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Q: Treatment for symptoms of menopause ( Answered 5 out of 5 stars,   0 Comments )
Subject: Treatment for symptoms of menopause
Category: Health > Women's Health
Asked by: kgs85-ga
List Price: $50.00
Posted: 25 Sep 2005 10:33 PDT
Expires: 25 Oct 2005 10:33 PDT
Question ID: 572398
I would like information concerning treatment for night sweats and hot
flashes as a result of menopause. I am interested in the efficacy of
various treatments, and the risks and side effects of each. Please
consider specific treatments such as hormone replacement therapy
patches and pills (such as combipatch and femhrt), bioidentical
substances, and antidepressants such as effexor.Thank you.
Subject: Re: Treatment for symptoms of menopause
Answered By: crabcakes-ga on 26 Sep 2005 12:37 PDT
Rated:5 out of 5 stars
Hello Kgs85,

HRT (Hormone Replacement Therapy)


    Low dose birth control pills are used only for women in
peri-menopause. Perimenopause is the time from having regular periods
to having no periods, usually around age 50.  Perimenopause can last
10 years!

?If your menses are occurring sooner than 21 days it may be
perimenopause or a more serious gynecological condition and you need
to be evaluated by your health care provider. Menses occurring later
than 45 days is more consistent with menopause or perimenopause. If
physical symptoms predominate, especially hot flashes, vaginal dryness
and night sweats, and if they last throughout the month unrelated to
menses think more about menopause. Remember menopause before the age
of 40 is called premature menopause and is rare. However perimenopause
can begin before age 40. Surgical removal of the ovaries is the most
common cause of premature menopause. Hopefully you know if your
ovaries have been removed, but you may not. Years ago doctors
routinely removed ovaries in women undergoing a hysterectomy (removal
of the uterus). Now many gynecologists do not remove the ovaries.

Until you are firmly in menopause, that is, no periods for one year,
you can still get pregnant. If you don't smoke, low dose oral
contraceptives can be used right up to menopause.?

  The primary reason for taking low dose oral contraceptives is to
prevent pregnancy! In peri-menopause, a woman can still get pregnant.
These oral contraceptives can help prevent bone loss and possibly
protect you from ovarian and uterine cancer. The low dose birth
control is taken just as regular dose birth control pills, and women
who have a history of clots, heart disease, breast cancer, or who
smoke, should not take them.

?The decision to change from the low-dose birth control pills to
estrogen replacement therapy is usually made around the age of 49 to
52. Your doctor can also measure a hormone called FSH
(follicle-stimulating hormone) to see if you're in menopause. If the
FSH measurement is over 30, you've probably entered menopause.?

?If you are still having periods and are considering hormone therapy
for multiple or severe perimenopausal symptoms, talk to your health
professional about low-dose birth control pills or low-dose HRT. After
menopause, birth control pills aren't used for hormone therapy.?

?Before menopause, hormone therapy with low-dose estrogen-progestin
birth control pills or low-dose HRT (estrogen-progestin) evens out
fluctuating hormone levels, which can help with irregular and heavy
menstrual bleeding (dysfunctional uterine bleeding), hot flashes,
insomnia, concentration and mood problems, and vaginal symptoms. Birth
control pills also prevent pregnancy.?

    Full Menopause

?Meno (menstruation) pause (stops) is, technically, the last menstrual
flow of a woman's life. The years just before and just after the
menopause itself are referred to as the climacteric. For most women
the climacteric spans from early/mid 40s to late 50s/early 60s,
including the premenopausal years, the menopausal climax years, and
the post-menopausal years, popularly known as the Change of Life.?

?During this 2-5 year climax period, the bones refuse to take in
calcium and bone scans will show growing osteoporosis; flashes,
flushes, and night sweats may be frequent; palpitations, emotional
sensitivity, and sleeplessness are common. Depending on the individual
woman and her circumstances, other physical and emotional changes may
come with the Change, or she may experience next to nothing.?

Tips for handling menopause:

Take time for solitude. Although many women feel enormous satisfaction
in tending and nourishing others, as our reproductive years come to a
close, it is appropriate to turn away from care-taking. Hot flashes,
sleeplessness, moodiness, and the like are easier to recognize as
allies of wholeness when you are free to follow your own needs without
concern for others. Take one day to be totally by yourself, or a
Crone's Year Away, or anything in between.

Experiment with eggs, meat, and butter in your diet. Some women find
these foods, especially if from organic sources, decrease menopausal
symptoms. Some practitioners insist they increase menopausal distress,
especially when from commercial sources.

