Menopause relief and treatment

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Hot flashes: Prescription treatments for hot flashes include clonidine (Catapres), a medication that also lowers blood pressure. Bellergal, which contains a medication called phenobarbital, has also been used for hot flashes. It has the potential to become addictive and should only be used for a short period of time. It also can make you sleepy. Studies are under way using certain antidepressants (known as SSRIs) to see if they reduce hot flashes. Hot flashes usually last 2-3 years, but many women can experience them for up to 5 years. An even smaller percentage may have them for more than 15 years.

Several nonprescription treatments for hot flashes are available, and lifestyle choices can help. Soy protein is a popular remedy for hot flashes, although data on its effectiveness are limited. Some doctors recommend 60 grams of soy protein, or about 2 cups of soy milk, daily. Soy contains phytoestrogens, or natural plant estrogens (isoflavones), which are thought to have effects similar to estrogen replacement therapy. The safety of soy in women who have a history of breast cancer has not been established, although clinical studies say soy is no more effective than a placebo for treating symptoms. Soy comes from soybeans and is also called miso or tempeh. The best food sources are raw or roasted soybeans, soy flour, soy milk, and tofu. Soy sauce and soy oil do not contain isoflavones. Regular aerobic exercise was found to reduce hot flashes. Avoid foods that may trigger hot flashes, such as spicy foods, caffeine, and alcohol.

Abnormal vaginal bleeding: Prior to treatment, a doctor excludes other causes of erratic vaginal bleeding. Women in menopausal transition tend to have considerable breakthrough bleeding when given estrogen therapy. Therefore oral contraceptives are often given to women in menopause transition to regulate their periods, relieve hot flashes, as well as to provide contraception. Oral contraceptives are considered safe in healthy, non-smoking women.

Bone loss: Several medications may be used for preventing and treating osteoporosis. The bisphosphonates, which include alendronate (Fosamax) and risedronate (Actonel), have been shown in clinical trials to reduce bone loss in postmenopausal women and to reduce fracture risk in women who have osteoporosis. The medications themselves are poorly absorbed, however, and must be taken on an empty stomach with a large glass of water. You should not eat anything for one-half hour after taking the bisphosphonate medication. Do not lie down immediately after taking the medication, because these medications can irritate your esophagus. With the new version, you may only need to take this medication once a week. Raloxifene (Evista), a selective estrogen receptor modulator or SERM, is another therapy for osteoporosis. It reduces bone loss and appears to reduce the risk of back fractures in women with osteoporosis. Research is being done on whether raloxifene protects women against heart disease and on whether it reduces the risk of breast cancer. At this point, the US Food and Drug Administration has only approved raloxifene for the prevention and treatment of osteoporosis.
Calcitonin (Miacalcin or Calcimar are brand names) is a nasal spray that has been found to reduce the risk of back fractures in women who have osteoporosis.
A prevention drug currently under investigation is the drug PTH (parathyroid hormone).

Mood symptoms: Even though moodiness, irritability, and tearfulness are commonly attributed to menopause, studies are underway to determine which of these symptoms are actually due to menopause versus other conditions such as medical depression. Even though many women experience improvement in irritability with oral hormone therapy, hormone therapy alone will not be adequate treatment for a woman suffering from true medical depression (a true depression may require antidepressant medications that are different from medications for menopause). Accordingly, women who are experiencing significant mood symptoms should be evaluated by their doctors to exclude depression and other medical illnesses.

Vaginal symptoms: Prior to being treated for vaginal irritation, burning, and itching, women should first undergo an evaluation by a doctor, including a pelvic exam, to verify that the symptoms are due to estrogen deficiency.

There are local (meaning vaginal) and oral treatments for the symptoms of vaginal estrogen deficiency. Local treatments include the vaginal estrogen ring, vaginal estrogen cream, or vaginal estrogen tablets. Oral treatments include multiple types of estrogen either alone, or estrogen given with progesterone (read the Hormone Therapy article). Local and oral estrogen treatments are both effective in relieving vaginal symptoms and are sometimes combined for this purpose. In women for whom oral or vaginal estrogens are deemed inappropriate, such as breast cancer survivors, or women who do not wish to take oral or vaginal estrogen, there are a variety of over-the-counter vaginal lubricants. However, they are probably not as effective in relieving vaginal symptoms as replacing the estrogen deficiency with oral or local estrogen.

Osteoporosis: The goal of osteoporosis treatment is the prevention of bone fractures by stopping bone loss and increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture, none of the available treatments for osteoporosis are complete cures. In other words, it is difficult to completely rebuild bone that has been weakened by osteoporosis. Therefore, the prevention of osteoporosis is as important as treatment. Osteoporosis treatment and prevention measures are:Lifestyle changes including quitting cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D. Estrogen therapy for postmenopausal women and those with other low estrogen conditions. Women using HT for the short-term (less than 5 years) control of hot flashes will probably derive protection against osteoporosis during the time they are using HT. Other safe and effective non-hormonal prescription medications can be used to address osteoporosis in women who stop taking HT when hot flashes cease, and in women not taking HT. Medications that stop bone loss and increase bone strength, such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), and calcitonin (Calcimar).

Heart disease: Although it was previously felt that oral estrogen decreases the risk of heart disease in postmenopausal women, research with a large enough number of women in well-designed research (specifically, the Women's Health Initiative) has only just become available. The research suggests that estrogen does not protect against heart disease in women who do not yet have heart disease, nor is it protective in women who are already known to have heart disease. In fact, women with heart disease who begin HT may be at increased risk of a heart attack in the first year of starting oral HT. In the near future, we will have more research studies regarding this issue so we can know if the Women's Health Initiative results can be extended to other HT brands and preparations, and whether the results apply to patches as well as oral HT. In summary, oral HT is not appropriate for heart disease protection, but is clearly appropriate for women with hot flashes who intend short-term (less than 5 years) use and have no other contraindications.

The standard of treatment for menopausal symptoms is replacement of one or both of the major female hormones. Often abbreviated as "HRT" hormone replacement therapy restores both estrogen and progesterone. HRT is frequently prescribed for menopausal women who have not had surgery to remove the uterus. The addition of progesterone helps to protect against cancer of the uterus. Synthetic progesterones are called "progestins". Estrogen replacement therapy (ERT) is often used in patients who have had a hysterectomy since those women no longer have a risk for uterine cancer.

HRT/ERT is associated with decreases in rate of bone loss, menopausal symptoms. In addition, HRT/ERT may reduce the risks for heart disease, colorectal cancer, alzheimer's disease. HRT/ERT may not be a good decision for some women, however. Patients with the following conditions may need other types of treatment: known or suspected pregnancy, known or suspected breast cancer, history of breast or ovarian cancer in two first-degree relatives (mother, sisters), abnormal uterine bleeding, active treatment for blood clots in the legs. For women who are planning to take HRT for heart disease protection, the American Heart Association now advises that women do not start or continue combined HRT (products that contain both a progesterone and an estrogen component) solely for the prevention of coronary heart disease.

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