Brought to you by Northwest Health & Wellness, expert(s) at Hormone & Metabolism.

Menopause brings changes, choices

Each woman in her lifetime will have to deal with the realities of menopause. And while symptoms may be very clear, the information about how to treat them can be overwhelming and confusing.
Most women do not need any special treatment for menopause, but some women may have menopause symptoms that need treatment, and several are available.

There is no one treatment that is good for all women, so it's a good idea to talk about the treatments with your health care provider so you can choose whatÕs best for you. Sometimes menopause symptoms go away over time without treatment, but thereÕs no way to know when.

Hormone Replacement Therapy (HRT)

If used properly, hormone therapy is one way to deal with the more difficult symptoms of menopause. It is an FDA approved treatment for hot flashes and vaginal dryness.
Hormone therapy should not be used solely to prevent heart or bone disease, stroke, memory loss, or Alzheimer's disease. As with all treatments, HRT has both benefits and risks; it is important to talk about these issues with your health care provider.

Hormone therapy can help with menopause by reducing hot flashes, treating vaginal dryness, slowing bone loss and improving sleep. But for some women, HRT may increase their chance of blood clots, heart attack, stroke, breast cancer and gall bladder disease.

If you decide to use HRT, use the lowest dose that helps and for the shortest time needed. Check with your health care provider every six months to see if you still need HRT.

Bio-identical Hormone Therapy (BHRT)

The term bio-identical hormones sometimes referred to as Ōnatural hormonesĶ is a term that has been used interchangeably in the literature. To scientists and healthcare providers, bio-identical hormones are those that are chemically or molecularly identical to the hormones produced in a womanÕs body primarily in the ovaries. A womanÕs body can make various estrogens as well as progesterone, testosterone, and other hormones.

Synthetic hormones have been produced commercially to be chemically exact duplicates of some of these naturally-occurring, bio-identical hormones. These hormones are made available through FDA approved brand-name prescription drugs.

Bio-identical hormones are made in specialized compounding pharmacies that are governed by their individual State Board of Pharmacy. The most common delivery method is a topical cream or gel form. Sublingual (under the tongue) drops or tablets, oral capsules, implantable pellets, and vaginal preparations are also available through compounding pharmacies.

Custom-compounded hormones may provide certain benefits, such as individualized prescriptions and dosage forms that are not available commercially. As with all medications there may be risks to the consumer. Some people may be concerned that compounded medications are not FDA approved. It is important to note that some bio-identical hormones are manufactured by pharmaceutical companies, are FDA approved and are commercially available in oral forms or skin patches. If you have questions about this please contact a local compounding pharmacy.

Alternative remedies

Several alternative remedies exist for women to try. Herbal menopausal remedies which include combinations of black cohosh, wild yam, and/or soy are among the most popular. Some women will experience complete relief of their menopause symptoms, although for other women they do not find the herbal remedies helpful at all. It is important to remember that it has not been clinically proven that herbs or other "natural" products are helpful or safe for the treatment of menopausal symptoms. Studies are being conducted to learn about the benefits and risks of alternative therapies and natural remedies.

Synthetic estrogen and progestin

The WomenÕs Health Initiative has released the following findings regarding synthetic estrogen and progestin therapy. Results compared women taking synthetic estrogen and progestin to those taking placebo pills.

- The number of women who developed breast cancer was higher in women taking synthetic estrogen plus progestin.
- The numbers of women who developed heart attacks, strokes, or blood clots in the lungs and legs were higher in women taking synthetic estrogen plus progestin.
- The numbers of women who had hip and other fractures or colorectal cancer were lower in women taking synthetic estrogen plus progestin.
- There were no differences in the number of women who had endometrial cancer (cancer of the lining of the uterus) or in the number of deaths.

What are the Increased Risks for Women Taking Synthetic Estrogen plus Progestin?

For every 10,000 women taking synthetic estrogen plus progestin pills, 38 developed breast cancer each year, compared to 30 breast cancers for every 10,000 women taking placebo pills each year. Also, 37 had a heart attack, compared to 30 out of every 10,000 women taking placebo pills.

The study also found 29 women had a stroke each year, compared to 21 out of every 10,000 women taking placebo pills, and 34 had blood clots in the lungs or legs, compared to 16 women out of every 10,000 women taking placebo pills.

What are the Reduced Risks for Women Taking Synthetic Estrogen plus Progestin?

The study found that for every 10,000 women taking synthetic estrogen plus progestin pills, 10 had a hip fracture each year, compared to 15 out of every 10,000 women taking placebo pills each year. Additionally, 10 developed colon cancer each year, compared to 16 out of every 10,000 women taking placebo pills.

What were the actual hormones that women in the synthetic estrogen-plus-progestin study were taking?

Women who were randomized to receive active hormones were taking conjugated equine estrogens 0.625 mg each day and medroxyprogesterone acetate 2.5 mg each day.

This is the most commonly prescribed postmenopausal hormone therapy in the United States for women who have a uterus (used each day by more than six million women).

When did the increased risk of breast cancer become apparent for women taking synthetic estrogen-plus-progestin compared to women taking placebo pills?

There was no difference in the development of breast cancer during the first four years between women taking synthetic estrogen plus progestin and those taking placebo pills. After that time, the numbers began to increase. After an average of 5.2 years, there was an increased risk of breast cancer in women taking synthetic estrogen plus progestin compared to those taking placebo pills.

Does this information apply to Selective Estrogen Receptor Modulators (SERMS) or phytoestrogens?

These preparations were not studied in the WomenÕs Health Initiative Hormone Program, and therefore, we cannot make any conclusions about the risks or benefits of SERMs, such as raloxifene or tamoxifen or phytoestrogens.

How does this information affect my decision to use HT for relief from hot flashes, sleep problems and mood swings?

The WomenÕs Health Initiative and the observational studies on the risk of ovarian cancer were long-term studies which were not meant to address the shorter-term use of hormone therapy. Thus, the information from these studies should be used by women considering use of hormone therapy for longer than three or four years.

Information provided by the National WomenÕs Health Information Center and the North American Menopause Society