Opting for Estrogen
Some women find menopause fairly manageable, but others (80 percent) suffer big-time symptoms—hot flashes, crabbiness, vaginal dryness and more. Many women and their doctors worry about women's increased risk of developing osteoporosis, or brittle bones, and heart disease. Both are more likely to occur after menopause, because the body's production of estrogen and progesterone drops significantly.
Almost 25 percent of postmenopausal women in the United States take estrogen or hormone-replacement therapy (HRT), a combination of estrogen and progesterone. Although these medications can have side effects and risks, they usually ease the symptoms of menopause and decrease the risk of osteoporosis. Some doctors believe that they prevent heart disease as well.
Doctors often start women out on Premarin, the same form of estrogen that many researchers use in HRT studies. It has been approved for treatment of menopause-related hot flashes and night sweats since 1942, and for osteoporosis prevention since 1988. It's derived from pregnant mares' urine. Prempro is Premarin combined with progestin, which is synthetic progesterone.
The progestin is intended to balance the supplemental estrogen and prevent uterine cancer, a risk increased by taking estrogen alone. Women who have had a hysterectomy do not need to take progesterone with estrogen for this purpose but may want to take it for bone mass maintenance purposes.
The standard dose of Premarin is 0.625 milligrams, but .3 mg works as well at stopping hot flashes, said Helen Carcio, a nurse practitioner at Pioneer Women's Health in Greenfield, Mass. Combined with calcium, vitamin D and progesterone, the lower estrogen dose is as effective in maintaining bone density.
For her patients who can't or don't want to take Premarin or Prempro, Carcio recommends estrogen derived from soy plants. She also prescribes natural forms of progesterone, including one derived from Mexican yams. Unlike progestin, plant-based progesterone does not lower HDL, the "good" cholesterol.
Opting for Estrogen (cont'd)
The side effect from HRT that women find most annoying is menstrual-like bleeding, but a new HRT is available that stops it, Carcio said. Taking estrogen and progesterone together every day helps prevent bleeding as well as manage other menopause symptoms.
Estrogen comes in both pill and nonpill forms. Women can wear a skin patch that releases estrogen into their blood, or they can apply an estrogen cream to the vaginal area to help stop dryness. An estrogen ring inserted in the vagina puts the hormone where some women feel they need it most.
Finally, women can take medications other than estrogen that address individual menopausal symptoms or conditions. Certain drugs treat just hot flashes, for example. A new drug, raloxifene hydrochloride, acts like estrogen in parts of the body. It helps prevent osteoporosis and may decrease the risk of heart disease and breast cancer, but it does nothing for hot flashes or vaginal dryness.
To help improve sex drive, women are trying the hormone testosterone. Wearing testosterone patches may improve sexual and psychological well-being in women who are in surgical menopause due to total hysterectomy or removal of the ovaries, researchers report in the Sept. 7, 2000, New England Journal of Medicine. Your ovaries produce about half of your testosterone. The rest comes from the adrenal glands.
However, taking too much testosterone can have serious side effects, and the "safety of taking testosterone for extended periods of time has not been established," according to the North American Menopause Society's Menopause Guidebook.