Another Road to Relief?

The risks of hormone replacement therapy are leaving many women searching for other ways to treat the effects of menopause.

Life After 50

August 11, 2002|By Elizabeth Large | Elizabeth Large,Sun Staff

Carol Sandler has a lot to think about these days -- along with about 14 million other American women.

A decade ago the 59-year-old Baltimorean started taking hormones for mild symptoms of menopause, but now she's wondering if they might do more harm than good. Because of the furor over new research, she and a lot of other women are looking at alternate treatments for everything from hot flashes to brittle bones.

A massive study has suggested that women on one of the most prescribed forms of hormone replacement therapy, or HRT, have a higher risk of breast cancer, heart disease and stroke. Because the results came from a controlled, long-term clinical trial by the National Institutes of Health -- which ended this part of the study abruptly last month on the strength of the findings -- the news made front-page headlines across the country.

"I don't know how to interpret it," Sandler says. When she read about the results, she made an appointment with her doctor to talk about it, and to find out what alternate treatments were available if she did decide to stop.

The problem with alternatives is that hormone replacement therapy is an "umbrella drug." A decade ago doctors were prescribing hormones as a one-pill-cures-all that would improve your skin, your memory and your sex life; prevent brittle bones and heart attacks; and -- oh, yes -- deal with those unpleasant changes that come around menopause: hot flashes, night sweats, sleeplessness, vaginal dryness and mood swings.

Unfortunately, no alternative is going to do all that. And besides, scientists say only two benefits of HRT have been clinically proven: Hormones relieve menopausal symptoms, and they stave off bone loss. New drugs are available to prevent osteoporosis, or bone loss, some of which are even more effective than estrogen. But if you're wondering what to do about the hot flashes, the alternatives are iffier.

Alternate medicine as an alternative

The most widely used alternate treatments for the symptoms of menopause are alternative medicine: herbal remedies, soy products and acupuncture. Traditional health care providers are somewhat skeptical about their benefits.

"There is estrogen and estrogen combined with progesterone, and then there's all the rest," says Dr. Wulf Utian, executive director of the nonprofit North American Menopause Society. Most of the rest, he says, are no better than placebos. But some, like plant estrogens or phytoestrogens, may bring some relief. These are weak estrogens that occur in foods, including:

* tofu, soy milk and soy ice cream

* lentils, chickpeas and other legumes

* citrus fruits, apples and tomatoes

* whole grain cereals

* fennel

* celery

* green tea

Plant estrogens may alleviate mild symptoms of menopause; and, hey, it's always good to eat more whole grains and fruits. But like other kinds of estrogen, large amounts of "natural" estrogen could promote cancer growth. Carefully controlled scientific research just hasn't been done yet.

Some studies suggest phyto-estrogens may relieve symptoms 40 percent of the time. But placebos, often called "sugar pills," have been shown to reduce meno-pausal symptoms at least 30 percent of the time -- in one study, the number was as high as 50 percent. That may be because symptoms last an unpredictable length of time anyway, Utian cautions.

Then there are the phyto- estrogen supplements, mostly herbal remedies, which are being heavily marketed right now as a safe alternative to hormones to reduce hot flashes, vaginal dryness and irritability. Studies have had mixed results, and in general, evidence of their usefulness is in short supply. But one may work for you, even if it's just the placebo effect. Most are probably harmless, but it doesn't hurt to keep in mind that they are only loosely regulated by the government. Some of the most popular are:

* soy powders and capsules

* red clover

* dong quai or angelica

* flaxseed

* evening primrose

In a recent Mayo Clinic trial, soy supplements didn't help hot flashes, but soy foods may work better. Asian women, whose diet is high in soy, report fewer hot flashes and night sweats around menopause. They get the equivalent of half a cup of soy milk a day on average.

Black cohosh, an herbal medicine used by women worldwide for hot flashes and irritability, doesn't contain phytoestrogens but may reduce hot flashes. It's sold over the counter as Remifemin. The NIH is planning a clinical trial to study its effectiveness.

Side effects a factor with traditional drugs

For those women going off hormones who prefer more traditional medicines, antidepressants like Prozac may help with severe symptoms, but these are powerful drugs with serious side effects.

If quitting hormones causes vaginal dryness, there are several prescription products that supply low doses of estrogen locally, although none does the job as well as oral estrogen or a patch.

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