Menopause

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Treatment

Postmenopausal women should strive to eat a healthy diet that includes enough calcium and for a lifestyle that includes plenty of exercise.

Calcium management
Adequate calcium intake is important to prevent osteoporosis and bone fractures. Daily calcium intake for postmenopausal women should be around 1200 mg. Women should eat foods rich in calcium (e.g., dairy products, leafy green vegetables, tofu, calcium-fortified foods), as well as foods that promote calcium absorption. A glass of milk provides about 300 mg. Intake of foods that rob the bones of calcium, such as animal protein and salt, should be limited.

Vitamin D helps the body absorb calcium. Fifteen minutes of sun exposure every day provides sufficient vitamin D. Foods such as fortified milk, liver, and tuna contain vitamin D. Women should ask their health care provider or nutritionist if they should take a vitamin D supplement.

Calcium supplements are available in several forms: calcium carbonate, calcium chloride, calcium lactate, calcium gluconate, bone meal, dolomite, and calcium citrate. Tums, a chewable antacid that contains calcium, is an easy way to take calcium. To maximize absorption, calcium supplements should be taken with food.

Exercise
Exercise is an important part of preventative health care for postmenopausal women. By increasing cardiovascular fitness and strengthening the bones, exercise helps prevent heart disease and osteoporosis. Low impact, weight-bearing exercises, such as walking, jogging, tennis, racquetball, and dancing are helpful. Women diagnosed with osteoporosis or cardiovascular disease should consult with their health care provider before initiating an exercise program.

Hormone Replacement Therapy
Hormone replacement therapy (HRT) uses estrogens and progestin (synthetic progesterone) to ease the symptoms of menopause. The hormones are available in a variety of forms: pills, vaginal creams, vaginal ring inserts, implants, injections, and patches worn on the skin.

HRT has many short-term and long-term side effects. It is important to weigh all of the potential benefits and risks, preferences, and needs before beginning HRT. The benefits and side effects vary considerably from woman to woman. Women who take HRT should be closely monitored by a health care professional to ensure that they benefit as much as possible from the hormone therapy. Sometimes, changing the dosage or the way it is administered can help to control side effects.

Minor side effects include bloating, breast tenderness, cramping, irritability, depression, and menstrual bleeding for months or years following menopause. More serious risks include:

• Breast cancer: Women who have not had a hysterectomy and use estrogen supplements are at increased risk for invasive breast cancer.

• Cardiovascular disease: HRT causes an increased risk for stroke, heart attack, and cardiovascular disease.

• Endometrial cancer: Endometrial cancer has been linked to high-dose estrogen supplements. Women who have not had their uterus removed are prescribed low doses of estrogen with progestin (progestin protects against endometrial cancer).

• Women who take HRT are at increased risk for deep vein thrombosis (DVT; blood clots).

HRT may help to prevent or delay the development of many diseases, including the following:

• Osteoporosis
• Alzheimer's disease
• Colon cancer
• Macular degeneration (the leading cause of visual impairment in persons over age 50)
• Urinary incontinence
• Skin aging

Various types and dosages of estrogen and progestin are available and the type of HRT often depends on particular symptoms. For example, women who experience vaginal dryness may opt for a vaginal cream or vaginal ring insert, both of which alleviate dryness. The vaginal ring insert can also help urinary tract problems. For women who suffer from hot flashes, pills or patches may be helpful.

Estrogen Medications
Conjugated estrogens are a mixture of estrogens prescribed to treat menopausal symptoms. The conjugated estrogens in Premarin® and Premarin Vaginal Cream® are obtained from pregnant mare urine. The conjugated estrogens in Cenestin® are synthetic.

Dienestrol (Ortho-Dienestrol®) is a synthetic, nonsteroidal, estrogen vaginal cream used to treat atrophic vaginitis. Side effects include vaginal discharge, increased vaginal discomfort, uterine bleeding, vaginal burning sensation, breast tenderness, and peripheral edema.

Esterified estrogens (Estratab®, Menest®) are estrogenic substances consisting of 75-85% natural estrogens and 15-25% equine (mare urine) estrogens. They are supplied in tablet form and are used to treat hot flashes and atrophic vaginitis and urethritis (infections due to thinning and drying of vaginal tissues).

Estradiol is one of the three major estrogens made by the human body and is the major estrogen secreted during the menstrual years. It is available as an oral pill (Estrace®), transdermal skin patch (Climara®, Estraderm®, Vivelle®), vaginal tablet (Vagifem®), and vaginal cream (Estrace Vaginal Cream®).

Estropipate (estrone) is an estrogenic substance derived from estrone, one of the three major estrogens produced by the body. Estrone is produced from estradiol and is a less potent estrogen. It is available in pill form (Ogen®, Ortho-Est®) and prescribed to treat hot flashes and vaginal atrophy and to help prevent osteoporosis.

Ethinyl estradiol (Estinyl®) is a synthetic nonsteroidal estrogen available as a tablet, that is prescribed to treat hot flashes (vasomotor symptom). It is administered on a cyclical basis (i.e., 3 weeks on and 1 week off) with attempts to discontinue or taper at 3- to 6-month intervals.

Testosterone
Testosterone is one of the androgens or "male hormones" and is also produced by women. Testosterone contributes to muscle strength, appetite, well-being, and sex drive (libido). The level of testosterone falls rapidly after menopause, and some women take testosterone supplements in addition to estrogen and progestin as part of HRT. However, supplemental testosterone can produce side effects and has potentially serious risks.

Common side effects include weight gain, acne, facial hair, and liver disease. Testosterone can exacerbate estrogen's carcinogenic effect on breast and uterine tissue.

Other online resources
The North American Menopause Society publishes a free, comprehensive booklet that viewers can download or order. The website is a comprehensive online resource for menopause information. See related articles on alternativemedicinechannel about natural hormones, nutritional supplements, herbal remedies, and other natural approaches to menopause.

Menopause, Treatment, Hormone Replacement Therapy reprinted with permission from womenshealthchannel.com
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