Menopause and HRT Controversy

Most women alive to day in the developed countries will spend more than a third of their lives in their post menopausal years. In case of developing countries the period will be sorter, may be 10 to 15 years. Menopause is often associated with incomfertable symptoms like hot flashes, vaginal dryness and mood swings ...... and possibly a heightened risk of heart disease and osteoporosis. However, the good news is that there are now many ways to minimize the ill effects of menopause.

Changes in Life Style :

Without any doubt, the most important ingredient for health before, during and after menopause are :

a) Proper Diet :

Diet can do a great deal to cancer, and osteoporosis. By proper, it is meant to be mostly made/composed of fruits, vegetables and grains, and minimal fat, salt and sugar. If eating habits are not perfect, a daily intake of one mullivitamine pill may be allowed. To reduce the risk of osteoporosis, one should, starting at menopause increase the consumption of Calcium to 1500 mg per day. And one is to ensure a daily intake of 400 international (1m) unit of vitamin D from dairy products, vitamin supplements and/or sum exposure. (The skin makes vitamin D when exposed to the sun.)

b) Exercise :

Besides staving off heat disease and osteoporosis, regular work outs improve mood and over overall wellbeing.

Best :

"Weight bearing" aerobic activities like walking, running, cycling along with weight lifting. Try to fit in atleast three 20 minutes sessions a week.

c) Good Habits :

Hot flashes can often be controlled by stoping smoking drinking caffeine and spicy food.

Alternative to HRT :

If somebody may not choose hormone replacement Therapy (HRT), there are other options for relieving problems such associated with menopause.

  1. Alendronate : When approved by the FDA, this drug was the first nonhormone remady for osteoporosis.
  2. Calcitonin-salmon (Miacalcin) : This nasal spray is another option for osteoporosis. It's good for women who are more than five years past menopause and who have low bone mass. For maximum effectiveness, it must be taken with atleast 1000 mg of calcium and 400 1m vitamin D 400 1m a daily.
  3. Progestin : If only hot flashes are the problem, oral progestin (without estrogen) may help. But it won't help other menopause symptoms ..... and it may boost the risk of heart disease.
  4. Relaxation - Biofeedback, deep breathing, yoga and meditation can all be used to reduce the intensity of hot flashes.
  5. Vaginal lubricants : Replens or ky Jelly may help.

Current Advances :

The combination of a twice daily slow release fluoride tablet and 400 mg of calcium has been shown to reduce spinal fractures by 70 per cent among women suffering from osteoporisis and build bone mass in the hip and spine at the rate of two per cent to six per cent a year.

Remedies yet to be proved : Some doctors believe that megadoses of vitamins E and C reduce menopause syndrome and cut the risk of heart attack and cancer. Vitamin E may also relieve hot flashes and vaginal dryness. However their role in treating menopause symptoms remains unproven, especially when taken in supplement form. There is also lot of hype about herbal remodies like sarsaparilla, domiana or dong quai, but there is no evidence that any of these work.

HRT Debate

Recent media reports have stressed the dangers of hormone replacement therapy (HRT). But two eminent gynaecologists, who have researched hormone therapy for themselves, say it is a bit more complicated. Doctors have long recommended hormone replacement therapy (HRT) to not only prevent hot flashes and other menopausal symptoms, but also to curb the risk for heart disease and osteoporosis. But when researchers recently halted a major study on the benefits of HRT, millions of women were forced to re-evaluate their options for controlling menopausal symptoms.

After five years of study, researchers at the women's Health Initiative (WHI) found that women who took a daily tablet of synthetic estrogen and synthetic progesterone had a 26 percent higher rate of breast cancer, a 29 per cent higher rate of heart attack and a 41 per cent higher rate of stroke than those taking a placebo. As a result of these findings, the 16,608 women being studied were instructed to stop taking the medications immediately. Two leading women health expets Dr. Christiane Northrup MD, age 53 and Dr. Jaycee Kakkis, MD, age 46, physicians themselves, interviewed, have addressed these issues for them and their patients in the following way:

Dr. Northrup

What is Your Opinion of The Whi Study?

I felt that the study had major flaws from the outset. Women took a pill consisting of estrogen made from the urine of a pregnant mare, in combination with a chemically synthesized form of the hormone progesterone.

In all the years of human evolution, except for about the last 50, these chemicals have never been introduced into human bodies. And this so-called medicine-prescribed at the same dosage for millions of women, whether they weighed 110 or 210 pounds-was supposed to reduce the risk for heart disease, osteoporosis and other chronic degenerative diseases in the majority of women who took it. Given that the hormone dosages weren't individualized and didn't match those found in human females, I'm not surprised that there were adverse consequences.

Do You Ever Recommend HRT?