Relax and enjoy your hot flashes. Ride them like waves, feel them in
your spine, ski the edges of your flushes, honor the volcanic heat of
your core. Like labor pains, hot flashes are the outward sign of
metamorphosis. Like labor pains, they are worse when resisted. Herbal
allies help those with unrelenting flashes relax and enjoy, too.

Spend time with a journal. Buy a blank book and write in it, draw in
it, paste articles in it. Visions and dreams are particularly vivid
and intense in the menopausal climax years; keep your journal handy so
you can record them. Your emotional energies are readily available
during the menopausal climax years; draw them in your book. Memories
abound during these years; cherish them in your journal. Write your

Plan your Crone's Crowning. As months pass and the moon waxes and
wanes without drawing forth your menses, you pass through the second
stage of initiation, death. Your identity as Mother dies. Let yourself
break all the rules. Be someone totally different than you thought you
could be.

This page had quite a few additional tips.

HRT (Hormone Replacement Therapy)

?HRT is designed to increase levels of the female hormone oestrogen
which fall as women go through the menopause, (this booklet does not
look at the experience of the menopause in detail - for this, see both
the Women?s Health booklet on the Menopause and our online leaflet?

You can download a nice Menopause Manual here, from the North American
Menopause Society. (It is not copiable)

?It had been thought that HRT would reduce the risk of heart disease
in postmenopausal women. However, data from large studies such as the
Women's Health Initiative (WHI) and HERS trials have shown that
combined estrogen-progestin therapy does not reduce the risk of heart
disease, and in fact, might increase risk slightly [1,6]. In the WHI
trial of unopposed estrogen, no increase in risk was seen.
The WHI also reported an increased risk of breast cancer with combined
estrogen-progestin (similar to that seen in previous studies), and an
increase in stroke and blood clots (in the leg and lung). On the other
hand, a decrease in the risk of colon cancer and fractures (due to
osteoporosis) was also seen. However, the investigators concluded that
the risks of HRT may outweigh its benefits in many women.?

?Some women who use a combination of estrogen and progestin to control
the symptoms of menopause might find symptoms return when they stop
the hormones, according to the latest findings from the Women?s Health
Initiative (WHI)?

?An estimated 2 million American women go through menopause each year.
The Women?s Health Initiative found that women ages 50-79 years should
not use menopausal hormone therapy to prevent heart disease or
dementia. But, if women are bothered by moderate to severe menopausal
symptoms, the Food and Drug Administration recommends that they can
use estrogen (with progesterone if the woman has her uterus) at the
lowest effective dose for the shortest time needed to manage them.?

Here is a chart of most current forms of HRT. Many have links for
further information:

CombiPatch HRT

The recently approved CombiPatch is available in two sizes, and is
worn on the skin of the lower abdomen, changed every 3-4 days. The
patch slowly releases estrogen and progestin into the skin. These two
hormones then are absorbed into the bloodstream. This patch is
contraindicated in women who have had a hysterectomy, cancer, blood
clots, a heart attack,  dementia or liver problems. Showering and
swimming does not harm the patch.

?Using estrogens and progestins may increase your chances of getting
heart attacks, strokes, breast cancer, and blood clots. Using
estrogens with progestins may increase your risk of dementia. You and
your healthcare provider should talk regularly about whether you still
need treatment with CombiPatch.?

?·  Start at the lowest dose and talk to your healthcare provider
about how well that dose is working for you.
·  Estrogens and progestins should be used at the lowest dose possible
for your treatment, only as long as needed. The lowest effective dose
of CombiPatch has not been determined in clinical trials. You and your
healthcare provider should talk regularly (for example, every 3 to 6
months) about the dose you are taking and whether you still need
treatment with CombiPatch.?

?The clinical trials conducted before CombiPatch was approved found
the most common side effects to be breast tenderness and breakthrough
bleeding. But because the progestin in the patch is NTA, it probably
will cause fewer side effects than other progestins. All in all, this
looks like an excellent choice for a woman who prefers a patch to a
pill -- and likes the idea of getting everything in one simple step.
·	Standard dosage: .05 mg estradiol; .014 mg NETA; .05 mg estradiol, .025 mg NETA
·	Pros: Very easy to use -- one patch gives you everything you need;
supplies steady dosage of both estrogen and progestin
·	Cons: As with other patches, may cause allergic skin reactions

Side effects of CombiPatch
Common side effects include headache, back pain, intestinal upset and
urinary tract disorders.

