Hormone Replacement Therapy

Weighing Your Options. Should I take HRT?

Here are some things to consider when deciding whether to begin hormone replacement therapy:

• Who would benefit most from HRT?
• Other medicines for menopause-related concerns
• What about soy?
• Other types of therapies
• The decision is a personal one

Who Would Benefit Most From HRT?

Virtually any woman past menopause may obtain some benefit from hormone replacement therapy, but it may be of particular benefit to women:

• Who have severe menopause symptoms, like hot flashes.
• Who are at increased risk for osteoporosis.
• Who had experienced an early menopause and who need to prevent early onset of osteoporosis. This includes young women who have amenorrhea (a condition in which menstrual periods stop because of severe weight loss, excessive physical training,chemotherapy, radiation therapy, or other causes).
• Who are young but whose ovaries have never developed properly and who need estrogen to develop mature female characteristics.

Alternatives To HRT

A number of other drugs are available that can help the discomforts of menopause and provide protection against certain diseases that can occur as a result of lower estrogen production.

• For hot flashes – Bellurgal is a non-hormonal drug that is approved for the treatment of hot flashes. It relieves symptoms in about half of the women who try it.
• To prevent osteoporosis – Newer medicines that can help prevent osteoporosis include alendronate (Fosamax), raloxifene (EVISTA), and calcitonin (Miacalcin, Calcimar).
• For vaginal dryness – Try moisturizers and non-estrogen lubricants such as KY Jelly or Replens.
• To prevent heart attacks – Aspirin and over-the-counter pain relievers can relieve discomforts. In addition, regularly taking a small dose of aspirin may help prevent colon polyps and heart attacks. Because aspirin can be associated with gastrointestinal problems, women should consult with their doctor before taking aspirin regularly.
• To lower cholesterol – Cholesterol-lowering medications (statins) can be prescribed to bring down high cholesterol levels and have few side effects.

What About Soy?

Recent attention has been turned to the benefits of soy . Soy has been shown to:

• Decrease hot flashes
• Lower cholesterol
• Have some of the same beneficial effects on blood vessels that estrogen has
• Slightly increase bone density

A diet with increased soy protein does seem to have beneficial effects. However, very little data is available on the safety of soy. One small study showed an increase in breast cancer among women who consumed soy.

The estrogen activity of soy is very low, so some of the major benefits of estrogen treatment cannot be obtained with soy alone.

Other Types Of Therapies

Whether they are taking hormone replacement therapy or not, women should pursue a healthy lifestyle for protection against all aging-related conditions. A healthy lifestyle includes:

• Regular weight-bearing exercise such as brisk walking or dancing.
• Not smoking.
• Eating a healthy diet rich in fresh fruits, vegetables, and whole-grain foods.
• Staying active sexually (this helps preserve the lining of the vagina)
• Limiting alcohol use

Some women report great benefit in relieving menopause symptoms from stress-management techniques such as:

• Therapeutic massage
• Acupuncture
• Meditation
• Relaxation therapy

Many women ask about “natural” remedies. Certain herbs are thought to be effective, but few reliable clinical studies have been performed. But it is important to know that herbal and vitamin therapies also may have potentially dangerous side effects.

• Black cohosh, for example, is a plant estrogen that may have an effect on menopause symptoms – but it also may increase cell growth in the uterus, which may be a risk factor for uterine cancer.
• Ginseng has hormonal qualities, and there are some reports of uterine bleeding associated with its use.