It’s unfortunate in some ways that the medical community, and women themselves, have taken the view that menopause is a medical condition that needs treatment. While some of the symptoms of menopause do impact the quality of your life such as sleeplessness, hot flashes and depression, it’s also a fact that it’s a necessary part of the aging process. True some of the potentially more dangerous conditions of menopause, such as depression and osteoporosis, may need to be dealt with medically, but as with all medical treatments comes the fact that the cure may be worse than the “disease”. And this has proved true in the case of hormone replacement therapy (HRT).

For years, the best medical treatment recommended for menopause
was the use of HRT, but in 2002 all of this began to be questioned when the US government stopped a drug trial of the Women’s Health Initiative (WHI) to test the uses of hormone replacement therapy. Evidence began to emerge that HRT caused an increase in breast cancer, heart disease, blood clots, strokes, and endometrial cancer. Even though this study also showed HRT use decreased osteoporosis risk and maybe also colon cancer, in 2002, the cons began to outweigh the pros and women began to reject HRT.

More information is available for women today due to new studies and tests, but there are still questions and concerns regarding HRT. A study conducted by WISDOM (Women’s International Study of Long Duration Estrogen after Menopause) started in the early 1990’s was closed early due in part to the problems found in the WHI study but WISDOM was breaking down HRT use by the age and was getting some more promising data on the use of HRT. The Women’s Health Initiative studied women aged 50 – 79 years old and the study reflected the long term effects of HRT use but not short term use by women just starting menopause. Unfortunately both of these studies left questions. Two questions listed in the WISDOM study as specifically not addressed are: 1) What is the long term effect of HRT if started at the onset of menopause? 2) Are there differences among the various types of HRT available?.

HRT is still in use today, but it is generally only recommended for short term use, usually one to two years for women who are under going natural menopause. Young women having surgical menopause brought on my hysterectomy or other procedures stay on hormone replacement therapy longer, sometimes until the onset of natural menopause.

HRT has many different forms and many different delivery systems. It usually includes a low dose estrogen with progesterone, or sometimes a synthetic progesterone, called progestin may be used. Testosterone is sometimes included in the treatment and this is used to help treat loss of sexual desire. Various combinations of these hormones may be given depending on what your doctors feels is the best way to proceed. Delivery systems include pills, creams, patches, IUDs, vaginal rings and sometimes shots.

 HRT Risks:

• Breast cancer
• Ovarian cancer
• Gallbladder disease
• Moodiness
• Water retention
• Nausea
• Blood Clots
• Heart Attacks
• Strokes
• Breast sensitivity

Some of these side effects depend on the type of dosage and delivery system used. For example, creams and gels might upset your stomach. Also, these risks depend on the type of estrogen or progesterone taken. Conjugated equine estrogens (CEE) have been the most prescribed HRT so most of the current testing has been done on them and because most of the studies conducted have been done on equine estrogens, only the side effects and risks attributed to these estrogens are known. These same risks are not applicable to bioidentical human estrogen and more studies still need to be conducted as these treatments are gaining in popularity.

Only a discussion with your doctor can help you decide if HRT is the choice for you. If you do have a family medical history of cancer or any of the other HRT risks listed above, be sure to discuss this with your doctor.

When treating menopause, both the symptoms of menopause and the underlying hormone fluctuations of menopause need to be treated in order to achieve maximum relief. Unfortunately at this time, there are very limited treatment options available for the vast majority of menopause symptoms and it’s important to keep in mind that menopause itself is not a disease, it’s the most natural occurrence on earth just like puberty and pregnancy.

Prescription drugs- Bio-identical hormone therapy is one option available for menopausal woman. These drugs have similar chemical hormone balances as the female body. It is the most natural, prescription choice available on the market, due to the fact that the hormones are derived and extracted from plants. These hormones are available in cream and gel form for quick absorption, reducing side-effects significantly. The only disadvantage to the therapy is the lack of research on safety and effectiveness of the product range. Of all the therapy types, estrogen therapy also known as hormone replacement therapy or HRT, a combination of progesterone and estrogen, is probably the best known. Estrogen assists in reduction of hot flashes and cholesterol while also successfully treating uncomfortable urinary and vaginal problems related to menopause.

Estrogen disadvantages- Estrogen therapy unfortunately has some major disadvantages such as increased risk of cancer specifically breast and endometrial, heart attacks, strokes, thrombosis, clotting, discomfort during sex and gallstones. Estrogen is available in creams, gels, patches and capsules

SSRI’s – Selective serotonin reuptake inhibitors also known as SSRI’s
are a class of medications used to treat depression. When depressed menopausal women were taking SSRI’s, they had fewer hot flashes. Many women, whether depressed or not, have found relief from hot flashes while using SSRI’s. Only a short dose is needed to tell whether the treatment will work or not, usually you will know in a week or two if SSRI’s will get results. Unfortunately, SSRI’s don’t work on all women for treating menopause.

Clonidine and Gabapentin – Limited testing of these drugs on menopausal women for the treatment of hot flashes has yielded positive results, but not enough clinical testing has been done. Clonidine is typically used to treat ADHD and gabapentin is used to treat epilepsy so they have been tested for the treatment of these diseases, just not for the treatment of hot flashes.

Other Traditional Treatments- Calcium intake can be increased to 1500 mg’s per day, this will help combat osteoporosis. Anti- depressants as well as anti-anxiety medication are also prescribed to reduce panic, depression and anxiety attacks often associated with menopause. Vitamin and mineral supplements are highly recommended as nutritional deficiencies are also common during menopause.

Of the treatments listed above, only estrogen has been tested extensively for the treatment of menopause. SSRI’s, clonidine, and gabapentin have been found to give results for hot flashes but more testing needs to be done. Sometimes a doctor may be willing to try these options if you aren’t getting relief from other medical treatments.

Photo is used courtesy of flickr creative commons and is the work of Generalnoir