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RECENT WOMEN'S HEALTH STORIES

 
April 2, 2001
WOMEN'S HEALTH
Sweating Out Menopause
Is Hormone Replacement Therapy Right for You?
By Louisa C. Brinsmade

Menopause Image

Kathleen's signs of menopause started when she was 45. "Way too young…" she laughs. Now 54, her hot flashes wake her from a sound sleep with a raging heat that spreads quickly throughout her body. "They're like the highest fever you've ever had - but they only last about a minute or two," she explains. Her night sweats sometimes bring on anger and exasperation, but Kathleen has been working to relax during her episodes by using breathing exercises she learned in yoga class. Other than the occasional foray into natural tea remedies, she doesn't use medication to control or ease the decline of estrogen that is causing her symptoms of menopause.

Kathleen is not on any kind of hormone replacement therapy (HRT), and probably isn't going to go that route, she says, even though she is a likely candidate for estrogen supplements. Her philosophy stems from a lifelong commitment to letting nature take its course. She feels that her body knows best, not necessarily her doctor. Kathleen has not yet tried alternative estrogen sources, such as soy milk or other soy products that are high in phytoestrogen (estrogen-like) properties. She has tried some of the herbs known to help relieve the severity of hot flashes, like black cohosh root tea, and others, but says she has not seen a significant change.

Leslie, 56, had been on hormone replacement therapy for four years before deciding to end her treatment in February. Her decision was short-lived. The results from her bone density test came back positive for osteopenia - a precursor to osteoporosis. Given that estrogen is shown to prevent osteoporosis, she quickly returned to her HRT treatment. Leslie, like many other women in their menopausal years, had been conflicted about long-term medication to alter what seemed a natural "change of life."

"I was so sick of taking pills everyday, that I just stopped," Leslie explains. "But when I told my doctor, he said to go get a bone density test. After I saw the results, I decided to go back on the HRT. For me, I realized the benefits outweighed the hassles. I need to do something to strengthen and rebuild my bones."

Over 40 million American women are in the menopausal age range between 45-55 when the ovulation cycle ends and the natural decline of estrogen and progesterone begins. It can be a time of great discomfort for many women, with the signs of hormonal decline ranging from mild mood swings to severe night sweats, stress incontinence, and discomfort during sexual intercourse. About 25% of U.S. women use supplemental hormones to relieve the symptoms of menopause or, similar to Leslie, use them to prevent osteoporosis.

There are many more benefits associated with estrogen supplements than menopause relief or osteoporosis prevention alone. Estrogen replacement has also been linked to heart disease prevention and may even help slow the onset of Alzheimer's disease.

But there are risks as well. Estrogen taken alone by women who have not had a hysterectomy may lead to cancer of the uterus by encouraging cell growth which can be malignant. Simply adding progestins to your estrogen medication can prevent endometrial cancer by stunting that growth, but the decades-long question of whether estrogen causes breast cancer remains unanswered. HRT for breast cancer survivors and those with a family history of the disease is a very controversial issue; estrogen in any drug combination is not recommended for those women due to the assumption that the tumors that may form in the breast would have a greater chance of being cancerous. This assumption has not been proven, and studies are underway to find definitive answers. The Women's Health Initiative (WHI), a 15-year nationwide clinical study sponsored by the National Institutes of Health, and several other studies are evaluating the effects of long-term use of HRT in postmenopausal women.

HRT is a very personal choice and should be made with the help of your doctor. Not only will you need to take into consideration your family medical history, but also your lifestyle choices and general feelings about menopause. There are a variety of estrogen products to suit individual needs, as well as non-estrogen prescription drugs like Evista, that are used to treat osteoporosis and may also decrease the incident of breast cancer. There are also natural remedies that may help alleviate the symptoms of menopause. Most importantly, make an informed decision for a healthier change of life.

Is HRT right for you?

Remember, this is a decision you should make with the help of your physician, but to be a more informed patient, here are some questions to consider.

Do I have any of the following menopausal symptoms? Are they causing me severe discomfort?

  • hot flashes and skin flushing
  • night sweats
  • depression and mood swings
  • decreased libido
  • vaginitis
  • vaginal dryness

Am I at Risk for Osteoporosis?

The following genetics/conditions/lifestyle choices may put you at risk.

