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The next step

Hormone Replacement Therapy is currently the focus of media attention in the light of the Women's Health Initiative study. Fitness expert PEG JORDAN looks at a few of the common questions asked.

For all ages ... It is important to adopt a healthy lifestyle

FOR decades, millions of middle-aged women were told that the benefits of hormone replacement therapy (HRT) outweigh the risks, so "just keep taking your estrogen". But with the release of the third major clinical study last month that says just the opposite, many women, along with their doctors, are wondering what to do.

The study of over 16,000 women, sponsored by the National Heart, Lung and Blood Institute, United States, concluded that long-term use of the most popular hormone therapy, a brand known as "Prempro" (which comes from pregnant mare urine) may increase the risk of coronary disease, stroke, blood clots and breast cancer.

Doctors have prescribed various combinations of estrogen and progestin for menopausal symptoms for over three decades. About one-third of women in the age group of 45-55 have troubling symptoms; one-third have very mild or rare symptoms, while the rest seem to breeze right through menopause with few or no complaints at all.

The most popular therapies were combinations of estrogen and progestin in a single pill — Prempro, "Premphase" and "Premarin". But none is identical to a woman's natural estrogens, a problem often cited by natural health advocates.

For women who couldn't tolerate the side effects of HRT, which included irritability, clouded thinking, fatigue and weight gain, some new generation "estrified estrogens" were tried, namely, "Estratab", "Menest", and "Estratest". Still, women's health advocates argued against these chemical substitutes and paved the way for compounding pharmacists to create mixtures of estrogens that were more identical to those found in women's bodies.

FemHrt, made by Pfizer and Activella, a vegetable-based estrogen from Pharmacia, contain a modified progestin.

Again, women's health advocates said chemical hormones are the trouble, and researchers kept looking for healthier alternatives, especially in the case of progestin. Many doctors believed that progestin was the culprit in triggering serious health risks, and some drugs have tried to parcel it out in smaller, cyclic doses.

Recently, there have been debates about the need for hormonal therapy. Spokespersons for women's health initiatives questioned the automatic prescribing of HRT as a modern-day ritual passageway through menopause. "We seemed to be in a blind trance, following the marketing promises of major pharmaceutical firms' promises of youthfulness and disease-free aging," said health researcher Vicki Noble, author of Shakti Woman.

Noble adds that most of the news stories have so far lamented the so-called "fact" that women who suffer from hot flushes have no other option for help. She notes that the gentle, non-invasive healing remedies and botanical support that can help women through menopause are often overlooked.

Here is a compilation of advice from medical researchers and women's health advocates concerning the most common questions.

Should I stop taking HRT?

If you've been on "Prempro" for many years, discuss with your doctor about switching or stopping. If you're on other types of hormone combination therapies, also talk to your doctor and bring up some of the natural alternatives listed below.

What happens if I stop taking hormones? Will my symptoms reappear?

They definitely could. There are ways to phase out of hormone therapy slowly over two to three weeks.

Is there any reason to take HRT?

For women who have very distressing symptoms, short-term therapy of a few months or a few years may be helpful.

Check out the newer hormonal therapies that are more identical to estrogens found in women's bodies. But discuss this with your doctor and be aware of your family history.

What are the cancer risks of HRT?

Several studies have found increased risk of cancer from long-term HRT use (over five to 10 years).

What's best: pills, patches or creams?

Pills seem to carry the highest risk in most studies. Many women get relief with the hormonal creams that are rubbed on the skin, but they haven't been studied as extensively for risks. Creams with wild yam extract or other types of vegetable-based progestins attempt to deliver hormones through the skin, which may be a superior delivery approach for women facing heart disease risk, although there is no direct study on this yet. Patch brands contain only estrogen, and estrogen-alone is riskier than estrogen and progestin in combination. Women who take these patches also take a progestin pill.

Are there natural alternatives to HRT?

Many naturopathic and homoeopathic physicians, as well as ayurvedic doctors, have a host of botanical remedies and dietary adjustments that can alleviate symptoms to a great extent. Medical schools are far more open to these non-pharmaceutical approaches than they were before.

By far, one of the greatest ways to get through menopause is to adopt a healthy lifestyle. The five key lifestyle choices determined by the world's largest health trial for women include: Do not smoke. Be more physically active. Eat a diet rich in fruits, vegetables, whole grains, and fibre, and low in saturated and trans fats (those partially hydrogenated fats found in bakery goods, cookies, crackers, processed foods and fast food). Maintain a healthy weight and do not gain excessive weight, especially around the abdomen. Take a multivitamin every day. In addition, try these healthy alternatives for hot flushes: Black cohosh (Cimcifuga racemosa) is a herb that is proven to decrease hot flushes in several studies. Ginkgo biloba extract was shown to improve menopause-related forgetfulness. Increasing your intake of soy foods is also helpful since the vegetable-based estrogen in soy protein (tofu, tempeh) competes for the receptor sites within the body, lessening the impact of more serious estrogenic effects. Vitamin E can also be an aid. Consider 400 to 800 IU per day. About 1200 mg per day of Vitamin C was given to women experiencing menopausal symptoms. Weight-bearing and aerobic exercises (walking, jogging, strength training, dancing and yoga) can also be helpful to reduce your risk for osteoporosis and heart disease, as well as decrease the frequency and severity of hot flushes.

What if the symptoms are truly debilitating?

For those women who do suffer extreme symptoms, using HRT as a short-term approach is very beneficial.

Are menopausal symptoms universal?

Many cultures do not share the menopausal syndromes experienced by women in modern cultures or who live busy, urban lives. More health advocates are beginning to suspect that there is an indoctrination of middle-aged women into symptom recognition and a lock-step medicalising over this phase of life.

If my symptoms are mild, what should I do?

Try to follow the healthiest lifestyle you can, and wait it out. Symptoms will no doubt decrease and disappear in time. Some women learn to reframe their symptoms, calling hot flushes their "power surges" and take advantage of the increased sense of gumption and assertiveness they grant a woman at midlife.


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