Menopause: Treatment Options

Menopause is a natural part of a woman's life cycle and is impossible to prevent. However, you can take steps to lessen symptoms and minimize discomfort once it begins. The most common form of treatment for menopause-related problems is hormone replacement therapy (HRT).

HRT replaces the hormones estrogen and progesterone, which are lost during menopause. It may be taken in various forms, including pills, skin patches, vaginal creams, vaginal rings, suppositories or injections. HRT helps relieve symptoms and prevent diseases linked to menopause. About 6 million American women take a combination of estrogen and synthetic progesterone after menopause, according to the National Heart, Lung and Blood Institute.

Hormones are chemical substances that carry instructions from one group of cells to another. The two most important sex hormones are estrogen and testosterone. They contribute to the development of sexual characteristics and reproduction. Both women and men produce estrogen and testosterone. However, women have much higher proportions of estrogen, whereas men have much greater proportions of testosterone.

Estrogen appears to offer women a number of important health benefits. It helps prevent bone loss, helps prevent buildup of plaque in the arteries, keeps the vagina lubricated and supple, and keeps the lining of the urethra from thinning, which helps prevent urinary tract infections.

During the years just prior to menopause (around age 50), the ovaries begin to shrink, causing levels of estrogen and another hormone called progesterone to drop. When estrogen is no longer produced in large amounts by the ovaries, menstruation stops. At the same time, without estrogen the woman may experience various adverse symptoms including hot flashes and vaginal dryness. She is also at a higher risk for heart disease, osteoporosis, Alzheimer's disease and other health problems.

Some of the benefits of HRT during and after menopause include:

• A reduction in the symptoms associated with menopause, such as:
  
  
  • Hot flashes. A feeling of warmth in the face, neck and chest, sometimes accompanied by night sweats or headaches.
    
    
  • Vaginal dryness. During menopause, vaginal skin may become dry and thin. Sex may become painful, and the woman may experience vaginal itching (pruritus) or burning.
    
    
  • Mood swings.
  
  
  
• Protection against certain diseases. Hormones are known to help prevent colon cancer and osteoporosis (a thinning and weakening of the bones). (Earlier claims that HRT helps prevent heart disease have not been supported by further research.)

If you are receiving HRT, it is likely that you will take one of the following:

• Estrogen. This HRT option is usually reserved only for women who no longer have a uterus. It can be made synthetically from plants and other sources, or made from the urine of pregnant horses.
  
  
• Estrogen with progesterone. This is the primary type of HRT given to women who still have a uterus. The progesterone helps prevent overgrowth of cells (hyperplasia) in the lining of the uterus that can lead to cancer. Progesterone that is made synthetically is called progestin. Another form of progesterone is known as "natural progesterone" or "micronized progesterone." It is very similar to the natural hormone.

It is usually recommended that women remain on HRT from several months to a few years. For years, physicians regularly prescribed HRT for all menopausal and postmenopausal women, even if their symptoms were not bothersome. However, the Woman's Health Initiative revealed health risks associated with HRT that have made physicians more cautious about prescribing these drugs. Sponsored by the National Institutes of Health, this 15-year study of more than 160,000 postmenopausal women ended in 2002. Because of this study, the current recommendation is for most menopausal women not to take HRT indefinitely.

However, HRT is often used on a long-term basis for preventing osteoporosis in women whose risk of getting the disease outweighs the risk of treatment. HRT can reduce the amount of calcium lost from the bones as a woman ages.

Other nonestrogen drugs that can be used to prevent osteoporosis include bisphosphonates (such as alendronate and risedronate) and selective estrogen receptor modulators (such as raloxifene). However, these drugs are relatively new, so how they affect the body over the long term is not entirely understood.

Many health risks are now known to be associated with HRT. Some of the most serious include blood clots, breast cancer and uterine cancer. The U.S. Food and Drug Administration (FDA) currently requires manufacturers of estrogen medications to include information about these risks in revised labeling that accompanies the drugs.

Still, the likelihood of side effects due to HRT is low. If you are of menopausal or postmenopausal age, discuss with your physician whether or not HRT is right for you.

If you choose not to undergo HRT, you can still take several steps to improve your health:

• Have regular checkups with your physician.
• Avoid tobacco products.
• Eat a balanced diet and maintain a healthy body weight.
• Ask a physician about taking calcium and vitamin D supplements to improve the health and strength of your bones.
• Exercise.
• Check blood pressure, cholesterol and blood sugar.
• Schedule breast exams and mammograms.

Menopausal symptoms can range from annoying to severe and can be extremely disruptive to your life. However, certain lifestyle changes and, in some cases, medications can lessen the impact that menopause has on your life, making this inevitable change as unobtrusive as possible.