As expected, researchers found the rate of breast cancer and blood clots in the group taking the oestrogen/progestin combination was slightly up. But they also found a very disturbing increase
in heart attack and stoke--the very ailments they believed HRT would protect against.
While these results have caused many women to re-evaluate HRT, doctors point out that your personal risk for developing these problems is very small --less than one-tenth of 1 percent per year. And in spite of the data from the study, HRT may eventually be recommended to women who have especially severe menopausal symptoms and no history of breast cancer or heart disease. Rather than
using HRT for years, your doctor may prescribe a short course, just for the period when your symptoms are at their worst. You'll then gradually taper off the harmonies to avoid bringing on the symptoms all over again.
So what other drug options are there to HRT? If osteoporosis is your primary concern, you might try a biophosphonate, such as alendronate (Fosamax) or risedronate (Actone). These reduce fracture risk by 40 to 50 percent, have no hormones in them and some need to be taken only once a week. A newer choice for preventing osteoporosis is the so-called 'designer oestrogen' drug raloxifene (Evista), a selective-oestrogen to keep bones strong. For heart disease prevention, a statin drug such as atorvastatin (Lipitor) might help (see High cholesterol, page 180), and for hot flushes ask your doctor about using an antidepressant or a blood pressure medication. With these or any other prescription drugs, also discuss side effects these or any other prescription drugs, also discuss side effects before you start; they might be worse than your present symptoms.
>I have heart disease and was considering HRT. is the HERS study something I should pay attention to?
Even before the Women's health initiatives was cancelled in 2002 (see page 229), results from the Heart and Oestrogen/Progestin Replacement Study (HERS) shook experts confidence about the
role of HRT as a heart protector. The five-year HERS study, which concluded in 1998, found that women who already had heart disease were 50% more likely to have a heart attack during their first two years on HRT than those who didn't take hormones. But during the study's fourth and fifth years, those an HRT actually had fewer heart attacks and deaths from heart disease. The original trial was extended for an additional 2.7 years (called HERS 11). Its results support the conclusions of the original trial: HRT neither worsens nor improves a heart condition.
Lifestyle changes
Regardless of whether you're on medication for your symptoms, making some changes in your daily habits will help keep you physically and mentally agile. Because unwanted weight gain tends to go hand in hand with menopause, adopt a low-fat, high-fibre diet that includes lots of whole grains and fresh fruit and vegetables. To keep hot flushes in check, cut way back on alcohol, caffeine, chocolate and spicy foods. If your diet's shy on bone-building calcium (aim for 1200 to 1500 mg daily), include more reduced-fat dairy products, calcium-fortified foods and canned salmon (with the bones). You might also want to eat more tofu and other soy products which are rich in isoflavones, oestrogen-like compounds found in plants. Research shows that isoflavones may help relieve hot flushes and night sweats, and possibly even protect against osteoporosis and breast cancer. Soy isoflavone supplements, however, have never been found to have the same effects as dietary soy, and some research suggests that very large doses of the supplements (again, not soy foods) may cause a hormone imbalance that increases the risk of certain oestrogen-sensitive cancers.
PROMISNG DEVELOPMENTS
If you favour a natural approach to the natural changes in your body, consider these popular herbal remedies for menopausal symptoms. The TGA does not currently regulate herbal supplements, so talk with your doctor about taking them.
Finally, if you're feeling anxious or having self-esteem problems, consider seeing a counsellor or joining a women's support group.
Natural methods
In addition to getting plenty of calicum in your diet, it's also important to get enough vitamin E, vitamin D and magnesium. These can be taken in supplement form to boost the amount you get from foods. Vitamin E stimulates the body's oestrogen production, and as one of the antioxidant vitamins (along with the carotenes and vitamin C), it acts to prevent LDL ('bad') cholesterol from causing plaque to form in your artery walls. Magnesium and vitamin D help to prevent osteoporosis and are often combined with calcium in a 'bone-building' supplements. There are also a number of other herbal supplements such as black cohoshand red cover, which you also might want to consider (see above) to help keep menopausal symptoms in check. In addition, some women have found success with acupuncture, an ancient Chinese technique in which thin needles are inserted at key points on the body, in relieving headaches, sleep disturbances and other menopasual symptoms.
in heart attack and stoke--the very ailments they believed HRT would protect against.
While these results have caused many women to re-evaluate HRT, doctors point out that your personal risk for developing these problems is very small --less than one-tenth of 1 percent per year. And in spite of the data from the study, HRT may eventually be recommended to women who have especially severe menopausal symptoms and no history of breast cancer or heart disease. Rather than
using HRT for years, your doctor may prescribe a short course, just for the period when your symptoms are at their worst. You'll then gradually taper off the harmonies to avoid bringing on the symptoms all over again.