   FemHRT is another patch, manufactured by Parke Davis, in different
doses than the CombiPatch.
?Femhrt 1/5 is a combination of an estrogen hormone, ethinyl
estradiol, and a progestin hormone, norethindrone acetate. It should
be used to relieve symptoms associated with menopause, and also for
the prevention of osteoporosis.
For the treatment of menopausal symptoms:
Femhrt 1/5 will replace the dropping levels of estrogen in women
experiencing menopause. The treatment will reduce moderate to severe
symptoms, such as hot flashes or feelings of warmth in the face, neck,
and chest. Femhrt should be taken to relieve these symptoms only as
long as the symptoms persist, especially if patient is taking hormones
for other reasons.
For the prevention of osteoporosis - Femhrt is most effective in the
prevention of osteoporosis (the thinning of the bones) when taken as
part of an osteoporosis-prevention regimen, including exercise and
calcium supplements.?

Side Effects:
?Taking estrogen-containing drugs increases the risk of cancer of the
uterus, and may, under some conditions, increase the risk of breast
cancer. Although the risk is not as severe when progestins accompany
the estrogen (as in the femhrt 1/5 combination), patients taking
femhrt should get regular check-ups and perform regular breast
self-examinations. Gallbladder disease, blood clotting, and vaginal
bleeding are all also possible serious side-effects to the hormone
Additional side-effects reported by women taking the estrogen hormone include:
nausea and vomiting, breast tenderness or enlargement, headache,
retention of extra fluid (edema), runny nose, abdominal pain,
enlargement of non-cancerous tumors (fibroids) of the uterus, skin
rashes and other skin abnormalities.?

HRT Side Effects:
?There are a number of risks and side effects associated with HRT. It
is difficult to determine the extent to which NHRT is associated with
most risks and side effects because of the lack of long-term clinical
trials using NHRT or comparing bio-identical hormone replacement with
other forms of HRT in the United States.
HRT risks and possible side effects include:
·	Increased risk of endometrial cancer in women with a uterus if
estrogen is taken without progesterone or a progestin
·	Slightly increased risk of breast cancer after 4 or more years of
HRT, as shown in the WHI study that used continuous combined oral
estrogen and progestin (Prempro). Estrogen alone or other HRT regimens
may not raise the risk of breast cancer significantly.
·	Increased breast density, making mammograms more difficult to
interpret and possibly increasing breast cancer risk. This appears to
be an effect primarily associated with taking oral progestin
continuously with estrogen (e.g., Prempro).
·	Slightly increased risk of ovarian cancer
·	Slightly increased risk of blood clots, associated primarily with
oral estrogens such as Premarin*
·	Increased risk of gallbladder disease, associated primarily with
oral estrogens such as Premarin*
·	Slightly increased risk of heart attack or stroke, both in women
with cardiovascular disease and in healthy women. This effect may be
associated primarily with HRT using continuous combined oral estrogen
and progestin (Prempro) or the daily use of an oral progestin such as
Provera with estrogen.
·	Breast pain (often a temporary problem) 
·	Nausea, associated primarily with oral estrogens*
·	Bloating and fluid retention, primarily associated with progestins,
e.g., medroxyprogesterone acetate
·	Negative effects on mood, primarily associated with progestins,
e.g., medroxyprogesterone acetate
*Note: These side effects seem to be associated with oral estrogen and
not with transdermal estrogen.

?Monthly vaginal bleeding often occurs when women take estrogen and
progestin in a cyclical style (usually estrogen every day, but
progestin only part of the month) rather than all the time. Spotting
or bleeding may also occur when HRT is taken in the continuous
combined style (both estrogen and progesterone or progestin every
day). Problems with bleeding and spotting may improve over time or
with a change in dose, regimen, or type of progestin/progesterone
used. Women who do not want any bleeding at all may find these effects
Some women find that trying a different type of HRT, such as switching
to bio-identical hormones, using a transdermal product instead of
pills, or trying a different regimen, may reduce or eliminate side
effects and work better for them.?

?Common side effects include breast tenderness, nausea, headaches, leg
cramps, irregular bleeding, weight gain and bloating. Women are
usually advised to persevere with HRT for 6 to 8 weeks to see if these
symptoms subside. If unwanted side effects persist after this time,
altering the dosage or changing the product, e.g. from tablets to
patches may bring relief. But for some women, the side effects are
unacceptable and they choose to stop HRT.

Less common side effects are reduced sex drive, depression, vaginal
bleeding (other than the expected monthly bleed if progestogen is
taken) pains in the chest, groin and legs. Adverse effects should
always be reported to your doctor and those in the less common group
are of more concern.

