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Some related articles :Hormone Therapy no panacea - Study Tracks Menopause Treatments' Effect

any women worried about the latest findings on the possible health risks of long-term hormone replacement are ready to abandon the therapy or have decided not to start it. But how? How can a woman stop hormones without suffering the menopausal symptoms that may have prompted her to start in the first place? What can a woman do instead to protect her bones, her heart or any other part of her that estrogen was supposed to help?

The Women's Health Initiative findings of increased risks of heart disease, breast cancer, strokes and gallbladder disease unleashed all kinds of advice about alternatives to the popular hormone combination known as Prempro. But many of the alternatives have undergone far less testing for safety and effectiveness than the drug they seek to replace.

One critical piece of advice is rarely mentioned: substituting one hormone product for another is not the answer, since there is now no way to know whether any hormone product is safer than Prempro.

For those who choose to remain on hormone replacement by mouth or patch, most experts believe that the safest approach is to use the lowest possible dose needed to relieve symptoms.

Dr. Roger Lobo, an obstetrician-gynecologist at the Columbia-Presbyterian Medical Center in New York, suggests using at most 0.3 milligrams of an estrogen-only product daily and, for women with a uterus, using progesterone (natural or synthetic) for several days two or three times a year to reduce the risk of endometrial cancer.

Getting Off Hormones

For those now using hormones to control menopausal symptoms like hot flashes, mood swings or sleep disturbances, quitting cold turkey is not the best way to become hormone-free. Dr. Sally McNagny, a former investigator for the Women's Health Initiative study of hormone replacement, suggests gradual weaning over many months.

Start by cutting out one pill during the week, then several weeks later eliminate another, then another, until you are down to one pill every other day. Then try cutting the dose in half. Finally, try eliminating each of those pills one at a time.

If at any point disruptive symptoms reappear, return to the last eliminated dose. Continue at that level for some months before trying again to cut back further. For most women, the acute symptoms of menopause are relatively short-lived, lasting only a year or two, although some women continue to experience hot flashes of varying intensity for a decade or more.

Finding Substitutes
HOT FLASHES Testimonials abound as to which products are safe and likely to do the most good in countering this common symptom of menopause. But few of these many substances have been tested in well-designed clinical trials, and virtually none have been tested for long-term safety. Also, their ability to relieve hot flashes and night sweats seems to vary greatly from woman to woman.

Some women swear by one soy product or another. Soy contains weak plant-based estrogens. But to obtain enough of these estrogens to counter a severe case of hot flashes or night sweats may require doses that are as strong, or nearly so, as pharmaceutical estrogen products and may present comparable risks.

For women concerned about estrogen's effects on the breast, oncologists caution against using soy extracts like isoflavones formulated into pills or powders, since these may be no safer than Premarin or Prempro.

Others have found relief in an herbal remedy called black cohosh. German researchers who have tested this (using the product Remifemin) in placebo-controlled trials report that many women will achieve significant relief after taking the herb twice a day for at least a month, with an 80 percent reduction in hot flashes after 12 weeks. As for other herbal remedies, research evidence of their effectiveness is scarce, and some like kava kava and dong quai can be hazardous.

Another possibility is a half dose of an antidepressant in the Prozac family like Effexor or Paxil, which helps about 70 percent of women, although the long-term effects of these drugs is also unknown.

Simple changes can help, too. Avoid high necks, and dress in layers so that outer garments can be shed easily when the internal temperature rises. Install ceiling fans and use portable fans where you work and cook. Sleep in a cool room wearing as little as possible. Avoid foods that aggravate hot flashes, including caffeinated beverages, chocolate, spicy foods, alcohol and hot foods and drinks, and add soy-based foods to your daily diet.

VAGINAL DRYNESS Contrary to common belief, estrogen is not what sustains a woman's libido — testosterone is. But vaginal atrophy, dryness and itching that often follows the loss of estrogen can result in painful sexual intercourse, an increase in vaginal infections and even discomfort during activities like jogging or biking.

Vaginal applications of estrogen are effective and considered safe, because little of the hormone is absorbed into the bloodstream. A popular remedy is vaginal insertion of an estrogen cream one to three times a week or use of an estrogen-containing vaginal ring. Vaginally applied estrogen can also counter recurrent urinary tract infections in postmenopausal women.

Nonhormonal options for temporary relief of vaginal dryness include gels or creams like Replens, Vagisil, Astroglide and K-Y jelly.

BONE LOSS The rapid acceleration of bone loss at menopause is most effectively countered by estrogen. One relatively new drug, raloxifene (Evista) acts like estrogen on bone but lacks estrogen's harmful effects on the breast and uterus. In fact, a large national study still in progress strongly suggests that raloxifene protects against breast cancer, much like tamoxifen. But in about 20 percent of users, raloxifene causes hot flashes, which may diminish with time.

For older women experiencing significant bone loss, tablets of biphosphonates (Fosamax or Actonel) taken weekly are effective at staving off and treating osteoporosis. Their main side effect is esophageal and gastric irritation, which may preclude their use by women with chronic reflux.

Also crucial is to provide your bones with enough building materials — calcium and vitamin D — and to create the mechanical stresses needed to rebuild bone through weight-bearing activities like walking or jogging or strength-training exercise like lifting weights.

> HEART HEALTH The very disappointing finding that hormone replacement failed to prevent heart disease and may instead cause it has sent women back to the basics to maintain cardiovascular well-being. Start with a heart-healthy routine — a diet low in saturated fats and rich in vegetables, fruits, unrefined (fiber-rich) carbohydrates and adequate calcium. Avoid cigarette smoking and engage in daily (or nearly so) moderately intense aerobic exercise like brisk walking, cycling and lap swimming.

If other measures are needed to control cardiac risks, take medicines daily to normalize blood pressure or blood sugar or lower high cholesterol, and adopt a balanced diet and exercise program that can help you achieve and maintain a normal weight.

BRAIN FUNCTION "Use it or lose it" seems to be as apt a motto for the brain as it is for muscles. Remaining intellectually and socially involved may not prevent Alzheimer's disease, but it can help to maintain a sharp mind. Experts on aging recommend doing crossword puzzles, playing bridge, attending lectures, reading books and joining discussion groups.

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