Recent studies have raised questions and concerns that the benefits of HRT are outweighed by the risks. A report in the August 20, 2002 issue of JAMA (Journal of the American Medical Association) confirms the benefits of HRT to prevent bone fractures and probably colorectal cancer but found that the effects of HRT on dementia were uncertain. Harms include an increased risk of blood clots and stroke, an increase in breast cancer with 5 or more years of use, and a probable increase in gallbladder disease. New evidence suggests that HRT does not reduce the risk of heart disease and may modestly increase risk.
HRT, in the form of estrogen alone or combined with progestin, is taken by 14 million U.S. women. It is used to reduce acute symptoms of menopause such as hot flashes, and many physicians have prescribed it to prevent chronic conditions such as heart disease. Heart disease is the leading cause of death among women in the United States.
"Now, more than ever, it is critically important for menopausal women to know their options," said Dr. Mary Hardy, Medical Director of the Integrative Medicine Program at Cedars-Sinai. "Herbal remedies, diet, exercise and well-proven treatments that reduce the risk of heart disease and osteoporosis should all be discussed with the patient's health care provider."
Alternative therapies begin with modifying your lifestyle and diet, as well as using herbs and other supplements. "Maintaining a healthy weight, learning relaxation techniques and making good nutritional choices such as reducing alcohol intake can all help," says Dr. Hardy. "Alcohol consumption can actually cause flushing," she adds. Dr. Hardy recommends adding to your diet fiber and legumes, such as soy, which are rich in protein and isoflavones. Isoflavones, commonly referred to as phytoestrogens, are compounds in plants that can bind to estrogen receptors and thereby modify the action of estrogen in the body. In addition, soy protein has been designated a heart healthy food.
Beyond lifestyle changes, botanical interventions can also offer women good alternatives. Extracts of phytoestrogens rich plants, such as soy or red clover, have been shown in research studies to decrease symptoms of menopause and may help maintain healthy bones. However, there is concern over the theoretical risk that these weakly estrogenic compounds may cause. Black cohosh, a native American plant without estrogenic activity, has been shown in a number of clinical trials conducted in Europe to be helpful for relieving the symptoms of menopause without this theoretical risk.
Dr. Hardy advises "Don't forget the basics. Every woman should take enough calcium and vitamin D every day." Choose your calcium carefully so that you get the required amount of a good quality product. You may look to fortified foods and juices to help get in the 1200 to 1500 mg required every day. You may have to get creative if you don't like taking the pills, but don't neglect calcium. It's essential for preventing or minimizing osteoporosis later in life."
For women suffering from vaginal dryness during or after menopause, Dr. Hardy suggests an unlikely sounding, but effective treatment: wild yam cream. Commercially available progesterone creams claim to be made of natural progesterone, but they are actually made from wild yams, a natural vegetable in which the chemical progesterone is found.
If you are a menopausal or postmenopausal woman who is concerned about HRT you should begin with a visit to your doctor. Discuss your concerns and get a clear picture of the risks and benefits of any course of treatment decided upon.