Yes. Some perimenopausal and menopausal women need hormones to control symptoms or feel their best. Working with her doctor, a woman should have her hormone levels checked and then decide what she needs. Some women's bodies, like mine, make adequate levels of hormones. Others don't. Some women feel best on HRT, while others don't. Women who have had their ovaries removed often need HRT for a few years.

If hormones are recommended, they should be bio-identical. This means they are chemically identical to the hormones manufactured in a woman's body, not patented animal versions or synthetic substitutes, which are so widely used today. And the doctor should check hormone levels every year, since a woman's body changes.

For myself, I wouldn't hesitate to use hormones if I needed them, but since my hormone levels are adequate and I don't have any health problems, I do not take them. Instead, I use natural alternatives to control my menopausal symptoms.

What Do You Use In Place of HRT?

Soy does nearly everything HRT does without any of the side effects. I use soy to help control symptoms, such as hot flashes. Soy can also help control insomnia, dry skin and hair, depression and vaginal dryness, as well as strengthen the bones and heart. The active ingredient in soy is isoflavones, a plant-derived "phytoestrogen" that acts like the estrogen found in the body. Do not take isolated soy isoflavones in pill form. Recent studies have shown that large amounts may increase breast cancel-risk. Eat soy foods, including edamame (soybeans), soy milk, soy burgers and tofu.

How Do You Protect Yourself Against Heart Disease, Bone Loss And Other Age-Related Conditions?

In addition to eating soy, I follow some simple strategies. To build bones, I lift weights two to three times per week. Each day, I take 1,200 milligrams (mg) of calcium, 800 mg of magnesium and 400 mg to 800 mg of vitamin D -and get 15 minutes of sunlight without sunscreen in either the early morning or late afternoon. (I wear sunscreen the rest of the day.) To protect my heart, I take a brisk, 30-minute walk five times a week and eat a heart-healthy diet, including at least five daily servings of colorful fruits and vegetables.

Dr. Kakkis

What Is Your Opinion Of The WHI Study?

I think the negative results of the WHI were overstated. By analyzing 10,000 of the study subjects on HRT, researchers found that eight additional women developed breast cancer or had a stroke and seven additional women developed heart disease each year, compared with those not taking HRT.

In Light Of These Findings, Should Everyone Stop HRT?

I don't think so. Also, most experts think that women who get breast cancer within 10 years of starting HRT have a pre-existing condition that was simply accelerated by HRT. In other words, HRT is not the cause of their cancer. The study also showed some benefits of HRT. Among the women analyzed, six fewer developed colorectal cancer and five fewer suffered hip fracture each year. Should women with a family history of colon cancer and osteoporosis stop HRT? I don't think so. Finally, quality-of-life issues-hot flashes, insomnia, irritability and depression-were not addressed by this study. I do not intend to stop taking hormones on the basis of the WHI results, nor am I advising my patients to stop.

What's The Best Way To Take HRT?

By using the lowest effective dose, which minimizes the risks. Typically, I start my patients at 25 per cent to 50 per cent of the standard dose of HRT. Then I monitor symptoms every six weeks and gradually increase the dosage only if the lower level is not working. The therapy is individually designed for each woman.

To get this type of treatment, a woman needs to work with a doctor who is familiar with the various options available for HRT. These include gels, creams, patches, pills and suppositories, as well as lower doses and "com-pounded" formulations, custom-blended by a compounding pharmacist.

If you don't find such a doctor, you're likely to be stuck with a standardized formulation that may not be right for you. The North American Menopause Society (NAMS) lists physicians who know about the latest in HRT. To find a physician in your area: Consult the NAMS Web site at ivww.menopause, org. Once you've found the right doctor, you need to have blood tests to detennine your hormone levels. Afterward, you should be re-evaluated by your doctor to see whether the therapy is working and to have it adjusted if it is not.

What Do You Take?

I take birth-control pills to control my perimenopausal symptoms. I'm still fertile, so the Pill acts as a contraceptive" while providing the needed mix of hormones to prevent hormonal fluctuations for a peri-menopausal woman my age. I intend to go from the Pill to low-dose HRT, and to take it for the rest of my life.

Do You Use Any Natural Remedies?

I eat edamame. It makes a delicious dish after 10 minutes of steaming. I have three, one-cup servings a week to control my perimenopausal symptoms. I also take 800 international units (IU) of vitamin E to help control hot flashes and 1,500 mg a day of calcium (500 mg per meal) to reduce muscle cramps, stabilize my mood and strengthen my bones.

Source : Managing Your Menopause : Dr. Wulf H. Utian, MD. The wisdom of menopause : Dr. Christiane Northrup MD Confessions of an Estrogen Evangelist : Dr. Joycc Kakkis MD and Health secrets.

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