Mind & Body
Managing MenopauseIs Hormone Replacement Therapy In Your Future?
By Triston V. Sanders
Hot flashes. Night sweats. Insomnia. Anxiety. Mood swings. Memory problems. Low energy levels. Irritability. Vaginal dryness. Low libido.
Many or all of these symptoms greet women when they hit menopause – the time in a woman’s life when her hormone production decreases. Women typically enter this phase in their lives between the ages of 45 and 52, and there is a dizzying array of things a woman can do to fight these frustrating symptoms. An estimated six million American women opt for hormone replacement therapy (HRT).
“Hormone replacement therapy, by whatever means, is either estrogen or progesterone or a combination of the two,” said Dr. Tamara Petrac of Sacred Heart Hospital on the Emerald Coast in Miramar Beach. “They are hormones that are made to replace those made by women to treat certain symptoms.” There is some evidence, said Petrac, “that hormones can also have some antidepressants affects.”
But some women fear that taking hormone replacement therapy may increase their risks of breast cancer, heart attack, stroke or Alzheimer’s disease. Several studies have been done on hormone replacement therapy and their effects on a woman’s health.
The Women’s Health Initiative conducted a well-known study using conjugated equine estrogen (CEE), or Premarin. In that study, researchers claimed there is an increased risk of stroke and no reduction in the risk of heart diseases in postmenopausal women who have had a hysterectomy.
“Premarin is a conjugated equine (horse) estrogen,” Petrac said. “The only product that was studied in the Women’s Health Initiative was the Premarin alone and Premarin with a progesterone (medroxyprogesterone).”
While Premarin still is an option for women, many other options are now available, such as “bioidentical hormones.” These are made from the same hormones a woman’s body produces, and are made from soy or yams.
Although some in the medical community have decided to disregard the Women’s Health Initiative studies, many health organizations still base their recommendations for women on them. The American Heart Association advises women to “weigh the potential risks of therapy against the potential benefits for menopausal symptom control.” And it states that “hormone therapy should be used for the shortest time period.” The organization’s Web site even directs visitors to the Women’s Health Initiative study.
For those wary of taking hormones, there are alternatives.
“There are many alternatives for HRT, but most women don’t have the same success for symptom control,” Petrac said. “One option is botanicals, which are numerous but haven’t been rigorously tested. Botanical medicine are plant products or phytochemicals that were initially isolated from plant material but are now being made chemically.” Botanicals include phytoestrogens and black cohosh, which is commonly used in Germany for hot flashes.
“Treatment needs to be individualized,” Petrac said. “This is something that every woman should discuss with her health care provider or doctor to see if HRT or natural hormones is something for them, or if alternatives need to be considered.”
Although treatment of menopause is controversial, there appears to be a consensus that exercise and diet may minimize the effects of menopause.
“The tide of women turning to alternative therapies actually is a good sign of women during the perimenopausal time taking an active interest in their wellness and motivating changes,” Petrac said. “The North American Menopause Society notes that many women use simply a healthy diet, exercise, vitamins and calcium. Thirty percent of women use acupuncture, natural estrogen, herbal supplements or plant estrogens.”
The evaluation process begins with a complete physical exam, including testing a woman’s current hormone levels and taking a medical history. There are many possibilities for dealing with menopause, and the choice is made after taking into consideration several factors, including hormone levels, family history, and severity and types of symptoms.