Inflammation and itching has sometimes been reported with skin
patches. This seems to be less of a problem with the newer matrix

Progestogens may cause various symptoms including swollen feet and
ankles, premenstrual tension, weight gain, breakthrough bleeding (that
is when bleeding occurs at times other than the expected monthly
bleed) depression and jaundice. The last three in particular should be
discussed with your doctor. Changing the type of progestogen may help
as some progestogens cause fewer side effects as may the Mirena IUD
which acts locally inside the womb.

Gallstones can enlarge especially with HRT tablets so women may need
to change to a different form of HRT. HRT can also increase the
likelihood of women developing gallstones.

HRT does not usually make blood pressure rise. Women with pre-existing
high blood pressure which is being monitored and treated should be
able to take HRT.?

Previous answer on HRT


For hot flashes, SSRI antidepressants (Effexor, Paxil, Lexapro, etc.),
and a high blood pressure medicine called clonidine can help.

?SSRIs are a class of antidepressant. It had been noticed as a
'side-effect' that menopausal women who take these medicines had fewer
hot flushes. A recent clinical trial of an SSRI called paroxetine
showed that it did seem to reduce hot flushes. Some women in the trial
had no hot flushes whilst taking paroxetine. Many women in the trial
had some hot flushes, but much less often than before. Venlafaxine is
another SSRI which has been shown to reduce hot flushes.
These are relatively new findings from small clinical trials. So, the
exact role of SSRIs in the treatment of the menopause is yet to be
clarified. It may become a more common treatment if these effects are
confirmed with further research.?

?Bottom Line: Neither citalopram nor fluoxetine improved the vasomotor
symptoms (i.e., hot flashes) of menopausal women more than placebo. As
in other well-designed clinical trials of treatments for hot flashes,
there was a marked placebo effect and improvement in all groups over
time. (Level of Evidence: 1b)?

?Selective serotonin re-uptake inhibitors (SSRIs) for treatment of hot
flashes also have been found to be useful. Researchers reported that
paroxetine (Paxil; 20 mg/d) produced a 67% reduction in hot-flash
frequency and a 75% reduction in severity. The occurrence of adverse
effects was low,and most patients chose to continue the medication
after the trial ended. Fluoxetine (Prozac; 20 mg/d) and sertraline
(Zoloft; 50?100 mg/d) also are effective.?

?A team of Finnish researchers just wanted to get some longerterm data
on the efficacy of the selective serotonin reuptake inhibitors (SSRIs)
in treating menopause symptoms when they stumbled on an unpleasant
discovery. They found that while symptom control was good with SSRIs,
they didn't fare much better than placebo. So, were improvements due
to subjects' skewed perceptions? Was it all in their heads?
As the risks associated with hormone therapy have become clearer,
women are looking for other ways to deal with menopause. Based on the
results of clinical trials, SSRIs have become candidates for treating
both the psychological and the physical symptoms of menopause.?
?When the results were analyzed, the researchers found that all
treatments decreased the number of hot flushes: fluoxetine, by 50%,
citalopram, by 70%, and placebo, by 60%. In the study, the team
"regarded the medication to be effective if it was 20% better than
placebo. That was not achieved by citalopram or fluoxetine." On the
bright side, citalopram did improve insomnia better than placebo.
Over nine months of treatment, SSRIs "give some relief to menopausal
hot flushes, but the effectiveness is not comparable to estrogen and
therefore, they cannot be regarded as an effective treatment option
for menopausal hot flushes," concludes the doctor. Other studies have
shown estrogen therapy decreases hot flushes by up to 80%.?

?It is a common myth that as women enter the menopausal years, it is
?normal? to feel depressed. Serious depression, however, should never
be viewed as a ?normal? event, and women who suffer from it at any
time in life should receive the same attention as for any other
medical illness.?

?Minor mood problems, insomnia, and hot flashes are common during
perimenopause. In some women, these symptoms progress to a more severe
mood disorder known as major depression.  The risk for major
depression is greatest in women who have a history of depression in
the past or who had depression after childbirth (postpartum
depression). Women who have had problems with depressed mood around
the time of their menstrual periods (premenstrual dysphoric disorder)
may also be at higher risk for major depression in perimenopause.  And
some women do become depressed for the first time in their lives
during perimenopause.?
?Depression is sometimes a side effect of hormone replacement therapy,
for reasons that are not understood. (It may also occur in some
younger women who take birth control pills.)?

?It is important to give each treatment strategy enough time to work
before considering another. If hormones are tried first, a response
should be seen within 2-4 weeks. If the response is not satisfactory,
the experts strongly suggest adding an antidepressant.  If an
antidepressant is used first, it must be adjusted to a high enough
dose, and then given for at least 1?2 months to tell if it will help.
If an SSRI antidepressant does not work in this time frame or produces
intolerable side effects and has to be stopped sooner, the experts
strongly recommend switching to a second SSRI.?