  • Menopause: Bone density loss occurs after menopause because the ovaries stop making estrogen.
  • Removal of ovaries: If a woman has her ovaries removed before menopause, the sudden drop in estrogen can result in rapid bone loss unless she takes estrogen.
  • Diet low in calcium
  • Race (Caucasian and Asian women are at highest risk)
  • Sedentary lifestyle
  • Slim build
  • Eating disorders (anorexia nervosa or bulimia)
  • Family history
  • Some medications (diuretics, steroids, anticonvulsants)
  • Alcohol and tobacco use

Do I have a family history of heart disease, uterine, and breast cancer? How will HRT affect my risk for these conditions?

Weigh the benefits and risks with your doctor. Estrogen is shown to help prevent cardiovascular disease, although some women who take it do run higher risks of uterine and breast cancer. Consider, however, that cardiovascular disease kills 223,000 American women per year, while breast cancer kills 43,000.

Am I willing to undergo a daily regime of medication with some side effects?

Weigh your commitment to the therapy, and remember that HRT has possible side effects such as, break-through bleeding or even full menses, increased risk of endometrial cancer (unless progestins are supplied), blood clots, moodiness, bloating, and other side effects associated with birth control pills.

Would making changes in my current lifestyle help relieve my symptoms?

You can help prevent osteoporosis and relieve menopausal symptoms by:

  • Eating more estrogen-rich foods such as soybeans, tofu, soy milk and tempeh. Soy is the best way to reap the benefits of phytoestrogens that act like estrogen. Soy research on postmenopausal women in Japan where a soy-rich diet is maintained, showed only 10 to 15% of the female population complains of menopausal symptoms, compared to 80 to 85% of U.S. women. Other research shows that women on a soy-rich diet have lower incidences of breast cancer.
  • Avoiding alcohol, chocolate, coffee, and spicy foods. They can all make hot flashes worse.
  • Soaking in a tepid bath each morning for twenty minutes; this might prevent hot flashes all day long.
  • Taking calcium supplements.
  • Exercising regularly can reduce hot flashes and help prevent heart disease, while light impact exercise can actually build bone mass.

What are the benefits of HRT compared to the risks?

Keep in mind your medical history and that of your family as you read this list.

Estrogen's Benefits

Estrogen may prevent Alzheimer's disease.

Estrogen replacement therapy in menopausal women may help prevent or delay Alzheimer's disease according to studies conducted by researchers at The Johns Hopkins School or Medicine, USC, and others. Scientists at Johns Hopkins have shown that women with a history of estrogen replacement therapy after menopause reduced their risk of developing Alzheimer's disease by over 50%.

Estrogen helps prevent cardiovascular disease.

Cardiovascular disease is the number one killer of American women - over 223,000 women die per year from heart attack and stroke. Estrogen helps prevent this disease by lowering the "bad" cholesterol levels in the bloodstream and raising the "good" cholesterol levels that help clear arteries. Without estrogen, however, a woman's risk of cardiovascular disease eventually increases to that of a man's after age 65. This is especially problematic for women who have had a hysterectomy early in life.

Estrogen helps prevent osteoporosis

It is estimated that 65,000 American women die from complications of hip fractures (commonly as a result of osteoporosis) each year. About 25% of American women over 60 years of age have osteoporosis, losing one to three percent of their bone mass each year after 50. Estrogen helps the body build bone which reduces the number of bone fractures and back problems.

Overall health

According to a study published in the June 19, 1997 issue of The New England Journal of Medicine, women who take hormone replacement therapy for 10 years reduce their risk of dying from all causes by 37%.

Estrogen's Risks

May encourage the development of breast cancer.

Around 43,000 American women die of breast cancer each year. Estrogen replacement therapy for breast cancer survivors and those with a family history of the disease is a very controversial issue; The Women's Health Initiative (WHI) and several other studies are evaluating the effects of long-term use of HRT in postmenopausal women. Sponsored by the National Institutes of Health, the WHI is a 15-year nationwide clinical study that will investigate heart disease, osteoporosis, and breast and colon cancers in 63,000 women ages 50 to 79.

May encourage the development of endometrial cancer.

Estrogen taken alone is shown to encourage the growth of tumors on the endometrial lining of the uterus that may be cancerous. Combined with the progestin hormone, however, those dangers are diminished. Women who have had a hysterectomy may take estrogen without progestins.