So what other drug options are there to HRT? If osteoporosis is your primary concern, you might try a biophosphonate, such as alendronate (Fosamax) or risedronate (Actone). These reduce fracture risk by 40 to 50 percent, have no hormones in them and some need to be taken only once a week. A newer choice for preventing osteoporosis is the so-called 'designer oestrogen' drug raloxifene (Evista), a selective-oestrogen to keep bones strong. For heart disease prevention, a statin drug such as atorvastatin (Lipitor) might help (see High cholesterol, page 180), and for hot flushes ask your doctor about using an antidepressant or a blood pressure medication. With these or any other prescription drugs, also discuss side effects these or any other prescription drugs, also discuss side effects before you start; they might be worse than your present symptoms.
>I have heart disease and was considering HRT. is the HERS study something I should pay attention to?
Even before the Women's health initiatives was cancelled in 2002 (see page 229), results from the Heart and Oestrogen/Progestin Replacement Study (HERS) shook experts confidence about the
role of HRT as a heart protector. The five-year HERS study, which concluded in 1998, found that women who already had heart disease were 50% more likely to have a heart attack during their first two years on HRT than those who didn't take hormones. But during the study's fourth and fifth years, those an HRT actually had fewer heart attacks and deaths from heart disease. The original trial was extended for an additional 2.7 years (called HERS 11). Its results support the conclusions of the original trial: HRT neither worsens nor improves a heart condition.
Lifestyle changes
Regardless of whether you're on medication for your symptoms, making some changes in your daily habits will help keep you physically and mentally agile. Because unwanted weight gain tends to go hand in hand with menopause, adopt a low-fat, high-fibre diet that includes lots of whole grains and fresh fruit and vegetables. To keep hot flushes in check, cut way back on alcohol, caffeine, chocolate and spicy foods. If your diet's shy on bone-building calcium (aim for 1200 to 1500 mg daily), include more reduced-fat dairy products, calcium-fortified foods and canned salmon (with the bones). You might also want to eat more tofu and other soy products which are rich in isoflavones, oestrogen-like compounds found in plants. Research shows that isoflavones may help relieve hot flushes and night sweats, and possibly even protect against osteoporosis and breast cancer. Soy isoflavone supplements, however, have never been found to have the same effects as dietary soy, and some research suggests that very large doses of the supplements (again, not soy foods) may cause a hormone imbalance that increases the risk of certain oestrogen-sensitive cancers.
PROMISNG DEVELOPMENTS
- While ongoing studies attempt to sort out the benefits and drawbacks of HRT, researchers are also testing other drugs in order to determine their ability to manage menopausal symptoms. Future treatments may include combinations of oestrogen and testosterone (Estratest), to increase bone mass, improve sexual drive and sharpen alertness; and gabapentin (Neurontin), a neurological drug that may alleviate hot flushes.
If you favour a natural approach to the natural changes in your body, consider these popular herbal remedies for menopausal symptoms. The TGA does not currently regulate herbal supplements, so talk with your doctor about taking them.
- Black cohosh. This butter-cup relative has long been used for hot flushes and vaginal dryness. Its properties resemble oestrogen, and studies are needed to confirm its long-term safety and effectiveness. Until then, experts suggest only short-term use, no more than six months at a time. One product is Remifemin, available in pharmacies and health-food stores.
- Siberan ginseng. Used for centuries in China, this all-purpose herb helps relieve stress, boost mood, enhance immunity and increase mental alertness. It may also alter hormone levels and reduce menopausal symptoms.
- Dong qual. Often referred to as the 'female ginseng', this herb seems to have a balancing effect on the female hormone system. It's best taken in combination with herbs such as black cohosh and Siberian ginseng. Studies are inconclusive as to whether it works on its own.
- Red cover. Available in a menopause-targeted formula called Promensil, red clover contains isoflavones, powerful phyto-oestrogens. In a study at Tufts University, menopausal patients reported that Promensil cut hot flushes by half. Two other studies, however, revealed no benefits.
- Menopausal formulas. There are a number of 'women's formulas' for menopause that feature various herbs including black cohosh and dong quai. The amount of each herb may be so low, however, that it pays to take them separately. And remember that such a combination product is an alternative to, not an addition to, using black cohosh or other 'female' herbs.
Finally, if you're feeling anxious or having self-esteem problems, consider seeing a counsellor or joining a women's support group.
Natural methods
In addition to getting plenty of calicum in your diet, it's also important to get enough vitamin E, vitamin D and magnesium. These can be taken in supplement form to boost the amount you get from foods. Vitamin E stimulates the body's oestrogen production, and as one of the antioxidant vitamins (along with the carotenes and vitamin C), it acts to prevent LDL ('bad') cholesterol from causing plaque to form in your artery walls. Magnesium and vitamin D help to prevent osteoporosis and are often combined with calcium in a 'bone-building' supplements. There are also a number of other herbal supplements such as black cohoshand red cover, which you also might want to consider (see above) to help keep menopausal symptoms in check. In addition, some women have found success with acupuncture, an ancient Chinese technique in which thin needles are inserted at key points on the body, in relieving headaches, sleep disturbances and other menopasual symptoms.
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