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Managing Menopause: Options Beyond HRT
(source: Providence Cancer Center, Portland, Oregon)
In May 2002, the National Institutes of Health announced that it was halting the arm of its Women’s Health Initiative study that measured the effects of combined estrogen-progestin therapy (Prempro). Early results indicated that this type of hormone replacement therapy (HRT) increased the risk of many serious health conditions, including heart disease, breast cancer and stroke.
Concerned about these risks, many menopausal women have since opted against HRT – and have simply lived with the discomfort of their symptoms and concerns about the diseases that HRT was once thought to prevent.
Effective options for managing menopause do exist. Lifestyle changes like exercise and eating right can help every menopausal woman. Botanical therapies can effectively relieve symptoms for many women. And for some women, traditional medications – including HRT – continue to offer safe, effective options.
Managing menopause with:
Hormonal Therapies
For many menopausal women, combined estrogen-progestin therapy remains a reasonable treatment choice. Although the WHI study indicated that Prempro, the estrogen-progestin medication used, increased the risk of certain serious conditions, the increased risk was slight. Compared to women taking a placebo, the women who took Prempro had:
- 0.8 percent more breast cancer
- 0.7 percent more heart attacks
- 0.8 percent more strokes
- 1.8 percent more blood clots
- 0.6 percent fewer colon cancer
- 0.5 percent fewer hip fractures
For some women, the benefits of HRT outweigh those risks. HRT effectively manages the symptoms of early menopause, prevents and treats osteoporosis, and may reduce the risk of serious diseases like colon cancer. There are several hormonal medications other than HRT that may help your manage menopause. Ask your doctor if these may help you:
Other Medications
A variety of prescription and over-the-counter medications may help manage your menopausal symptoms without HRT, including:
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Antidepressants. These medications are increasingly prescribed for perimenopausal women. They may be right for you if you experience serious mood swings – and as an added benefit, they may relieve night sweats and hot flashes.
- Sleep aids. Try over-the-counter, non-habit forming medications first, like Tylenol p.m. or Benadryl. Herbal preparations like melatonin and sleepy-time tea can also help relieve insomnia. If these don’t help, prescription sleep aids are safe to use for a limited time.
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Osteoporosis medications. There are several drugs, such as Fosomax, that prevent and treat osteoporosis without influencing your hormones.
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Heart medications. Talk to your doctor about medication options if you’re at increased risk of heart disease. HRT is no longer recommended to reduce your risk, but there are many effective drugs available. Don’t rely on medications alone to reduce your risk. The best steps you can take to prevent heart disease include improving your diet, exercising, and managing your weight.
- Testosterone. During menopause, your ovaries’ production of libido-driving hormones decreases dramatically. Testosterone creams can reproduce the effects of those hormones and improve libido in many women. It’s available in drugstores as a cream that’s very easy to apply.
Weight Management
Weight gain is a common symptom of menopause. It’s frustrating when your old pants no longer fit – but more importantly, increased weight contributes significantly to risk of heart disease.
Increasingly, experts are acknowledging that low-fat diets aren’t the most effective way to lose weight. Studies show that people who lose weight on low-fat diets don’t keep it off. People who lose weight by eating a diet high in “good fats” are much more likely to maintain their new weight. Simply put, fat keeps you satisfied longer, so you eat less.
To manage your weight, follow a Mediterranean-style diet focused on small servings of whole fruits and vegetables, whole grains and beans, and healthy fats, including olive oil, canola oil and raw nuts. Minimize sweets, sweet drinks (including juices), and white-flour foods like pasta and bagels.
It's also important to include exercise in your routine.
Dietary Changes
Modifying your diet can significantly improve your menopausal symptoms and decrease your risk of serious disease. Consider making the following changes.
Adjust your intake of:
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Caffeine. Reducing or eliminating caffeine can significantly help relieve insomnia. However, green and black tea may reduce your risk of heart disease, with green tea possibly being more beneficial than black. Green and black tea also have benefit for overall immunity and reduction in osteoporosis risk. And, three cups of green tea daily may reduce your risk of breast cancer. The bottom line: if you continue to drink caffeine, it may be beneficial to drink tea more often than coffee.