Effexor has relatively few side effects, which are headache and high
blood pressure.

?How often do significant blood-pressure increases occur?

Three percent of EFFEXOR XR patients treated with doses of 75 to 375
mg/day had sustained elevations in blood pressure. Fewer than 1%
discontinued treatment because of it (versus 0.4% with placebo).
Experience with immediate-release venlafaxine showed that sustained
hypertension was dose related, increasing from 3% to 7% at doses of
100 mg/day to 300 mg/day, to 13% at doses above 300 mg/day.1 The
incidence of sustained increases in blood pressure at doses greater
than 300 mg/day has not been fully evaluated.2?

Effexor XR (Time release)
?The most common adverse events reported in EFFEXOR XR
placebo-controlled trials (incidence >5% and >2x that of placebo) were
nausea, dizziness, somnolence, abnormal ejaculation, sweating, dry
mouth, nervousness, anorexia, abnormal dreams, and tremor.?

A previous answer on SSRIs:

Hot Flashes (also known as Power Surges):

·	?Avoiding spicy, hot foods, caffeinated beverages and hot drinks can
cut down on the number of flashes.
·	Exercise, avoiding overheated rooms, and reducing stress reduce the
number and intensity of hot flashes.
·	A good stress reducer is meditation and breathing exercises. Deep
breathing during hot flashes helps women feel better and quiets the
·	It's a good idea to keep the air conditioner going in the summer and
keep the heat low in the winter. Your family may complain a bit but
when you explain to them how important this is for you they will
·	Wearing cotton bedwear helps when sleeping. During the day wearing
your clothes in layers is a good idea. You can take off what you need
to at the hint of a flash.
·	Drinking plenty of cold water with ice also can combat the flashes.
You can leave a glass of ice water to sip on your bedtable at night
for a quick heat relief.?

?Hot flashes are mostly caused by the hormonal changes of menopause,
but can also be affected by lifestyle and medications. A diminished
level of estrogen has a direct effect on the hypothalamus, the part of
the brain responsible for controlling your appetite, sleep cycles, sex
hormones, and body temperature. Somehow (we don't know how), the drop
in estrogen confuses the hypothalamus?which is sometimes referred to
as the body's "thermostat"?and makes it read "too hot."
The brain responds to this report by broadcasting an all-out alert to
the heart, blood vessels, and nervous system: "Get rid of the heat!"

The message is transmitted by the nervous system's chemical messenger,
epinephrine, and related compounds: norepinephrine, prostaglandin,
serotonin. The message is delivered instantly. Your heart pumps
faster, the blood vessels in your skin dilate to circulate more blood
to radiate off the heat, and your sweat glands release sweat to cool
you off even more.?
·  Wear cotton pajamas or a nightgown. If you perspire a lot at night,
your nightclothes are easier to change than the sheets.
·  Use cotton sheets only, not synthetics.
·  Get a bigger bed if you and your partner are on different heat
planets but you still want to stay in close orbit.
·  Take cool shower before bed.
·  Try a mild medication like Tylenol
·  Arrive at meetings early so that you can get the coolest seat.
·  Use your freezer liberally. A number of women talked about opening
the freezer at home (or in the supermarket) and sticking their head in
when a hot flash hits.

?Interventions that are potentially useful for hot flashes include
Megestrol acetate?
Bellargal S
Soy products
Avoidance of caffeine and hot beverages
Black cohosh
Vitamin E
Layered clothing
Paced breathing (biofeedback)
Aerobic activity?

?Clonidine, a blood pressure lowering drug, helps relieve hot flashes
in some women. Clonidine is administered by transdermal skin patch
(Duraclon), oral medication (Catapres), or a combination of both.
Clonidine seems to work well in some patients and to be completely
ineffective in others. Only a trial of medication can identify those
women who receive benefit. Side effects can range from dry mouth and
constipation to dizziness and sedation.?

This medicine may reduce flushing symptoms. However, it frequently
causes side-effects such as dry mouth, drowsiness, dizziness, and
feeling sick. It is therefore not commonly used, but may be worth a
try if all else fails.?

Alternate Therapies

BHRT (Bioidentical hormone replacement therapy)

?Just what are ?bioidentical hormones?? 
Bioidentical hormones are manufactured to have the same molecular
structure as the hormones made by your own body. By contrast,
synthetic hormones are intentionally different. Drug companies can?t
patent a bioidentical structure, so they invent synthetic hormones
that are patentable (Premarin, Prempro and Provera being the most
widely used examples).