Choosing the Right Estrogen for You

There are many different kinds of estrogen, and combination estrogen/progestin drugs available on the market today, either in pill or skin patch form. To meet individual needs, most of them come in different dosage amounts as well. The most popular HRT medicine is Premarin which is derived from the urine of pregnant mares although some women may prefer a plant-derived medicine instead. Our chart compiles the more popular drugs available for the best delivery method, dosage, and ingredients to suit your needs. Your doctor may add a prescription for progestins if you have not had a hysterectomy, and your particular estrogen drug does not include it.

Name of drug

Delivery

Estrogen plus?

Estrogen source

Different dosages?

Approved Uses and Notes

Activelle

pill

progestins

plant

no

Menopause symptoms

Alora

patch

 

plant

yes

Menopause symptoms

Cenestin

pill

 

plant

For menopause symptoms only.

Cenestin is not approved for long-term uses, such as the prevention of osteoporosis, and physicians should reassess use of the product with their patients every 3 to 6 months.

Climara

Skin patch

 

plant

yes

Menopause symptoms, Osteoporosis prevention

CombiPatch

patch

progestins

plant

yes

Menopause symptoms, Osteoporosis prevention

Estrace

Pill or patch

 

plant

yes

Menopause symptoms, Osteoporosis prevention

Estraderm

Skin patch

 

plant

yes

Menopause symptoms, Osteoporosis prevention

Estratab

pill

 

synthetic/ plant mix

yes

Menopause symptoms, Osteoporosis prevention

Estratest and Estratest H.S. (half-strength)

pill

testosterone

plant

yes

Approved for treatment of menopausal symptoms of persons not improved by estrogen alone.

Estinyl

pill

 

plant

yes

Menopause symptoms, Short-term use only, Not for osteoporosis prevention

Estring

Vaginal ring

 

plant

no

Vaginal dryness

FemPatch

patch

 

plant

no

Menopause symptoms

Menest

pill

 

synthetic/ plant mix

yes

Menopause symptoms, Osteoporosis prevention

Ogen

pill

 

Synthetic/ plant

yes

Menopause symptoms, Osteoporosis prevention

Ortho-Est

pill

 

Synthetic/ plant

yes

Menopause symptoms, Osteoporosis prevention

Premarin

pill

 

animal

yes

Menopause symptoms, Osteoporosis prevention. The most prescribed HRT drug, Premarin is made from PREgnant MARes' urINe (hence the name)

Prempro

pill

progestins

animal

yes

Menopause symptoms Osteoporosis prevention

Premphase

pill

progestins

animal

no

Menopause symptoms Osteoporosis prevention

Vivelle

patch

 

plant

yes

Menopause symptoms

Natural Remedies

Remedy

Condition

Delivery method

Black cohosh

Hot flashes, irritability, pain

40mg extract, twice daily

Chasteberry

Balances hormones; relieves menopausal symptoms

225mg extract, twice daily

Combination teas

Hot flashes Look for tea products that include these herbs: ginseng, black cohosh, dong quai, wild yam root, licorice root, false unicorn and sarsaparilla Dong quai Estrogen depletion

200mg extract, three times daily. Do not take during heavy menstrual bleeding.

Evening Primrose oil (contains gamma-linoleic acid)

Hot flashes/sleeplessness, tension, irritability, depression

Boil the root and drink as tea, or buy the seed oil in capsules - take 2 to 8 capsules a day depending on the brand.

Mexican Wild Yams - A natural source of progesterone

Hot flashes

Mexican Wild Yam is often ground and combined with a cream product to be absorbed through the skin

Panex Ginseng

Hot flashes

Use 500 mg twice a day for those weighing less than 130 lbs., three times a day for those up to 160 lbs., and four times daily for those over 160 lbs.

Soy products

Estrogen depletion

Soy milk, tempeh, tofu and many other soy products are high in phytoestrogens that act like the body's own natural estrogen hormone.

Valerian root

Intense sweating and sleeplessness

2-4 capsules at night - Valerian may damage the liver with overuse.

Rx.com does not warrant the accuracy of the information or guarantee the claims, benefits or safety of specific products. The claims made about specific products have not been evaluated by the Food and Drug Administration. Please consult with a healthcare professional before starting any diet, exercise or supplementation program. For further information please consult our full legal disclaimer.

