A recent study published in the New England Journal of Medicine found no increased risk of breast cancer with oral contraceptives in women 40 and older. New types of contraceptives are now available including lower doses, shorter placebo weeks, and both a contraceptive patch and a contraceptive vaginal ring.
If you're considering taking hormones to manage menopausal symptoms, be aware that the doses of estrogen and progestogen typically taken to manage menopausal symptoms are not adequate to provide protection against an unwanted pregnancy. A woman who is still fertile must use contraceptives containing higher levels of hormones or use additional birth control methods in addition to hormone replacement.
Antidepressant medication: Lower doses of several medications used to treat depression and anxiety have been found effective in relieving hot flashes in as many as 70 percent of women. These drugs include venlafaxine (Effexor), fluoxetine (Prozac) and paroxetine (Paxil) and are available in tablet form.
Cardiovascular medication: The blood pressure drugs Catapres and Aldomet taken in lower doses than are used to treat high blood pressure may also relieve hot flashes in some women. They are typically prescribed in tablet form or as skin patches.
Side effects are possible with these medications. Ask your health care professional for more information, if you consider using one of these medical strategies for hot flashes.
Hormone Therapy (HRT)
Once thought safe for the long-term prevention of osteoporosis and heart disease as well as for the short-term relief of menopausal symptoms such as hot flashes, the safety of HRT for both short-term and long-term use is now under intense study by the federal government.
Hormone therapy comes in two forms: estrogen and a synthetic form of the hormone progesterone (progestin) combined, or HRT, and estrogen replacement therapy, or ERT, when estrogen alone is prescribed. Hormone therapy is typically given to women who have not had hysterectomies because estrogen is known to increase the risk of uterine cancer. Postmenopausal hormone therapy is available in a variety of applications: pills, creams, skin patches, vaginal ring and injections.
In January 2003, the U.S. Food and Drug Administration (FDA) announced that it would require a new, highlighted (boxed) warning on all estrogen products for use by postmenopausal women. The so-called "black box" is the strongest step the FDA can take to warn consumers of the potential risks of a medication. The warning highlights the increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen. This warning came on the heels of three major studies published in July 2002 which showed significant health risks in connection with the long-term use of both forms of hormone therapy, estrogen-progestin therapy and estrogen alone.
Experts offer these guidelines to help understand these recent findings on hormone therapy:
- Women who take hormone therapy to prevent osteoporosis should discuss their personal risks for heart disease and breast cancer with their health care professional. Alternative treatments and preventive medications for osteoporosis are available.
- If you are currently using hormone therapy, talk with your health care professional first before stopping your medication; if you are using hormone therapy to relieve menopausal symptoms, stopping the medication abrupting could make your symptoms worse. How you taper off your medication will depend on what type of therapy you are using. Conditions such as elevated cholesterol and low bone density may return to pre-HRT levels and require intervention.
- Ask your health care professional about alternatives to HRT for specific medical conditions and overall health. In the summer of 2003, a new lower dose version of a combination estrogen and progestin drug for postmenopausal women (medroxyprogesterone, sold as Prempro) is expected to become available. Bear in mind, too, that a recent major federal clinical trial, part of the Women's Health Initiative, recently concluded that, contrary to popular belief, estrogen and progestin, are effective for short-term relief from hot flashes and night sweats, but nothing else. They have no significant impact on general health, or quality of life factors, such as energy, mental health, symptoms of depression, or sexual satisfaction.
- If you are considering "natural" supplements as an alternative, it is also important to keep in mind that studies related to their effectiveness are sparse and that the FDA doesn't oversee the production of supplements, nor does it require manufacturers to prove their products are effective, as it does with prescription or over-the-counter medications.
Alternatives to hormone therapy for cardiovascular health
Lifestyle strategies for cardiovascular health may include exercise, not smoking, avoiding excess weight and limiting salt and alcohol. For example, a balanced diet rich in antioxidant vitamins with fish two to three times a week may also be prescribed. Several different classes of safe, effective medications designed to lower elevated blood cholesterol and low stroke risk are also available. Drug treatment may be recommended together with lifestyle changes such as a diet low in saturated fat to lower cholesterol levels.