Photo By: Jana Leön
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HRT Alternatives
By Melissa Hendricks
So what works and what's next?
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Hot Flashes
• Does HRT help? Yes. Estrogen alleviates hot flashes and night sweats. It also relieves mood swings in women with disturbed sleep.
• Alternatives: Most research on HRT has involved the drugs Prempro or Premarin, which contain estrogens derived from the urine of pregnant mares. Alternative "bio-identical" or "natural" hormones, such as Tri-est or Estrace, contain estrogens synthesized from plants. But these drugs have not been as thoroughly tested. Other proven treatments for hot flashes include low doses of the antidepressants Effexor (venlafaxine), Prozac (fluoxetine), and Paxil (paroxetine). Some women say soy relieves their symptoms, but clinical evidence is equivocal. The same is true for black cohosh. But the Chinese herb dong quai and evening primrose oil have not been proven more effective than placebos.
Vaginal Dryness
• Does HRT help? Yes.
• Alternatives: Estrogen products inserted in the vagina work. These include rings such as Estring; creams such as Estrace, Premenn, and Crinone; and tablets such as Vagifem. Vitamin E suppositories or non-hormonal lubricants such as Replens or K-Y jelly may also help some women.
Heart Attack and Stroke
• Does HRT help? No. In the WHI study that was recently halted, women who took estrogen-progestin therapy had more heart attacks and strokes. Whether estrogen-alone therapy protects from heart disease is unclear.
• Alternatives: Aerobic exercise and a healthy diet reduce the risk of heart disease. (Smoking increases the risk.) More powerful tools include the statin drugs for lowering cholesterol; beta blockers and ACE inhibitors for lowering blood pressure; and aspirin for reducing the risk of heart attack and stroke.
Broken Bones
• Does HRT help? Yes. HRT slows down bone loss in postmenopausal women.
• Alternatives: Two other classes of drugs strengthen bones. Bisphosphonates such as Fosamax (alendronate) reduce the risk of fractures, but they can cause damage to the esophagus. Selective estrogen receptor modulators, or SERMs, such as Evista (raloxifene), also reduce fracture risk. But SERMs can aggravate hot flashes and increase the risk of blood clots. Proven methods for building stronger bones include weight-bearing exercise such as weightlifting, yoga, tai chi, or even walking; taking calcium and vitamin D supplements; not smoking; and limiting alcohol.
Alzheimer's Disease
• Does HRT help? So far, no. Estrogen increases blood flow and stimulates neurons. But in clinical trials, HRT has not improved symptoms or slowed their progression in Alzheimer's disease patients. Research in this area is continuing.
• Alternatives: Some clinical trials have shown that vitamin E delays some symptoms of Alzheimer's disease and that gingko biloba slightly improves mental functioning in patients with dementia.
Incontinence
• Does HRT help? No. The large HERS study showed that HRT can even exacerbate incontinence.
• Alternatives: Avoiding coffee and other drinks containing caffeine, a diuretic, can help. So can Kegel exercises, which strengthen pelvic floor muscles. Studies have also shown estrogen vaginal creams are effective. Women who have problems during athletics may want to try one of several FDA-approved devices (such as Fem-Assist or the Reliance Urinary Control Insert) that are placed temporarily in or over the urethra.
Wrinkles
• Does HRT help? Possibly. Estrogen strengthens collagen, the connective tissue that makes skin elastic and flexible; stimulates the fat layer that underlies and helps fill out the skin; and helps skin retain moisture. Most doctors say smooth skin is not reason enough to use hormone therapy.
• Alternatives: Experts advise slathering on the moisturizer and sunscreen; avoiding direct sun exposure; drinking eight 8-ounce glasses of water each day; and not smoking. Prescription skin products containing retinoic acid, such as Renova or Retin-A, may improve fine lines, wrinkles, and sun damage somewhat, but some women find they cause dryness, redness, and itching.
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