Treating Menopause

The treatment of menopause is not limited to hormone therapy. A well-balanced, low-fat diet, adequate exercise, 1,000 to 1,200 milligrams of calcium a day and 400 IU of Vitamin E a day are recommended. Most physicians recommend estrogen as well, because it decreases the risk of heart attack, stroke, osteoporosis, Alzheimer's disease, colon cancer and mascular degeneration. On the downside, estrogen increases slightly the risk of blood clots, and women who already have serious heart disease are placed at an increased risk of a heart attack during their first year of estrogen use.

The greatest risk of estrogen therapy is related to breast cancer. Some experts feel there is an increased risk, and others feel there is no increased risk among women who take estrogen. The Centers for Disease Control and Prevention published a summary of several studies in which they found no increased risk in the first five years of estrogen therapy, but a 30 percent increase after 15 years. This risk of breast cancer appears to begin after 7-10 years of consecutive use. Interestingly, women who develop breast cancer while on estrogen have a lower risk of dying from their cancer than women who develop breast cancer when not on estrogen.

Higher doses were associated with greater risk. But the increased risk is small: approximately two percent to three percent. For most women, the benefits of hormone therapy outweigh the risks, considering the high mortality rate from heart attack, stroke, and complications following hip fracture, especially after 65 years of age. Research shows that, on average, women taking estrogen live longer and healthier lives than women who don't take estrogen replacement. Unless a woman has had a hysterectomy, it is essential that she take progesterone to counteract the effects of estrogen on the lining of the uterus. Estrogen alone increases the risk of endometrial cancer. With the addition of progesterone, the increased risk is nullified.

Methods of hormone replacement therapy

There are several methods of hormonal replacement therapy, or HRT. Estrogen can be taken in pill form or in a skin patch, called transdermal delivery. The skin patch allows the estrogen into the body without passing through the liver to be metabolized, as it is when taken orally. Some women don't like patches because they can loosen with sweating or bathing, and because 20 percent to 30 percent of patients develop a skin rash. Estrogen creams or gels that are absorbed through the skin are also available, and estrogen is also available in the forms of injections or pellets that can be implanted under the skin.

Estrogen and progesterone can be taken together in a single pill, or they can be combined in a patch or cream. With this combination, most women eventually stop having periods. Unfortunately, some women have continuous spotting for a number of months before their periods stop.

Estrogen and progesterone can also be administered cyclically: The estrogen is taken daily, either in pill or patch, and the progesterone is taken for 12 days a month. With this regimen, most women will have periods. When menses become very light, conversion to daily estrogen and progesterone usually results in no periods. If you have a family history of breast cancer, you may want to consider the benefits and risks of HRT more carefully. On the other hand, if you have a family history of heart attack, stroke or osteoporosis, HRT should be strongly considered. Note, however, that women who already have heart disease may not be good candidates to start estrogen. Be sure to discuss all the ramifications with your health-care provider.

A woman's ovaries also naturally produce testosterone. After menopause, this hormone (which affects energy and the sex drive) can fall. Blood tests can be performed to see if replacement is needed. Some women prefer "natural methods" of hormone delivery, using herbal or other homeo-pathic preparations. Although these forms of medication can relieve the symptoms of menopause, they are not as closely scrutinized by the Food and Drug Administration, and their potency and effectiveness can vary widely. There is little documentation of their effect on the risk of heart attack, stroke, osteoporosis or Alzheimer's disease.

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