Hormone replacement therapy (HRT) is the most common medical treatment for menopausal symptoms, but what other options are available, and how will they help you?
HRT Pros
HRT consists of replacement oestrogen, and in some cases, progesterone. Progesterone is usually added when the woman has not had a hysterectomy, since the action of oestrogen alone on the womb can cause endometrial cancer. In these cases, HRT will induce menstruation (unless the uterus has been removed) and some premenstrual-type symptoms.
HRT can reduce or eliminate almost all of the symptoms of menopause and can protect against the long-term effects of oestrogen deficiency, i.e. cardiovascular disease, stroke, and osteoporosis. It is also now thought that HRT may delay or help prevent the development of Alzheimer's disease.
HRT Cons
There are some unwanted effects of HRT. Oestrogen can cause endometrial cancer if used alone, so progesterone is added to the treatment in women who have not had a hysterectomy. It is thought that the risk of some forms of breast cancer may be slightly elevated with prolonged use of hormones, as is the risk of developing deep vein thrombosis (blood clot), which can move to the lungs and become life threatening.
A family history of breast cancer and thrombosis is used by doctors to establish whether it is safe to prescribe HRT. Contraindications from using HRT include unexplained vaginal bleeding, hypertension, migraines, hyperlipidemia (elevated blood lipid concentration), endometriosis, gall bladder disease, chronically impaired liver function or liver disease.
SERMS
Selective (o)estrogen receptor modulators (SERMs), for example raloxifene, were originally developed for the treatment of breast cancer, but now appear to be effective in preventing osteoporosis. They are compounds that have a high binding affinity for oestrogen receptors, and therefore provoke the same responses in the body as oestrogen.
SERMs have been shown to lower LDL (bad) cholesterol, and are thought to have a cardioprotective effect, although this remains to be proven. Studies have confirmed that raloxifene is capable of mirroring the effects of oestrogen in treating the symptoms of oestrogen deficiency. SERMs do not treat other symptoms of menopause such as hot flushes.
A great deal of research is being performed in order to learn more about the benefits and drawbacks of SERMs in the hope that they may be used in future to treat a host of diseases.
Medicines for other symptoms
Treatments are available for menopausal symptoms, such as oestrogen cream for vaginal dryness, or pessaries for a prolapse.
Calcium preparations are used to help prevent or manage osteoporosis, anti-depressants or tranquillisers are sometimes prescribed to treat more severe cases of psychological disruption, and sleeping pills may be helpful in situations where hot flushes due to erratic hormones are causing problematic sleep disturbance.
Alternative treatments There has been little research into the effects of alternative remedies for the treatment of menopausal symptoms, but many women claim to have experienced beneficial affects from taking Vitamin E for hot flushes and Vitamin B2 for headaches. St. Johns Wort is effective in treating mild depression and anxiety, and a herbal remedy called Black Cohosh is thought to have oestrogenic effects. Liquorice is a herb thought to help hot flushes, but it can increase blood pressure, and so, as with all herbal preparations, should be used with caution. Soya beans and soya milk are high in phytoestrogens, which relieve symptoms of perimenopause by acting on oestrogen receptors. Yoga and the Alexander technique reduce menopausal symptoms such as hot flushes and night sweats, while relaxation techniques such as meditation and visualisation may assist by relieving mental and physical stress. |
20/05/2009