin) and estradiol (an estrogen). The therapy is designed for women who have gone through menopause and still have their uterus. By replacing the hormones that the body produces less of after menopause, Angelique helps to alleviate a number of uncomfortable and disruptive symptoms.
The active ingredients: Drospirenone and Estradiol
- Estradiol: This is a bioidentical estrogen, meaning it is the same form of estrogen naturally produced by the ovaries before menopause. Its purpose in Angelique is to replace the lost estrogen, which in turn reduces symptoms like hot flashes and vaginal dryness.
- Drospirenone: As a synthetic progestin, drospirenone plays a crucial role in protecting the uterus. When a woman with a uterus takes estrogen, the hormone can cause the uterine lining (endometrium) to grow excessively, increasing the risk of uterine cancer. The addition of drospirenone helps balance the effect of estrogen, preventing this overgrowth. Drospirenone also has antimineralocorticoid activity, which helps to counteract the water and sodium retention that can be a side effect of estrogen.
How does Angelique work?
The mechanism of action for Angelique involves supplementing the body with the hormones that decline during menopause. As a woman enters menopause, her ovaries produce less estrogen and progesterone, leading to a variety of symptoms. Angelique works by providing a steady, continuous dose of both hormones. This continuous regimen is different from other HRT types that involve cyclical bleeding. The estradiol component addresses the estrogen deficiency, while the drospirenone protects the uterine lining from potential endometrial hyperplasia. In clinical trials, the combination has been shown to effectively reduce the frequency and severity of menopausal symptoms within a few weeks of starting treatment.
Indications and Treatment Targets
Angelique is specifically indicated for women with a uterus to treat the following conditions:
- Moderate to severe vasomotor symptoms: This includes hot flashes and night sweats, which are common and often disruptive symptoms of menopause.
- Moderate to severe vulvar and vaginal atrophy: This refers to the thinning, drying, and inflammation of the vaginal walls due to reduced estrogen, which can cause discomfort, dryness, and irritation. When prescribing treatment solely for these symptoms, a healthcare provider should first consider topical vaginal products.
Potential Risks and Side Effects
Like all medications, Angelique carries potential risks and side effects, and it is important for a patient and their doctor to discuss them thoroughly. The U.S. FDA has issued a boxed warning for estrogen plus progestin therapies like Angelique, highlighting potential increased risks for certain conditions.
Important Safety Information
- Cardiovascular Risks: HRT is not used to prevent heart disease. Estrogen with progestin may increase the risk of heart attacks, strokes, deep vein thrombosis (DVT), and pulmonary embolism (PE).
- Malignant Neoplasms: Combined HRT may increase the risk of breast and uterine cancer. The progestin in Angelique is included to mitigate the risk of endometrial cancer, but vigilance is still required.
- Hyperkalemia: Due to its drospirenone component, Angelique can increase serum potassium levels in some individuals, particularly those with kidney disease, adrenal insufficiency, or those taking other medications that raise potassium. Potassium levels may be monitored, especially during the first month of treatment.
- Dementia: Studies involving women aged 65 and older showed an increased risk of developing probable dementia with combined HRT. It is unknown if this applies to younger women.
Common side effects
Common adverse reactions reported in clinical trials include:
- Headache
- Breast pain or discomfort
- Abdominal pain and bloating
- Irregular vaginal bleeding or spotting
- Mood swings
- Nausea
- Weight gain (potentially due to fluid retention)
Comparison with Other HRT Options
HRT comes in various forms, including patches, gels, and other oral tablets. The best option depends on individual health, lifestyle, and symptom profile. A discussion with a healthcare provider is essential.
| Feature | Angelique (Drospirenone/Estradiol Oral Tablet) | Estradiol Transdermal Patch (e.g., Climara, Vivelle-Dot) |
|---|---|---|
| Hormones | Continuous combined estradiol and drospirenone | Contains only estradiol (estrogen) |
| Administration | Once-daily oral tablet | Patch applied to the skin, typically twice weekly |
| Protection for Uterus | Contains progestin (drospirenone) to protect uterine lining. Appropriate for women with a uterus. | Requires a separate progestin for women with a uterus to prevent endometrial cancer. |
| Systemic Exposure | The oral route leads to systemic exposure that can affect the liver. | The transdermal route avoids the first-pass effect in the liver. |
| Effect on Blood Pressure | Drospirenone has antimineralocorticoid properties, which can help manage fluid retention. Blood pressure should be monitored. | Does not have the specific properties of drospirenone. |
| Generic Availability | No generic version currently available. | Lower-cost generic versions are available. |
Administration
Angelique is taken as one tablet daily, every day, without interruption. It is crucial to take the tablet at approximately the same time each day to maintain consistent hormone levels. If a dose is missed, it should be taken as soon as possible, but if more than 24 hours have passed, the missed dose should be skipped. There are different available strengths to address various menopausal symptoms.
Conclusion
Angelique is a continuous combined hormone replacement therapy that effectively treats moderate to severe menopausal symptoms like hot flashes and vaginal atrophy in women with an an intact uterus by providing a combination of estradiol and drospirenone. The inclusion of a progestin like drospirenone is vital for protecting the uterine lining from potential cancer risks associated with estrogen-only therapy. While generally well-tolerated, it is crucial to be aware of the potential side effects and safety warnings, particularly regarding cardiovascular events, certain cancers, and hyperkalemia. The lowest effective dose for the shortest duration consistent with treatment goals is recommended. As with any HRT, the decision to use Angelique should be made in close consultation with a healthcare provider, considering individual health risks and symptom severity.
For more detailed information, consult the U.S. FDA prescribing information for Angelique.