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Spicy dishes. Avoid altogether any foods that trigger a hot flash.
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Alcohol. Talk to your doctor about the pros and cons of including alcohol in your diet. Alcohol aggravates many symptoms of menopause, but low-level intake offers benefits for your heart. One drink a day is associated with a 20-50 percent reduced risk of heart disease. Greater intake does not offer additional benefit for the heart, and may increase your risk of other serious diseases.
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Supplements. Start getting your nutrients from whole foods.
Increase your intake of:
- Calcium. Increase your intake of calcium and vitamin D, which helps your body absorb calcium. Be sure to get 1200-1500 mg calcium and 400 international units (IU) vitamin D daily. Dietary sources are best, but supplements may be used if necessary.
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Fiber. Water-soluble fibers in whole fruits and vegetables, beans, and whole grains help lower cholesterol and slow digestion so you snack less.
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Vitamin E. Dietary vitamin E reduces the risk of heart disease. Vitamin E supplements don’t. Get vitamin E from sources like vegetable oils, wheat germ, whole-grain products, avocados and nuts.
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Chocolate. Your weakness for chocolate may actually do you good. Eating less than 1 oz. (20gm) of dark chocolate daily is associated with 25 percent less heart disease.
- Nuts. Hazelnuts, almonds and walnuts are rich sources of calcium. Eating 5 oz. weekly of these nuts, as well as pecans, is associated with 35 percent less heart disease.
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Oat bran. Eating 2-3 tablespoons of oat bran daily can decrease your bad cholesterol by 10-25 percent, and increase your good cholesterol.
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Fruit and Veggies. Whole fruits and vegetables help lower your risk of cancer, heart disease, diabetes, stroke. Get a minimum of 5 servings of whole fruits and veggies – not juices – daily.
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Good Fats. Extra virgin olive oil and omega 3 fats (found in fish oil, flaxseeds walnuts, canola, soy) are associated with significantly reduced heart disease risk. Have two servings of oily fish weekly (choose from wild salmon, herring, trout or water-packed tuna) or 2000mg fish oil daily.
Use “condiment fats,” or fats that make other foods taste good – such as cheese, meat and butter – sparingly. Avoid altogether fats that are high in trans-fatty acids, which increase the risk of heart disease and diabetes. These “bad fats” are found in partially-hydrogenated vegetable oils, used as ingredients in many pre-packaged foods. Check food labels on all store-bought items, and avoid restaurant foods as much as possible.
Botanical Therapies
If you’re interested in trying botanical options for managing menopause, phytoestrogens and black cohosh may be your best bets.
Phytoestrogens are plant-based estrogens that act like natural estrogen in the body. They help relieve hot flashes in some women, and may lower your risk of heart disease and osteoporosis. Natural soy foods like tofu are the best source of phytoestrogens. However, isoflavone and soy capsules, as well as red clover and wild yam preparations, also may offer benefit.
Despite common concerns, phytoestrogens from natural food sources appear to be safe for breast cancer survivors, but the safety of soy extracts is less clear.
The plant black cohosh is proven to help alleviate hot flashes, night sweats, vaginal symptoms, and, in some women, mood swings. Black cohosh preparations can effectively relieve menopause symptoms, but won’t help prevent the diseases associated with menopause, such as osteoporosis.
All of these therapies can be found with the menopause remedies in the natural foods section of your grocery store. Talk to your doctor before starting any of these botanical therapies.
Exercise
Women who exercise regularly have fewer menopause symptoms.
Exercise is also one of the most effective ways to protect your heart health. Daily exercise reduces the risk of heart disease in women by 30-50 percent. Many people who combine daily exercise with dietary improvements have a dramatic reduction in their need for prescription heart medications. Exercise also reduces the risk of osteoporosis, breast cancer, stroke and dementia.
Walking is as effective as more vigorous exercise. Aim for 30-60 minute walks daily. Even if you don’t lose weight, you’re better off health-wise.
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