So Your Doctor Says YOU Cannot Be On Hormone
Replacement Therapy….Now What? Don’t worry,
There Is Help For You.

I have written twice previously about Hormone Replacement Therapy (HRT). 

The first time was in my Newsletter of August 12, 2002, when publicity had just been released about the government study that was stopped because it was felt the risks of HRT outweighed the benefits.  Since I’ve been on this therapy myself for seventeen years now with excellent results, my advice then was, while it might not be for everyone, before dismissing Hormone Replacement Therapy completely, a person should consult a competent doctor, well versed in the subject.

The second time was in my Newsletter of September 15, 2004, reporting on research that had come to light showing an actual improvement in life expectancy in younger women who began HRT before turning 60.

But, I have never discussed alternatives for the many of you whose doctors advised against Hormone Replacement, or who simply stopped or never began because of the negative publicity.  What about the many problems HRT is supposed to prevent—such as osteoporosis, heart disease and urinary incontinence, in addition to the symptoms of menopause—that can result from the rapid decline in estrogen that occurs with menopause?

Estrogen and progesterone, the two major female hormones, are mostly produced by your ovaries and are involved in the process and regulation of ovulation and menstruation.  Estrogen affects many other parts of your body, as well.  It helps maintain the health of your bones, the tissues of your skin, breasts, uterus, urinary tract and vagina.  It also plays a role in raising levels of good cholesterol (HDL) and lowering levels of bad cholesterol (LDL).

Estrogen and progesterone production often start to gradually decline sometime in your 30’s.  In the years leading up to menopause, these hormone levels may rise and fall unevenly.  Some women make it through these fluctuations with few problems.  Others may experience hot flashes, disturbed sleep or mood swings.

So, if you and your doctor feel that the risk of HRT is too great (one study showed that seven additional heart attacks would occur over one year among 10,000 women taking estrogen with progestin), here are some alternatives.

Hot Flashes:  These sensations of heat, which can be accompanied by a red face, perspiration, a rapid heartbeat and a feeling of light-headedness, are experienced by most women around the time of menopause, with greatly varying intensity and duration.

For mild hot flashes, you may be able to find sufficient relief by:

Staying cool.  Slight increases in body temperature can trigger hot flashes.  Keeping cool may involve sipping cold drinks, layering clothes that can be removed when you feel too warm, opening windows or using fans or air conditioning.

Avoiding triggers. Spicy foods, hot beverages, caffeine and alcohol are among the more common hot flash triggers.

Relaxing and reducing stress.  Twice-daily sessions of deep, rhythmic breathing to relax and to reduce stress have been shown to decrease hot flashes by up to 40 percent.  These can be done for 15 minutes morning and night and whenever you feel a hot flash coming on.

Low-dose antidepressants. Although HRT remains the most effective treatment for hot flashes, so, if appropriate, your doctor might have you consider short-term use at the lowest effective dose, she/he might also prescribe a drug from a class of drugs called selective serotonin reuptake inhibitors (SSRI’s) that have been shown to have some effective\ness.

Osteoporosis Risk:  Bone loss accelerates when estrogen levels decline—particularly within the first five years after menopause.  

A program for preventing bone loss includes:

Getting adequate calcium and vitamin D. 1500 mg calcium, 600 IU Vitamin D daily.

Exercise and strengthening. Walking, stair climbing and use of weights or resistance.

Drugs. Your doctor could prescribe any of certain kinds, such as B isdphosphonates, Raloxifene, Calcitonin, Parathyroid hormone or certain blood pressure drugs.

Vaginal dryness:  Declining estrogen levels can cause thinning and shrinking of vaginal tissues.  This often causes burning, irritation and itching.  You may be able to find relief using:

Lubricants. Nonprescription water-based lubricants, used during sexual intercourse, can help.

Moisturizers. Nonprescription products, such as Replens and others, help moisturize vaginal tissues for a day or so with a single application.

Even if you’ve ruled out oral HRT, you may want to consider using estrogen delivered vaginally using a tablet, ring or cream.

Cardiovascular risk:  Risk of diseases that result from clogged arteries increases significantly as estrogen levels drop.  After menopause, women’s risk of cardiovascular disease equals men’s.  In fact, cardiovascular diseased is by far the leading cause of death among women.  (See my Newsletter of 01/20/2005.)

To reduce cardiovascular risk, maintain a healthy lifestyle and weight, and monitor your blood pressure and cholesterol levels.  Your doctor also may recommend a low, daily dose of aspirin to reduce your risk of blood clots.  

Colorectal cancer risk: A reduction in your risk of developing cancer in your large intestine (colon) or rectum is one benefit of taking estrogen plus progestin.

Preventing colorectal cancer without HRT involves having a healthy lifestyle, regular screening tests and possibly a daily aspirin.  

Urinary problems:  Reduced estrogen levels can contribute to the thinning, loss of tone and weakening of muscles that support the proper function of your bladder and urethra.  Some women may have difficulty passing urine, while some may also experience urinary incontinence.  It’s important that your doctor diagnose an exact cause in order to prescribe the proper solution.

Treatment for minor urinary problems may include:

Inserts. If you’re likely to leak at certain times (during exercise, for example), these small, balloon-tipped inserts can block urine leakage.

Behavior modification.  You may be able to “train” your bladder by going to the bathroom at regular intervals.  Adjusting your fluid intake and avoiding irritating foods and beverages (alcohol, citrus juice, caffeine, and spicy foods) may help.  Behavior modification can sometimes be more effective than drugs.

Strengthening the muscles. Do the so called, Kegel exercises:  contract for 10 seconds the muscles that you’d use to stop urine flow, release for a few seconds then repeat.  Do 10 to 20 repetitions.

Medications.  There is a plethora of drugs and other devices, even surgery in some specific cases, that you and your doctor might want to consider.

Life beyond menopause for some can be about adapting to changes. Adapting to a changing outlook on the risks and benefits of HRT use is one more adjustment.  If the decision is to avoid Hormone Replacement, the change involves options that you and your doctor can choose from to maintain optimal health beyond menopause.