Some women find menopause fairly manageable, but others (80 percent) suffer big-time symptoms—hot flashes, crabbiness, vaginal dryness and more. Many women and their doctors worry about women's increased risk of developing osteoporosis, or brittle bones, and heart disease. Both are more likely to occur after menopause, because the body's production of estrogen and progesterone drops significantly.
Almost 25 percent of postmenopausal women in the United States take estrogen or hormone-replacement therapy (HRT), a combination of estrogen and progesterone. Although these medications can have side effects and risks, they usually ease the symptoms of menopause and decrease the risk of osteoporosis. Some doctors believe that they prevent heart disease as well.
Doctors often start women out on Premarin, the same form of estrogen that many researchers use in HRT studies. It has been approved for treatment of menopause-related hot flashes and night sweats since 1942, and for osteoporosis prevention since 1988. It's derived from pregnant mares' urine. Prempro is Premarin combined with progestin, which is synthetic progesterone.
The progestin is intended to balance the supplemental estrogen and prevent uterine cancer, a risk increased by taking estrogen alone. Women who have had a hysterectomy do not need to take progesterone with estrogen for this purpose but may want to take it for bone mass maintenance purposes.
The standard dose of Premarin is 0.625 milligrams, but .3 mg works as well at stopping hot flashes, said Helen Carcio, a nurse practitioner at Pioneer Women's Health in Greenfield, Mass. Combined with calcium, vitamin D and progesterone, the lower estrogen dose is as effective in maintaining bone density.
For her patients who can't or don't want to take Premarin or Prempro, Carcio recommends estrogen derived from soy plants. She also prescribes natural forms of progesterone, including one derived from Mexican yams. Unlike progestin, plant-based progesterone does not lower HDL, the "good" cholesterol.