Though bioidentical hormones have been around for years, most
practitioners are unfamiliar with them. There are several branded
versions now available for use in the kind of hormone replacement
therapy (?HRT?) typical of synthetic hormones. This is generally a
one-size-fits-all dosage regime.?

?Are bioidentical hormones better than synthetic hormones?
We long ago concluded that the answer to this question is yes. But
that doesn?t mean bioidentical hormones are perfect.
The great appeal of bioidentical hormones is that they are natural,
and our bodies can metabolize them as it was designed to do,
minimizing side effects. Synthetic hormones are quite strong and often
produce intolerable side effects. Moreover, the compounded
bioidentical hormones can be matched individually to each woman?s
needs ? something that?s just impossible with mass-produced products.?

?Bioidentical hormones have the exact molecular structure as those
made in the human body. In other words, the two are isomolecular and
indistinguishable from each other. Bioidentical hormones produce the
same physiologic responses as those of endogenous hormones.  The Food
and Drug Administration (FDA) considers bioidentical hormones to be
natural regardless of their source, and as a result they cannot be
?Bioidentical hormones can be extracted and derived from a variety of
different sources,
such as plants (soy or yams) or animals (pigs or horses). They can
also be produced synthetically. However, hormones of plant or animal
extraction that are bioidentical to human hormones are still not
completely natural in the purest sense, because they undergo a
laboratory process and several synthetic processing steps before the
ioidentical end product is obtained. There is no commercially
available or compounded product that is both completely natural and
Pages 2-4 has a great comparison chart of all forms of HRT.

?Many consumers and some healthcare providers believe that the term
bio-identical hormone refers to a custom-mixed (?custom-compounded?)
recipe containing one or more of various hormones in differing
amounts, depending on an individual prescriber?s order. The recipe not
only contains the active hormone (or hormones), but also other
ingredients that either holds everything together (in the case of a
rectal suppository, an under-the-tongue tablet, or an under-the-skin
pellet) or provides a vehicle for applying the product onto the skin
(such as a cream or gel) or into the body (such as a liquid for a
nasal spray).

Custom-compounded hormones may provide certain benefits, such as
individualized doses and mixtures of products and dosage forms that
are not available commercially. However, there may be risks to the
consumer. These compounds do not have government approval because
individually mixed recipes have not been tested to prove that they are
absorbed appropriately or provide predictable levels in blood and
tissue. And there is no scientific evidence about the effects of these
hormones on the body, both good and bad.

 Although there is a long history of pharmacies providing a wide range
of compounded products, the fact that preparation methods vary from
one pharmacist to another, and from one pharmacy to another, means
that patients may not receive consistent amounts of medication. In
addition, inactive ingredients may vary and there can be
batch-to-batch differences. Reliable sterility and freedom from
undesired contaminants are also concerns. Expense is also an issue, as
many custom-compounded preparations are viewed as experimental drugs
and are not covered by insurance plans.?

?NAMS does not recommend custom-compounded products over well-tested,
government-approved products for the majority of women ? and does not
recommend saliva testing to determine hormone levels.?
North American Menopause Society

?Although estradiol has been widely available for many years,there has been
no comparably available bioidentical progesterone. Progesterone taken
by mouth is broken down in the gut,so the only available progestins
were,until recently,synthetic analogues such as medroxyprogesterone
and norethindrone. Proponents of bioidentical progesterone theorize
that the biochemical changes that occur in making synthetic progestins
are responsible for the mood changes,dysphoria,and fluid retention
often associated with HRT.16,27,48 Certain plants,particularly the
wild yam,produce sterols called saponins. Saponins have chemical
structures similar to naturally occurring progesterone. These sterols
can be used as precursors for the progesterone skeleton. Most
preparations of bioidentical progesterone contain US Pharmacopeia
(USP) grade progesterone that is formulated from these plant sterols
and is manufactured by Pharmacia Upjohn and sold in bulk.

  Proponents of the use of bioidentical progesterone believe that it
can counteract unopposed estrogen and has some direct health
benefits.41 They also are searching for a bioidentical progesterone
that will minimize side effects,escape breakdown in the
gastrointestinal tract,and be widely available.  Manufacturers of wild
yam creams,available over the counter,claim it is a source of
progesterone; however,the body is not able to convert this precursor
to progesterone. Creams containing less than 0.016% natural
progesterone can be sold without a prescription,but they cannot be
counted on to protect the endometrium from the stimulation of
unopposed estrogen.?