Helpful Supplements

Type

Condition

Dosage

Amino Acids

Sleeplessness

15 grams from supplements, or have a snack at bedtime, such as cereal, milk and bananas

Calcium

Loss of bone density

1.5 grams, or 1,500 milligrams per day for postmenopausal women. Take with magnesium and vitamin D for absorption.

*Vitamin E

Hot flashes

Between 400 and 800 IU's per day - ask your physician for exact dosage if you are diabetic or are taking high blood pressure medication.

Bioflavonoids

Hot flashes

250 mg five to six times daily

Vitamin C

Post-hot flashes

Hot flashes deplete the body of Vitamin C, replenish it with at least 500-1,000 mg daily

Soy isoflavones

Hot flashes, menopausal symptoms

50mg daily

B-Complex

Post-hot flashes

Hot flashes deplete the body of the Vitamin B family, replenish it with a complex-B supplement daily

* Do not take with digitalis

Rx.com does not warrant the accuracy of the information or guarantee the claims, benefits or safety of specific products. The claims made about specific products have not been evaluated by the Food and Drug Administration. Please consult with a healthcare professional before starting any diet, exercise or supplementation program. For further information please consult our full legal disclaimer.

Non-estrogen drugs to help prevent osteoporosis

Brand Name

Delivery/Active ingredient

Notes

Evista

Raloxifene is a new form of drug called a selective estrogen receptor modulator (SERM). It is used for treatment of osteoporosis, but may also decrease chances of breast cancer.

Raloxifene both simulates and blocks the actions of estrogen. According to researchers at the University of California in San Francisco, the drug has a positive, estrogen-like effect on postmenopausal bones and cholesterol levels, yet it does not mimic estrogen's adverse effects on the breasts and uterus that causes tissue that over time, may increase a woman's risk of breast or endometrial cancer. Research has also showed that postmenopausal women with osteoporosis who were treated with raloxifene hydrochloride (Evista) for three years lessened their risk of breast cancer by 76 percent.

Fosamax

alendronate sodium - for treatment of osteoporosis

The FDA approved a dosage of 5 mg daily for prevention of osteoporosis, and 10 mg daily for those already with the condition. Fosamax can be used in combination with HRT. It is also touted as the least-visible patch available. It has not been shown to be effective in preventing heart disease.

New HRT Theories/Studies

Estrogen supplements plus testosterone might improve emotional well-being of certain postmenopausal women. A study on 16 patients at the Royal Brompton Hospital in Toronto-all sufferers of Cardiological Syndrome X, a condition primarily affecting postmenopausal women with normal coronary arteries suffering from anginal symptoms (chest pains). The women were given Estratest (1.25mg esterified estrogens and 2.5 mg methyltestosterone). The quality-of-life survey of these patients showed a significant improvement in their emotional well-being. (Solvay Pharmaceuticals put Estratest, an estrogen/testosterone combination pill on the market in 1989. See estrogen drug table for details.)

The new Spanish Fly?

A UCLA study of 75 postmenopausal women who have undergone a hysterectomy or oophorectomy (removal of the ovaries) reported that with an estrogen/testosterone combined therapy, the women had improved sex drive, more frequent intercourse, and better orgasms.

Androgens/estrogen as a diet drug?

Results from a Johns Hopkins released in June 1999 show that androgens combined with estrogen increases muscle and decreases fat in postmenopausal women.

Estrogen as a potential treatment for Alzheimer's disease to get further study.

The Women's Health Initiative Memory Study (WHI-MS), sponsored by the National Institute of Health, is exploring estrogen as a potential treatment for Alzheimer's disease. The study will last at least six years and involve more than 8,000 post-menopausal women age 65 and older. To enroll in the study, or for more information regarding WHI-MS, contact the Women's Health Initiative at 800/54-WOMEN or the Los Angeles Chapter of the Alzheimer's Association.

Phytoestrogens may work as well as Premarin in reducing the chances of stroke.

A 1998 study at Wake Forest University School of Medicine compared the effects of treatment with mammalian estrogens from Premarin, with treatment with soy phytoestrogens -- natural estrogen alternatives -- in postmenopausal monkeys, all of whom had been fed a diet high in cholesterol. The phytoestrogens worked as well as Premarin in reducing cholesterol levels and therefore, the chance of stroke.

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