Is there anything that can be done to make Menopause more comfortable?

While menopause is a natural stage of life, some symptoms may be alleviated through medical treatments.

Hormone therapy (HT) provides the best relief, but certain forms appear to pose significant health risks. Some drugs afford limited relief from hot flashes. A woman and her doctor should carefully review her symptoms and relative risk before determining whether the benefits of HT or other therapies outweigh the risks. Until more becomes known, women who elect to use hormone replacement therapy are generally well advised to take the lowest effective dose of HRT for the shortest period possible and to investigate whether certain forms may pose fewer dangers of clots or cancer than others.

Hormone therapy

In addition to relief from hot flashes, hormone therapy (HT) remains an effective treatment for osteoporosis. In HT, estrogens, progesterone or other hormones are administered to compensate for the body's own insufficiency to produce them. There are several types of therapies, with various side effects.

Conjugated equine estrogens

Conjugated equine estrogens contain estrogen molecules conjugated to hydrophilic side groups (e.g. sulfate) and are produced from Equidae-animals (horses).

Adverse effects
Women had been advised for many years that hormone therapy after menopause might reduce their risk of heart disease and various aspects of aging. However, a large, randomized, controlled trial (the Women's Health Initiative) found that women undergoing HT with conjugated equine estrogens (Premarin), whether or not used in combination with a progestin (Premarin plus Provera), had a slightly increased risk of breast cancer, heart disease, stroke, and Alzheimer's disease sufficient to justify stopping the study.

After these results were reported in 2002, the number of prescriptions written for Premarin and PremPro in the United States dropped almost in half, as many women discontinued HT altogether. The sharp drop in prescriptions for Premarin and PremPro following the mid-2002 announcement of their dangers was followed by large and successively greater drops in new breast cancer diagnoses at six months, one year, and 18 months after that announcement, for a cumulative 15% drop by the end of 2003. Surprisingly, no similar drop in Canada's breast cancer rates was observed during the same period, though prescriptions of PremPro and Premarin were reduced in Canada as well. Studies designed to track the further progression of this trend after 2003 are underway, as well as to determine if the drop is related to the reduced use of HRT.

Other HT
Due to the controversy about Premarin-based HT, a number of doctors are now moving patients who request HT to help them through menopause to bioidentical hormone products such as Estrace, a form of the precursor to estrogen in the human body known as estradiol, which have produced fewer side effects than conjugated equine estrogens.

Over-the-counter products such as Estroven use soy-based phytoestrogens to more closely mimic human estrogen. However, all hormone replacement therapies carry health risks, including high blood pressure, blood clots, and increased risks of breast and uterine cancers.

Women who have had a hysterectomy tolerate estrogen-only HT better than mixed-hormone HT, and reduce their breast cancer risk brought on by progesin supplementation.

The anti-seizure medication gabapentin (Neurontin) seems to be second only to HRT in relieving hot flashes.

Contraindications of HRT

absolute contraindications:

undiagnosed vaginal bleeding
severe liver disease
pregnancy
Coronary artery disease (CAD)
venous thrombosis
Well-differentiated and early endometrial cancer (once treatment for the malignancy is complete, is no longer an absolute contraindication.) Progestins alone may relieve symptoms if the patient is unable to tolerate estrogens.

Relative contraindications:

Migraine headaches
personal history of breast cancer
History of fibroids
Atypical ductal hyperplasia of the breast
Active gall bladder disease (Cholangitis, Cholecystitis )

Antidepressants
Antidepressants such as paroxetine (Paxil), Fluoxetine hydrochloride (Prozac), and Venlafaxine hydrochloride (Effexor) have been used with some success in the treatment of hot flashes, improving sleep, mood, and quality of life. Of these, Paxil has been the most studied and may provide the most consistent relief.

There is a theoretical reason why SSRI antidepressants might help with memory problems-- they increase circulating levels of the neurotransmitter serotonin in the brain and restore hippocampal function. Prozac has been repackaged as Serafem and is approved and prescribed for premenstrual dysphoric disorder (PMDD), a mood disorder often exacerbated during perimenopause and early menopause. PMDD has been found by PET scans to be accompanied by a sharp drop in serotonin in the brain and to respond quickly and powerfully to SSRIs.

Blood pressure medicines
About as effective as antidepressants for hot flashes, but without the other mind and mood benefits of antidepressants, are blood pressure medicines including clonidine (Catapres). These drugs may merit special consideration by women suffering both from high blood pressure and hot flashes