?Estradiol, estrone, and estriol, and all of their metabolites are
bioidentical hormones; which are "naturally" found in the body.  In
contrast, Premarin, the most commonly prescribed estrogen formulation
for HRT, is mixture of two human estrogens, estradiol and estrone, and
10 or more horse estrogens, which are exogenous to humans.  The
problem with exogenous hormones is that while their activity in some
tissues is well studied, we can't be sure of it in other tissues.

Premarin is very natural in that it is derived from pregnant mare
urine and is not synthesized, but it is not natural in that it
contains many estrogens that are not naturally found in a woman's
body.  Some of these hormones, such as equilenin, are very potent
estrogens, even more so than estradiol.  As such, the level of these
potent hormones needs to be closely monitored.  Unfortunately, there
are no readily available blood or saliva tests for monitoring the
levels of these foreign hormones (and that also goes for the estrogen
substitutes such as raloxifene, known as Evista, and tamoxifen, known
as Novaldex). This is particularly important because, as we will see
in the next section, how one takes a hormone, especially an estrogen,
under certain circumstances dramatically alters the blood level.?

I?m afraid that while the concept of bioidentical hormones sounds
great, these hormones seem to fall in the area of junk science, for
now. A search on a reputable medical sites turns up nothing, and the 
sites I found seemed rather dubious. The North American Menopause
Society does not recommend BHRT or hormone testing of saliva.

Black Cohosh, Isoflavones, phytoestrogens

?Plant-derived estrogens ? Plant-derived estrogens, also called phytoestrogens, som
etimes help relieve hot flashes somewhat. Dietary sources of
phystoestrogens include soy products. Other phytoestrogens such as
ginseng, dong quai, and black cohosh can be purchased at health-food
stores. However, these supplements might increase breast cancer risk
because they act like estrogen in some tissues of the body. The
efficacy of these supplements for hot flashes has not been rigorously
proven. The same precautions should be used for these compounds as
with HRT in breast cancer survivors.?

?Still, most women assume that even if black cohosh doesn't help, at
least it doesn't hurt. This is not necessarily true. The study
reviewed here, which was done in mice, suggests that black cohosh
supplements may actually make breast cancer more likely to spread to
other organs or tissues.?
  ?This small study was done in animals, so its findings are not as
reliable as those of larger studies done in women. But it suggests
that you may want to think twice before taking black cohosh
supplements to relieve your hot flashes or other symptoms. This herbal
remedy may NOT be a safer alternative to standard HRT, especially if
you have already had breast cancer.?

?The German Commission E (which studies herbs) recommends that you
take this no longer than six months, however, this was before more
recent studies examining its toxic properties were conducted -- and
thesefound that black cohosh appears to be safe for long term use.  
In addition, a recent study found that black cohosh might encourage
the growth of breast cancer tumors, so if you're a cancer survivor
speak with your doctor before trying this.?

?According to a 1997 study conducted by the North American Menopause
Society, more than 30 percent of women use acupuncture, natural
estrogen(s), herbal supplements, or so-called plant estrogens
(phytoestrogens). At this time, there is not enough scientific
evidence to determine whether these therapies are beneficial. In
addition, we do not have sufficient information to show whether these
therapies are as safe or safer than conventional drugs being used for
menopausal symptoms, osteoporosis, or heart disease.
Botanical products containing or acting like estrogens may provide
some of the benefits of estrogen in relieving menopausal symptoms. For
example, studies have suggested that soy food products can benefit
women with mild hot flashes. Some limited research provides
conflicting results on the safety and effectiveness of herbal
products--such as ginseng, black cohosh, and dong quai--that are
marketed for menopausal symptoms. Currently, NCCAM is funding research
on several botanicals that have shown promise for reducing menopausal
symptoms, including black cohosh, red clover, hops, dong quai, flax
seed, and dietary soy.?

?Menopausal symptoms
Some data support the efficacy of isoflavones in reducing the
incidence and severity of hot flashes, although many studies failed to
find any difference between the isoflavone recipients and the control
group. Inadequate data also exist to evaluate the effect, if any, of
isoflavones on vaginal dryness. Clearly, more research is needed.?

