Many treatment options are available to help women deal with hot flashes, sleep disturbances, vaginal discomfort, mood swings and other common symptoms of menopause. With each treatment, there are known benefits and risks, as well as other possible effects to be considered. There is no one menopause treatment that is right for every woman. The decision about which approach to use - or whether to use any at all - should be made after consultation with your personal physician and/or gynecologist.
This article is designed to help you in that decision-making process by giving you information about what clinical studies have found regarding the pros and cons of current menopause treatments.
Hormone replacement therapy
Menopausal symptoms are caused by a decrease in the levels of reproductive hormones produced by a woman's body. To replace these hormones and thereby ease the discomfort, physicians often prescribe a treatment called hormone replacement therapy (HRT). HRT usually combines two hormones, estrogen and progestin, although women who have undergone a hysterectomy typically only take estrogen. The hormones are available in several forms: pills or tablets, vaginal creams, injections and skin patches. The form selected by the physician may depend on your symptoms - creams are more often used for vaginal dryness, while pills or patches can ease several menopausal symptoms.
Benefits
HRT has been determined to be the most effective remedy for hot flashes, sleep disturbances, vaginal discomfort and stress incontinence. In some women, it also helps relieve depression and mood swings.
Until recently, it was felt that, along with reducing menopausal symptoms, HRT could also reduce the negative long-term health effects that occur after menopause, including osteoporosis (thinning of bone), heart disease and stroke. It is true that HRT builds and maintains bone, preventing the decline of bone density and subsequent hip fractures and stooped posture that often occur as women age.
However, the recent Women's Health Initiative Study found that combined HRT did not decrease the risk of heart disease and stroke. In fact, the study was discontinued early when it was discovered that HRT actually caused a small but significantly increased risk of nonfatal heart attacks, strokes and blood clots in the legs and lungs. In addition, there was also an increased risk of breast cancer.
In this particular study, there was a decrease in both osteoporosis and colon cancer. The arm of the study using estrogen only is still continuing.
Side effects
The most common side effects of hormone replacement therapy are:
- Vaginal bleeding and spotting
- Nausea
- Breast tenderness and pain
- Premenstrual-like symptoms (bloating, cramps, headache, irritability)
More than 20 years ago, studies found that women receiving estrogen alone (the common practice then) had a much higher risk of developing cancer of the endometrium, the lining of the uterus. Physicians now prescribe HRT with lower doses of estrogen than in the past and with a second hormone, progestin - which prevents overgrowth of the uterine lining - significantly lowering the chance of cancer development.
Studies are under way to determine what risks today's HRT poses in terms of endometrial cancer, particularly in women who have already been treated for the disease.
Alternatives to HRT
The side effects and potential risks of HRT have prompted many women to try other medications, natural hormones and dietary supplements. Some of these options have proven benefits, while others are considered experimental.
Here is the most recent information on commonly used HRT alternatives:
Raloxifene
Unlike traditional hormones, raloxifene is a 'selective hormone,' meaning it only acts like estrogen in certain tissues. It has been found in studies to have no effect on breast or endometrial tissue.
Raloxifene is prescribed for the prevention of osteoporosis in postmenopausal women. There is preliminary evidence that raloxifene can build bone and help reduce the incidence of fractures. And, it has been shown to help lower cholesterol levels. Raloxifene is also being tested as a potential breast cancer prevention agent in women at high risk.
Because raloxifene acts selectively, most women do not experience many of the common side effects of estrogen replacements, such as bleeding, bloating and breast tenderness.
This medication will not help the symptoms of menopause, such as hot flashes. And it should not be taken by women who can still become pregnant, have liver problems or had blood clots that required treatment by a physician.
Natural progesterone
Natural progesterone is chemically identical to what a woman's body produces each month from ovulation to menstruation. It is therefore less likely to cause premenstrual-like symptoms associated with synthetic hormones, such as bloating, mood swings or depression. It is also less expensive than synthetic hormones, may be more effective for postmenopausal use, and may be a safer alternative for women with high blood pressure or lipid levels. Studies on its use in osteoporosis prevention and treatment have shown promise.
Soy foods and other plant estrogens
Soy beans are a rich source of plant-derived estrogens, or phytoestrogens. Phytoestrogens are also found in flax seeds and some herbs. Studies have found the following benefits of including foods containing soy (soy milk, tofu, soy flour) in the diet:
- Less incidence of postmenopausal hot flashes
- Lower blood pressure and cholesterol
- Increase in bone density
- Decrease in vaginal changes after menopause
Researchers are also looking at the possible link between consumption of soy products and lowered breast cancer risk. Potential risks of consuming large quantities of phytoestrogens have not yet been determined.
DHEA
Dehydroepiandrosterone (DHEA) is produced by the adrenal gland and is the body's most abundant steroid in young adults. Its levels decline gradually over time, so that elderly people only have 15 to 20 percent of the DHEA of a 25-year-old. Animal experiments have suggested that large amounts of DHEA may increase bone density, boost immune function and protect against a number of age-related physiologic changes in the heart, brain and metabolism. But there have been few studies completed in humans, so potential risks and side effects are unknown. Until current clinical trials are completed, DHEA supplementation is not recommended as a therapy for menopause, except within these controlled studies.
Herbal remedies
Some of the common discomforts of menopause may be eased through herbal remedies. Examples include:
- Black cohosh for hot flashes
- Kava for anxiety and depression
- Passion flower for sleeplessness
- Echinacea for vaginal and urinary tract infections
- Goldenseal for vaginal irritation and inflammation, and uterine cramps
Unlike prescription and over-the-counter medications, herbal supplements are not regulated by the Food and Drug Administration, so their purity, potency and safety are not assured.
If you have questions about which menopausal treatment is right for you, talk with your physician. He can help you reach a decision that fits your lifestyle and meets your needs.
Supported by an educational grant from Eli Lilly and Company
Last Updated: September 28, 2009