Making the Most of HRT and Nonhormonal Therapy

You should not rely entirely on hormones or other medications to enhance the quality of life after menopause. It is within your power to take very practical measures that can prevent or alleviate many of the symptoms that occur.

For example, there is a natural approach to take against osteoporo­sis. Remember that osteoporosis is preventable if you can control two main processes. First, you can develop as much bone as possible during your first forty years, before menopause. Second, you can reduce the rate of bone loss that may occur after menopause.

Success in doing these things often requires some changes in life­style that call for dedication and persistence. But, studies have shown conclusively that an inappropriate diet, lack of weight-bearing exer­cise, and heavy cigarette smoking contribute to loss of bone. If you are willing to make a few changes in your lifestyle, you could protect your skeleton.

There is still the problem of hot flashes and the question of whether, they can be alleviated without drugs. Hot flashes are one of the most disabling symptoms of menopause. They can interfere with the quality of a woman’s life and even with her ability to function. There is no doubt that HRT remains the most effective method known for dealing with this symptom.

For women who cannot tolerate taking estrogens, or who are not medically permitted to take HRT, the fact that nonhormonal medica­tions are not generally effective can be a desperate medical dilemma. Biofeedback training may provide some relief in such cases. With this process women learn to control and manipulate various body mech­anisms, such as heart rate, blood vessel diameter, and muscle tension, which are usually controlled without your awareness by your autono­mous nervous system. Research in biofeedback training is still in its early stages, but we hope that in the future it may offer a nonpharmacologic means of reducing the discomfort of hot flashes.

Work continues as well with progressive relaxation training, a fairly recent method for learning how to relieve stress and tension through practiced relaxation, which may bring some relief. While new tech­niques are under study, you can try other minor changes in your lifestyle to reduce the severity or the number of your hot flashes. Changing the kind of clothes you wear may help. Give up heavy sweaters and try layering clothing instead. Alter your activities when­ever possible to reduce stress. Attempting to gain some conscious control of your hot flashes through relaxation therapy may be produc­tive. A good relaxation therapist can teach you how.

Avoiding Cardiovascular Disease

As we will discuss later, the use of estrogen in HRT does appear to be associated with a distinct reduction in the risk of cardiovascular disease. Other factors can also be employed to reduce the incidence of this disease.

Other ways of combating heart disease without estrogen include stopping smoking. Smoking is the most harmful of all habits and probably the most significant cause of coronary heart disease. Another method is gaining control of the stresses in your life and working toward reducing your negative responses to them if you cannot elimi­nate the stresses themselves.

Enhanced Well-Being

Exercise also produces this special feeling of well-being. Often termed “runner’s euphoria” or “swimmer’s high,” athletes some­times cite this sense of well-being as one of the benefits of pursuing their sport. Many people start an exercise program, lose interest, and drop out. Quitting is most likely to occur during the first three months of an exercise program, which is a shame, because most studies show that the mood-enhancing effects of exercise develop strongly after three months of regular exercise. After several months, you usually achieve physical fitness as well. If you hang in there, you can expect to feel better, enjoy all of your activities more, combat exhaustion from work, and perhaps relieve menopausal discomforts.

Menopause and Hormone Replacement Therapy

Hormone replacement therapy (HRT) does exactly what its name suggests – it replaces the hormones that a woman’s body ceases to produce after the menopause.

Eternal youth

HRT has been touted as an ‘elixir of life’, a magic potion that can reverse the effects of ageing, keeping a woman young forever. HRT is not the answer to eternal youth, but it can make many women feel younger. Successful treatment of exhausting hot flushes and sleepless nights restores energy. In turn, feeling better means it is easier to take regular exercise and follow a healthy diet, both of which have their own benefits.

Critics are sceptical that the menopause requires any medical intervention and see it as a natural event that should run its own course. This is fuelled by the fact that not every woman becomes severely oestrogen-deficient after ‘the change’. Although the ovaries are the main source of oestrogen, the adrenal glands produce small amounts and oestrogen is also formed in fat. These extra-ovarian sources are insufficient to restore fertility but may be adequate to prevent the development of severe menopausal symptoms.

Fear of cancer, particularly breast cancer, is another cause for concern but studies suggest that the risks are minimal if HRT is taken for less than 10 years. Even then, the evidence for increased risk is controversial.

Many women accept these risks once they realise the benefits of HRT, although some find it hard to cope with a return of monthly ‘periods’ and the regular pill taking that many regimens require.

Progesterone protection

Although oestrogen replacement effectively relieves the symptoms of the menopause, it is not without its problems. Doctors noticed a sudden increase in cancer of the lining of the womb, the endometrium, that was clearly linked to treatment. The oestrogen was stimulating growth of the endometrium resulting in the formation of potentially cancerous cells. In a percentage of women, true cancer developed but in a form that, in most cases, responded to treatment. Fortunately, a simple means of prevention was found -a 12-day course of synthetic progesterone (called progestogens) taken each month ‘opposes’ the oestrogens creating an artificial bleed similar to a ‘period’, which expels any cancerous cells. Women who have had a hysterectomy are not at risk of endometrial cancer and can safely take ‘unopposed’ oestrogens.

Refuting myths

Many of the fears associated with HRT are due to its effects being confused with those of the oral contraceptive pill. In fact, they are entirely different.

The oral contraceptive pill contains high doses of synthetic oestrogens which are up to eight times more potent than the natural oestrogens used for HRT. These high doses are necessary to prevent the ovaries releasing an egg each   month, producing a contraceptive effect. A disadvantage of synthetic oestrogens is that they make blood more sticky, increasing the risk of clots and thromboses in veins and arteries, which can lead to heart attacks and strokes. In contrast, natural oestrogens have minimal effects on blood clotting, and the dose used for HRT is equivalent to the amount produced in the body during the normal menstrual cycle. Natural oestrogens reduce the risk of clots in arteries, so heart attacks and strokes are less likely to occur. The risk of a clot in the veins (venous thrombosis) in a woman taking HRT is the same risk as she would have during her re­productive years, although this is greater than for a postmenopausal woman who is not using HRT.

Because of these important differ­ences, women who were unable to take the ‘pill’ can safely take HRT.

Unfortunately many myths surround the use of HRT and misinformation abounds, even within the medical profession. Research shows that women obtain most of their information from non-experts, especially the media, so it is not surprising that there is so much confusion about HRT.