?Soy:  Rich in phytoestrogens, specifically isoflavones,
cholesterol-free and containing protein, omega 3 fatty acids, calcium,
folic acid, iron and other vitamins and minerals, soy is one of your
best bets to add to your diet to gain a wide range of health benefits
when you?re in coping with premature ovarian failure or early

More specifically, a number of recent studies have found that soy can
help reduce hot flashes, night sweats, and other menopausal symptoms. 
It can also help lower your cholesterol -- which often rises when you
enter premature menopause -- and help your coronary blood vessels
dilate, both of which are important in fighting heart disease.  In
addition, it may help lower triglycerides -- which often rise when you
take estrogen.  Finally, soy may help prevent osteoporosis.  Studies
have shown that soy isoflavones help cut down on bone resorption, keep
calcium from leaching from your bones, and increases bone density and
bone mineral content.
It?s a good idea to aim for at least 25 grams of soy protein daily to
help with symptoms.?

?Soy foods have been studied and seem to have a modest benefit to
reduce hot flushes. However, the studies are not conclusive. Soy foods
have been a staple part of the diet in parts of the world for
thousands of years and are presumed to be safe. So, it may be worth
trying to increase the amount of soy foods that you eat.
In general, for other complementary therapies there is not much
evidence to say that they reduce menopausal symptoms.?

?Dietary Soy. Soy is a phytoestrogen,one of a group of plants known to
have an estrogenic effect. Most phytroestrogens in human diets are
isoflavones or lignens. Isoflavones are found predominantly in soy
foods such as tofu,miso,tempeh, and other products using soy protein.
Lignens are found in grains,particularly flax,and to a lesser extent
in lentils,oat bran,and triticale.  Phytroestrogens have two
phenylnaphthalene-type chemical structures similar to those of
estrogens and have been found to bind to estrogen receptors.
Phytoestrogens may have estrogenic and antiestrogenic
properties,depending on the location of estrogen receptors in the
body. Many of the proposed health benefits of phytoestrogens are
unrelated to their affinity for estrogen receptors.  Epidemiologic
evidence shows a low prevalence of heart disease in cultures of
patients who consume soy.?

?Flaxseed: Another nutrient high in phytoestrogens (especially
lignans), flaxseed also is high in omega-3 fatty acids -- a key helper
in fighting heart disease.   And, like soy, it?s a good all-round
helper in your body.   More specifically, because it?s high in
phytoestrogens, flaxseed can help minimize symptoms like hot flashes.

Other natural remedies

·	?For women who are postmenopausal, men who are older than 50 years,
and other persons at risk for osteoporosis, the recommendation is 1500
mg of calcium daily.
·	For women who are premenopausal and men who are younger than 50
years without osteoporosis risk factors, the recommendation is 1000
·	Vitamin D intake should be 400-800 IU/d.

Additional Suggestions:

Register for a free account to read the latest in menopause news:;jsessionid=D3XqePUYiXEMMXzqKlagwk75giHTA9cWVx7VgWdWno0ow2zpEuHv!-1327864877!-949856145!9001!-1

Because my daughter has MS, I'm learning all about keeping cool! Try
this cooling vest:

Other cooling accessories

Consider too, a Chillow!:
?Your Chillow® can relieve hot flashes, headaches, sunburns, and more.
No noisy fan or over-cooling AC can do as much for a good night?s

Ordinary pillows are heat traps for your body heat. They get
uncomfortably warm while your body needs to be cool for sleep ? so you
flip it over, again and again. The Chillow® is a noiseless, low-cost
cooling alternative that is environmentally friendly ? non-electric
and non-toxic. It fits standard pillows and while it needs no
refrigeration it can be refrigerated briefly for more intense cooling

You?ll want another Chillow® to drape over the back of your chair at
work so you can lean back for a quick, cool-off. For a more relaxing
evening at home, put a Chillow® behind your back as you read or watch
TV. Everyone in the home will find a cool use for the Chillow®. Better
make sure they have their own!?

I hope this has effectively answered your questions. Due to copyright
restrictions, I am able to post only a small amount of information
from each site. Please read each link for more in-depth information.
As topics overlap greatly, a link on one topic often has additional
useful information on the other topics.

Please discuss your concerns with your doctor, as s/he knows your
medical and prescription history. Together you and your doctor should
be able to come up with an effective solution for menopausal symptoms.
I wish you comfort!

Please do not rate this answer until you are satisfied. Simply request
an Answer Clarification if anything is unclear, and I will be happy to
assist you further on this question, if possible.

Sincerely, Crabcakes

Search Terms
Menopause relief
Menopause therapies
Adverse effects + HRT
Hot flashes
menopause + HRT
alternative therapy + menopause
menopause + SSRIs
menopause + perimenopause
black cohosh + isoflavones + menopause
bioidentical hormones + menopause
kgs85-ga rated this answer:5 out of 5 stars
This was a very thorough and complete set of research results. It
helped me clarifiy and understand a complex issue, and I appreciated
the many links to additional information.

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