ALTERNATIVES TO HORMONE THERAPY
Because of the controversy surrounding hormone therapy, many women are seeking alternative therapies. When counseling patients, one must take a holistic approach. Most women seek relief of the most common symptom of menopause—hot flushes—but as noted above, the meno-pause affects women in different ways. As women age, theirrisk for heart disease begins to rise and, thus, it is important to advocate heart-healthy lifestyle changes. Likewise, preventivecounseling about osteoporosis, as previously discussed, should also be included. Alternative therapies for the short-term treatment of common symptoms of menopause include the following:
· Soy and isoflavones may be helpful in the short-term (≤2 years) treatment of vasomotor symptoms. Given the possibility that these compounds may interact with estrogen, these agents should not be considered free of potential harm in women with estrogen-dependent cancers.
· St. John’s wort may be helpful in the short-term (≤2 years) treatment of mild to moderate depression in women.Black cohosh may be helpful in the short-term (≤6 months) treatment of women with vasomotor symp-toms.
· Soy and isoflavone intake over prolonged periods may improve lipoprotein profiles and protect against osteo-porosis. Soy in foodstuffs may differ in biological activity from soy and isoflavones in supplements.
Most well-controlled studies of the common over-the-counter remedies have not shown dramatic improvements. In addition, many of these over-the-counter botanical sup-plements are not U.S. Food and Drug Administration (FDA)-regulated. Consequently, there is little quality con-trol. Patients need to be informed that “natural” does not necessarily mean safe. Moreover, many of these products have undesired side effects. Many soy products interact with thyroid medications, while Dong quai and red clover potentiate warfarin and other anticoagulants.
One of the most commonly utilized off-label medica-tions is progesterone. Numerous randomized, placebo controlled studies have demonstrated its efficacy, usually in the form of medroxyprogesterone acetate, in the treatment of hot flushes. Selective serotonin reuptake inhibitors (SSRIs) have also been used with some success. In random-ized, double blind studies, venlafaxine, paroxetine, and flu-oxetine were all shown to significantly decrease hot flushes. In addition, both gabapentin and cetirizine were found to provide moderate relief of vasomotor symptoms.
Lastly, patients should be advised of the potential relief achieved by lifestyle changes, such as eating a healthy diet that is less than 30% fat and rich in calcium, regular exercise, main-taining a healthy weight, avoidance of smoking, limiting alco-hol intake, and getting regular health care. These practices may not only help relieve some menopausal symptoms, but may help prevent other health problems.